Non-contact infrared thermometers compared with current approaches in primary care for children aged 5 years and under: a method comparison study.

BACKGROUND: Current options for temperature measurement in children presenting to primary care include either electronic axillary or infrared tympanic thermometers. Non-contact infrared thermometers could reduce both the distress of the child and the risk of cross-infection. OBJECTIVES: The objective of this study was to compare the use of non-contact thermometers with the use of electronic axillary and infrared tympanic thermometers in children presenting to primary care. DESIGN: Method comparison study with a nested qualitative study. SETTING: Primary care in Oxfordshire. PARTICIPANTS: Children aged ≤ 5 years attending with an acute illness. INTERVENTIONS: Two types of non-contact infrared thermometers [i.e. Thermofocus (Tecnimed, Varese, Italy) and Firhealth (Firhealth, Shenzhen, China)] were compared with an electronic axillary thermometer and an infrared tympanic thermometer. MAIN OUTCOME MEASURES: The primary outcome was agreement between the Thermofocus non-contact infrared thermometer and the axillary thermometer. Secondary outcomes included agreement between all other sets of thermometers, diagnostic accuracy for detecting fever, parental and child ratings of acceptability and discomfort, and themes arising from our qualitative interviews with parents. RESULTS: A total of 401 children (203 boys) were recruited, with a median age of 1.6 years (interquartile range 0.79-3.38 years). The readings of the Thermofocus non-contact infrared thermometer differed from those of the axillary thermometer by -0.14 °C (95% confidence interval -0.21 to -0.06 °C) on average with the lower limit of agreement being -1.57 °C (95% confidence interval -1.69 to -1.44 °C) and the upper limit being 1.29 °C (95% confidence interval 1.16 to 1.42 °C). The readings of the Firhealth non-contact infrared thermometer differed from those of the axillary thermometer by -0.16 °C (95% confidence interval -0.23 to -0.09 °C) on average, with the lower limit of agreement being -1.54 °C (95% confidence interval -1.66 to -1.41 °C) and the upper limit being 1.22 °C (95% confidence interval 1.10 to 1.34 °C). The difference between the first and second readings of the Thermofocus was -0.04 °C (95% confidence interval -0.07 to -0.01 °C); the lower limit was -0.56 °C (95% confidence interval -0.60 to -0.51 °C) and the upper limit was 0.47 °C (95% confidence interval 0.43 to 0.52 °C). The difference between the first and second readings of the Firhealth thermometer was 0.01 °C (95% confidence interval -0.02 to 0.04 °C); the lower limit was -0.60 °C (95% confidence interval -0.65 to -0.54 °C) and the upper limit was 0.61 °C (95% confidence interval 0.56 to 0.67 °C). Sensitivity and specificity for the Thermofocus non-contact infrared thermometer were 66.7% (95% confidence interval 38.4% to 88.2%) and 98.0% (95% confidence interval 96.0% to 99.2%), respectively. For the Firhealth non-contact infrared thermometer, sensitivity was 12.5% (95% confidence interval 1.6% to 38.3%) and specificity was 99.4% (95% confidence interval 98.0% to 99.9%). The majority of parents found all methods to be acceptable, although discomfort ratings were highest for the axillary thermometer. The non-contact thermometers required fewer readings than the comparator thermometers. LIMITATIONS: A method comparison study does not compare new methods against a reference standard, which in this case would be central thermometry requiring the placement of a central line, which is not feasible or acceptable in primary care. Electronic axillary and infrared tympanic thermometers have been found to have moderate agreement themselves with central temperature measurements. CONCLUSIONS: The 95% limits of agreement are > 1 °C for both non-contact infrared thermometers compared with electronic axillary and infrared tympanic thermometers, which could affect clinical decision-making. Sensitivity for fever was low to moderate for both non-contact thermometers. FUTURE WORK: Better methods for peripheral temperature measurement that agree well with central thermometry are needed. TRIAL REGISTRATION: Current Controlled Trials ISRCTN15413321. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 53. See the NIHR Journals Library website for further project information.

General practitioners commonly measure children's temperature using a thermometer placed in the armpit or ear canal. New 'non-contact' thermometers use infrared light to measure temperature without touching the child. They are easy to use and there is no risk of passing on infections. However, we do not know how well they measure temperature compared with thermometers that use the armpit or the ear. This study aimed to compare two non-contact thermometers with current thermometers. We measured children's temperature with all thermometer types, and asked children and their parents about their views. The study was performed in general practices in Oxfordshire with children aged ≤ 5 years who had come to see their general practitioner because they had recently become unwell. Both the cheaper and more expensive non-contact thermometers gave slightly lower temperature readings on average than current thermometers. The vast majority of readings ranged from 1.6 °C lower to 1.3 °C higher than current thermometers. The detection of fever of at least 38 °C was low to moderate for both non-contact thermometers. Most parents did not think that their child was distressed by having their temperature taken using any of the thermometers, but the armpit thermometer was rated as the least comfortable. When interviewed, parents were more negative about the armpit thermometers, although still willing to use them if they were recommended by doctors. Although we found that the readings from the different thermometers did not match, we do not know whether the non-contact or the current thermometers were giving readings that were closer to the real temperature of the child. To understand this, we would need to do a study that included a more invasive procedure for temperature assessment.

A prospective study of receptor profiles in breast cancer and the ipsilateral axillary lymph node metastases measured simultaneously in treatment naïve cases.

BACKGROUND: The heterogeneity of receptor profiles in breast cancer is well known. The differing receptor profiles of primary breast cancer and nodal metastases have been investigated and found to range between 10-50% depending on the hormone receptor tested. A study comparing the hormone status of primary breast cancers and the synchronous ipsilateral involved sentinel lymph node has not been performed in a South African population. METHOD: This is a prospective study where two specialist radiologists performed the simultaneous core needle biopsies of the primary breast cancer and the clinically positive axillary nodes. All receptor status analysis was conducted by one specialist histopathologist. RESULTS: Of 141 patients who gave written informed consent for this study, 29 were excluded; 112 patients met the inclusion criteria. Anonymised demographics of age, clinical stage, HIV status and metastatic screening were recorded. The simultaneous biopsies and receptor measurements identified 10 patients with discordant receptor status in the positive axillary lymph nodes. In each case, the receptor profile of the axillary lymphatic metastases was more aggressive than that of the primary tumour. The luminal A subtype had a significantly greater risk of discordance than other subtypes (p = 0.02). CONCLUSION: Core needle biopsy and receptor analysis should be considered on the positive axillary nodes in breast cancer patients. Adjuvant treatment should be targeted to the receptor profile of the lymph node metastases.

The specific biochemistry of human axilla odour formation viewed in an evolutionary context.

Human body odour is dominated by the scent of specific odourants emanating from specialized glands in the axillary region. These specific odourants are produced by an intricate interplay between biochemical pathways in the host and odour-releasing enzymes present in commensal microorganisms of the axillary microbiome. Key biochemical steps for the release of highly odouriferous carboxylic acids and sulfur compounds have been elucidated over the past 15 years. Based on the profound molecular understanding and specific analytical methods developed, evolutionary questions could be asked for the first time with small population studies: (i) a genetic basis for body odour could be shown with a twin study, (ii) no effect of genes in the human leukocyte antigen complex on the pattern of odourant carboxylic acid was found, and (iii) loss of odour precursor secretion by a mutation in the ABCC11 gene could explain why a large fraction of the population in the Far East lack body odour formation. This review summarizes what is currently known at the molecular level on the biochemistry of the formation of key odourants in the human axilla. At the same time, we present for the first time the crystal structure of the Nα-acyl-aminoacylase, a key human odour-releasing enzyme, thus describing at the molecular level how bacteria on the skin surface have adapted their enzyme to the specific substrates secreted by the human host. This article is part of the Theo Murphy meeting issue 'Olfactory communication in humans'.

Comparing alternatives to canine rectal thermometry at the axillary, auricular and ocular locations.

Body temperature is an important component in the diagnosis and treatment of disease in canines. The rectal temperature remains the standard of obtaining temperature within the clinical setting, but there are many drawbacks with this method, including time, access, animal stress, and safety concerns. Interest in using infrared thermometry in canines to obtain body temperature has grown as animal scientists and veterinarians search for non-invasive and non-contact methods and locations of obtaining canine temperatures. Here, we review evidence on axillary, auricular, and ocular region canine thermometry and the degree to which measurements in these locations are representative of rectal temperature values. Instrumentation refinement and development, as well as morphologic differences, play an important role in the potential correlation between the rectal temperature and these other locations. These caveats have yet to be fully addressed in the literature, limiting the options for those seeking alternatives to rectal thermometry.

A comparative study between intradermal botulinum toxin A and fractional microneedle radiofrequency (FMR) for the treatment of primary axillary hyperhidrosis.

Microneedle radiofrequency (FMR) for the treatment of primary axillary hyperhidrosis radiofrequency (RF) technology is a new modality that applied deep heat energy directly affecting the epidermis and dermis. Limiting data about FMR for axillary hyperhidrosis is concerning. To compare clinical efficacy between fractional microneedle radiofrequency and intradermal botulinum toxin type A injection. This study was a randomized, intraindividual split-side comparative study. Twenty female subjects clinically diagnosed of primary axillary hyperhidrosis were enrolled. All subjects randomly assigned to receive either FMR device on one side of axilla or 50 units of intradermal botulinum toxin A on contralateral side of axilla. Treatment with FMR device was scheduled for 2 sessions for 4 weeks apart. After treatment, mean Hyperhidrosis Disease Severity Score (HDSS) of both groups revealed remarkably better reduction from the baseline (p < 000.1). By comparing between the two groups at the endpoint visit (12th week), the botulinum toxin A group had significantly better reduction of mean HDSS score than the microneedle RF group with 1.60 (0.59) versus 2.05 (0.68), respectively (p = 0.0332). At the week-12 visit, the botulinum toxin A group had significantly better participant's satisfaction score by quartile rating scale than the microneedle RF group (2.55 + 0.69 versus 1.70 + 1.03, respectively, p = 0.004). Therefore, the botulinum toxin A group also demonstrated with significantly better improvement for their quality of life by DLQI score at the 12th week than the microneedle RF group (p = 0.013). Intradermal botulinum toxin A had better efficacy than fractional microneedle radiofrequency for the treatment of primary axillary hyperhidrosis.

Performance of axillary and rectal temperature measurement in private pediatric practice.

To better understand the role and reliability of axillary temperature measurements in clinical real life, axillary and rectal measurements in infants presenting in a private pediatric practice because of fever were compared. Prospectively, 169 infants (81 girls), median 9 (interquartile range 6-13) months of age, were examined at room temperature (20-24 °C). Two left and two right axillary, as well as two rectal measurements were taken with a digital thermometer and subsequently averaged. The median and interquartile range for axillary and rectal measurements were 36.9 (36.3-37.6) °C and 38.2 (37.4-38.9) °C, respectively (p < 0.0001). The limits of agreement in the Bland-Altman plots were 0.32 to 1.98 °C, with a mean bias of 1.15 °C. Axillary thermometers showed a good sensitivity for detecting rectal temperature > 38 °C (95%) but limited specificity (75%), with an area-under-the-curve of 0.95.Conclusions: Axillary readings are always lower than rectal ones, the limits of agreement are quite wide. Axillary readings can be used for screening but critical measurements should be confirmed by more reliable methods. What is Known • In infants and toddlers, temperature has been traditionally taken rectally. • Axillary measurements are better accepted and are recommended in current guidelines. What is New • Axillary temperature was always lower than rectal temperature. • The limits of agreement of axillary thermometers are wide. • Axillary thermometers have a good sensitivity but limited specificity and are therefore adequate for fever screening.

Developing a new device for continuously recording, in vivo, the excretion rate of sweat (perspiration) in humans.

BACKGROUND: Some methodologies used for evaluating sweat production and antiperspirants are of a stationary aspect, that is, most often performed under warm (38°C) but resting conditions in a rather short period of time. The aim is to develop an electronic sensor apt at continuously recording sweat excretion, in vivo, during physical exercises, exposure to differently heated environments, or any other stimuli that may provoke sweat excretion. MATERIAL AND METHODS: A sensor (20 cm2 ) is wrapped under a double-layered textile pad. Fixed onto the armpits, these two arrays of electrodes are connected to electronic system through an analog multiplexer. A microcontroller is used to permanently record changes in the conductance between two electrodes during exposure of subjects to different sweat-inducing conditions or to assess the efficacy of applied aluminum hydrochloride (ACH)-based roll-ons at two concentrations (5% and 15%). RESULTS: In vitro calibration, using a NaCl 0.5% solution, allows changes in mV to be related with progressively increased volumes. In vivo, results show that casual physical exercise leads to sweat excretions much higher than in warm environment (37 or 45°C). Only, an exposure to a 50°C environment induced comparable sweat excretion. In this condition, sweat excretions were found similar in both armpits and both genders. Decreased sweat excretions were recorded following applications of ACH, with a dose effect. CONCLUSION: Developing phases of this new approach indicate that usual method or guidelines used to determine sweat excretions in vivo do not reflect true energy expenditure processes. As a consequence, they probably over-estimate the efficacy of antiperspirant agents or formulae.

The Accessory muscles of the Axilla.

The axilla is a region of clinical and surgical importance with plenty of anatomical variations. One of these is the presence of accessory muscles. The literature was reviewed in order to identify the different supernumerary muscles that are described in the axilla. Variant muscle slips arising from the pectoral muscle or latissimus dorsi muscle have been described. There still remains controversy regarding the phylogenetic origin of these different muscles. We described the most frequently reported muscles, their origin, and course. Further research is required regarding the innervation and influence on glenohumeral and scapulothoracic kinematics.

Structural basis of malodour precursor transport in the human axilla.

Mammals produce volatile odours that convey different types of societal information. In Homo sapiens, this is now recognised as body odour, a key chemical component of which is the sulphurous thioalcohol, 3-methyl-3-sulfanylhexan-1-ol (3M3SH). Volatile 3M3SH is produced in the underarm as a result of specific microbial activity, which act on the odourless dipeptide-containing malodour precursor molecule, S-Cys-Gly-3M3SH, secreted in the axilla (underarm) during colonisation. The mechanism by which these bacteria recognise S-Cys-Gly-3M3SH and produce body odour is still poorly understood. Here we report the structural and biochemical basis of bacterial transport of S-Cys-Gly-3M3SH by Staphylococcus hominis, which is converted to the sulphurous thioalcohol component 3M3SH in the bacterial cytoplasm, before being released into the environment. Knowledge of the molecular basis of precursor transport, essential for body odour formation, provides a novel opportunity to design specific inhibitors of malodour production in humans.

Influence of the Male Axillary Extracts on Regulation of Menstrual Cycles in Women.

The effect of male axillary extract on the length and regularity of the menstrual cycle in women was studied in a long-term experiment (9 months). The male secret extract had no statistically significant influence on the menstrual cycle duration in the reproductive-age women (21-45 years) with normal (26-32 days) and regular cycles or in women with abnormally short (<26 days) cycles. In the group of the reproductive-age women with irregular and abnormally long (>32 days) cycles, as well as in the group of the premenopauseage women (46-51 years) with irregular cycles, the secret extract caused a significant shortening of the menstrual cycle as compared to the control. The effect was preserved for at least two months after the exposure completed.

Axillary motor nerve conduction study: Description of technique and provision of normative data.

BACKGROUND: Axillary nerve lesions can commonly occur secondary to trauma or brachial plexopathy. Our aim was to describe our technique of axillary nerve motor conduction studies and provide the respective normal values. METHODS: Active electrode was positioned over the most prominent portion of the middle deltoid, approximately 5-7 cm distal to the acromion. Reference electrode was positioned over the acromion. Ground electrode was placed between the active and the reference electrodes. Supramaximal stimulation was at the Erb's point. RESULTS: A total of 154 participants (61% male, age range 18-84) were included. There was a significant positive correlation between the subjects' age and the onset latency (Spearman's rho 0.312, p < 0.001) and a significant negative correlation between the participants' age and the CMAP (Spearman's rho -0.481, p < 0.001). For the total male population the lower normal value for the CMAP was 7.6 mV and the higher normal value for the onset latency was 5.0 ms. For the total female population the respective normal values were 6.5 mV and 3.5 ms. In order to detect an axillary nerve lesion, asymmetry of >40% in the CMAPS between the symptomatic and the asymptomatic side show a sensitivity of 95.2% and a specificity of 96.6%. CONCLUSION: We described our technique of axillary nerve motor conduction studies and provided the respective normal values stratified for age and gender. When suspecting an axillary nerve lesion it is always worth performing axillary motor NCS bilaterally and compare the CMAPs.

Axillary Temperature, as Recorded by the iThermonitor WT701, Well Represents Core Temperature in Adults Having Noncardiac Surgery.

BACKGROUND: Core temperature can be accurately measured from the esophagus or nasopharynx during general anesthesia, but neither site is suitable for neuraxial anesthesia. We therefore determined the precision and accuracy of a novel wireless axillary thermometer, the iThermonitor, to determine its suitability for use during neuraxial anesthesia and in other patients who are not intubated. METHODS: We enrolled 80 adults having upper abdominal surgery with endotracheal intubation. Intraoperative core temperature was measured in distal esophagus and was estimated at the axilla with a wireless iThermonitor WT701 (Raiing Medical, Boston MA) at 5-minute intervals. Pairs of axillary and reference distal esophageal temperatures were compared and summarized using linear regression and repeated-measured Bland-Altman methods. We a priori determined that the iThermonitor would have clinically acceptable accuracy if most estimates were within ±0.5°C of the esophageal reference, and suitable precision if the limits of agreement were within ±0.5°C. RESULTS: There were 3339 sets of paired temperatures. Axillary and esophageal temperatures were similar, with a mean difference (esophageal minus axillary) of only 0.14°C ± 0.26°C (standard deviation). The Bland-Altman 95% limits of agreement were reasonably narrow, with the estimated upper limit at 0.66°C and the lower limit at -0.38°C, thus ±0.52°C, indicating good agreement across the range of mean temperatures from 34.9°C to 38.1°C. The absolute difference was within 0.5°C in 91% of the measurements (95% confidence interval, 88%-93%). CONCLUSIONS: Axillary temperature, as recorded by the iThermonitor WT701, well represents core temperature in adults having noncardiac surgery and thus appears suitable for clinical use.

Axillary and Tympanic Temperature Measurement in Children and Normal Values for Ages.

AIM: The aim of the study was define the normal values of tympanic and axillary body temperature in healthy children. METHODS: This observational cross-sectional study was performed in healthy children aged 0 to 17 years who visited the ambulatory general pediatric of Istanbul Medical Faculty. RESULTS: Of 1364 children, 651 (47.7%) were girls and 713 were boys, the mean (SD, range) age was 72.5 (53.6, 1-204) months. The mean (SD) axillary body temperature was 36.04°C (0.46°C; minimum, 35.0°C; maximum, 37.6°C). The 95th and 99th percentiles were 36.8°C and 37.0°C, respectively. The mean (SD) tympanic body temperature was 36.91°C (0.46°C; minimum, 35.15°C; maximum, 37.9°C). The 95th and 99th percentiles were 37.6°C and 37.8°C, respectively. There were statistically significant differences between sexes for only tympanic body temperatures. Both axillary and tympanic body temperatures were statistically higher in 0 to 2 months compared with other age groups. For this age group, the 99th percentile was 37.5°C for axillary and 37.85°C for tympanic temperature. CONCLUSIONS: Axillary and tympanic body temperatures should be considered as fever when they are more than 37.0°C and 37.8°C, respectively. For 0 to 2 months, fever is 37.5°C and 37.85°C in axillary and tympanic temperatures, respectively.

Central-peripheral Temperature Monitoring as a Marker for Diagnosing Late-onset Neonatal Sepsis.

BACKGROUND: The prognosis for late-onset sepsis depends largely on a timely diagnosis. We assess central-peripheral temperature difference monitoring as a marker for late-onset neonatal sepsis diagnosis. METHODS: We performed a prospective, observational study focusing on a cohort of 129 very low-birth-weight infants. Thermal gradient alteration was defined as a difference of > 2°C maintained during 4 hours. We then determined its association with the late-onset sepsis variable through logistic regression. RESULTS: We enrolled 129 preterm babies in 52 months. Thermal gradient alterations showed an adjusted odds ratio for late-onset sepsis of 23.60 (95% confidence interval [CI], 6.80-81.88), with a sensitivity of 83% and negative predictive value of 94%. In 71% of cases, thermal gradient alteration was the first clinical sign of sepsis, while C-reactive protein was < 1.5 mg/dL in 64% of cases and procalcitonin < 2 ng/mL in 36%. These figures indicate potential for early diagnosis. CONCLUSIONS: Sustained increases of central-peripheral temperature differences are an early sign of evolving late-onset sepsis.

Validación de la biopsia selectiva del ganglio centinela en mujeres con cáncer de mama N1-2 con respuesta axilar completa tras la neoadyuvancia. Estudio multicéntrico en la provincia de Tarragona / Validation of sentinel lymph node biopsy in breast cancer women N1-N2 with complete axillary response after neoadjuvant chemotherapy. Multicentre study in Tarragona

Introducción. El objetivo de nuestro estudio fue evaluar los resultados de los ganglios obtenidos mediante biopsia selectiva del ganglio centinela en mujeres T1-T3/N1-N2 que después de la neoadyuvancia presentaron una axila N0. Material y métodos. Se realizó un estudio multicéntrico de validación diagnóstica en la provincia de Tarragona. Incluimos a mujeres afectadas por cáncer de mama en estadio T1-T3, N1-N2, que presentaron una respuesta axilar completa después de la quimioterapia neoadyuvante. El procedimiento consistió en la realización de la biopsia selectiva del ganglio centinela seguida de la linfadenectomía. El análisis estadístico consistió en la evaluación de la validez de la biopsia selectiva del ganglio centinela mediante la linfadenectomía como gold standard. Resultados. Se incluyeron 53 mujeres. La tasa de detección quirúrgica fue del 90,5% (en 5 pacientes no se encontró el ganglio centinela). El análisis histopatológico de la linfadenectomía mostró remisión completa de los ganglios axilares en el 35,4% (17/48) de las pacientes y enfermedad residual en los ganglios axilares en el 64,6% (31/48) de ellas. En 28 pacientes existía afectación residual en el ganglio centinela, en el 20% (10/48) de las cuales esta se localizaba únicamente en el ganglio centinela, estando el resto de la linfadenectomía libre de enfermedad. En 3 pacientes el ganglio centinela era negativo pero existía enfermedad en la linfadenectomía, resultando falsos negativos. Así, obtenemos una sensibilidad del 93,5%, una tasa de falsos negativos del 9,7% y una eficiencia de prueba global del 93,7%. Conclusiones. La biopsia selectiva del ganglio centinela, después de la quimioterapia en las pacientes que han presentado una respuesta axilar completa, proporciona información válida y confiable sobre el estado axilar después del tratamiento neoadyuvante, y podría evitar la linfadenectomía en casos con ganglio centinela negativo (AU)

Introduction. The aim of our study was to evaluate sentinel lymph node biopsy as a diagnostic test for assessing the presence of residual metastatic axillary lymph nodes after neoadjuvant chemotherapy, replacing the need for a lymphadenectomy in negative selective lymph node biopsy patients. Material and methods. A multicentre, diagnostic validation study was conducted in the province of Tarragona, on women with T1-T3, N1-N2 breast cancer, who presented with a complete axillary response after neoadjuvant chemotherapy. Study procedures consisted of performing an selective lymph node biopsy followed by lymphadenectomy. Results. A total of 53 women were included in the study. Surgical detection rate was 90.5% (no sentinel node found in 5 patients). Histopathological analysis of the lymphadenectomy showed complete disease regression of axillary nodes in 35.4% (17/48) of the patients, and residual axillary node involvement in 64.6% (31/48) of them. In lymphadenectomy positive patients, 28 had a positive selective lymph node biopsy (true positive), while 3 had a negative selective lymph node biopsy (false negative). Of the 28 true selective lymph node biopsy positives, the sentinel node was the only positive node in 10 cases. All lymphadenectomy negative cases were selective lymph node biopsy negative. These data yield a sensitivity of 93.5%, a false negative rate of 9.7%, and a global test efficiency of 93.7%. Conclusions. Selective lymph node biopsy after chemotherapy in patients with a complete axillary response provides valid and reliable information regarding axillary status after neoadjuvant treatment, and might prevent lymphadenectomy in cases with negative selective lymph node biopsy (AU)

A Novel Method for Studying the Pharmacokinetics of [(14) C]Umeclidinium After Application to the Axilla or Palm of Healthy Male Subjects.

Umeclidinium (UMEC), a long-acting muscarinic antagonist approved for chronic obstructive pulmonary disease (COPD), was investigated for primary hyperhidrosis as topical therapy. This study evaluated the pharmacokinetics, safety, and tolerability of a single dose of [(14) C]UMEC applied to either unoccluded axilla (UA), occluded axilla (OA), or occluded palm (OP) of healthy males. After 8 h the formulation was removed. [(14) C]UMEC plasma concentrations (Cp) were quantified by accelerator mass spectrometry. Occlusion increased systemic exposure by 3.8-fold. Due to UMEC absorption-limited pharmacokinetics, Cp data from the OA were combined with intravenous data from a phase I study. The data were described by a two-compartment population model with sequential zero and first-order absorption and linear elimination. Simulated systemic exposure following q.d. doses to axilla was similar to the exposure from the inhaled therapy, suggesting that systemic safety following dermal administration can be bridged to the inhaled program, and offering the potential for a reduced number of studies and/or subjects.

A practical comparison of temporal artery thermometry and axillary thermometry in neonates under different environments.

AIM: Thermoregulatory stability and monitoring are crucial in neonatal care. However, the current standard of temperature measurement using Axillary Thermometry (AT) poses multiple limitations. Temporal Artery Thermometry (TT) is a promising new method, which thus begs the question: Can TT replace AT in neonates? Previous studies reveal conflicting results, with none involving a Southeast-Asian multi-ethnic neonatal population under different environments. METHODS: A 6-month prospective comparative study involving neonates managed in a tertiary neonatal centre. Subjects were divided into 4 groups based on the required nursing environment: A) Room air B) Phototherapy C) Radiant warmers D) Incubators. Six hundred and sixty-one paired TT and AT temperature readings were obtained, with concurrent FLACC scoring to evaluate the discomfort associated with each thermometry method. RESULTS: TT readings were higher than AT in all groups. The mean temperature difference between both methods (TT-AT) was lowest in Group A (0.10 ± 0.19°C), followed by Groups B (0.50 ± 0.33°C), C (0.97 ± 0.76°C) and D (1.15 ± 0.57°C) respectively. Bland-Altman analysis revealed good clinical agreement (± 0.5°C) between both methods in Group A (7-0.27,0.47). However, Groups B (-0.14,1.13), C (-0.51,2.45) and D (0.03,2.27) showed poor agreement. Multiple GEE analysis revealed Malay ethnicity to be an additional predictor of decreased TT-AT ( ß = -0.13, p = 0.012). Compared to TT, AT was associated with higher discomfort levels (p <0.001). CONCLUSIONS: Given the good agreement and increased comfort with TT use, our study confirms that TT is comparable to AT for neonates nursed in room air. TT is therefore recommended for the temperature screening and monitoring of neonates nursed on ambient air. Its use in other environments and factors predictive of comparability of both methods requires further study.

False-negative Frozen Section of Sentinel Lymph Node Biopsy in a Chinese Population with Breast Cancer.

AIM: This study aimed to investigate the accuracy of frozen section (FS) in diagnosis of sentinel lymph node metastasis and to analyze the predictive factors for false-negativity. PATIENTS AND METHODS: Patients with breast cancer and clinically negative axillary were recruited for sentinel lymph node biopsy (SLNB). All nodes were examined by intraoperative FS and underwent further paraffin sectioning. RESULTS: A total of 1,272 patients underwent SLNB over an 8-year period, and 53 patients had false-negative FS. Univariate and multivariate analysis revealed that younger age, stellate mammographic pattern, and ER-positive status were statistically different when compared to the 53 members of the cohort who were truly negative on SLNB (control group). Eight patients were lost to clinical follow-up; the recurrence-free survival rate of the remaining 49 patients with false-negative SLNB did not differ from that of the 49-patient cohort (control group) (p=0.072), while these patients did experience poorer overall survival (p=0.035). CONCLUSION: Younger age, stellate mammographic pattern and ER-positive status were independent predictors for false-negative FS on biopsy.

Axillary temperature measurement: a less stressful alternative for hospitalised cats?

Rectal temperature measurement (RTM) can promote stress and defensive behaviour in hospitalised cats. The aim of this study was to assess if axillary temperature measurement (ATM) could be a reliable and less stressful alternative for these animals. In this prospective study, paired rectal and axillary temperatures were measured in 42 cats, either by a veterinarian or a student. To assess the impact of these procedures on the cat's stress state, their heart rate was checked and a cat stress score (CSS) was defined and graded from 1 (relaxed) to 5 (terrified). A moderate correlation was found between RTM and ATM (r=0.52; P<0.0001). RTM was on average 0.9 °C (1.6 °F) higher than ATM (P<0.0001), although a wide variation was found in the difference between these two measurements (-2.1 °C to 3.6 °C (-3.8 °F to 6.5 °F)). ATM failed to identify hypothermia in 25 per cent of the cases and hyperthermia in 19 per cent of the cases but may be considered less stressful than RTM. Indeed, RTM induced a mildly greater increase in heart rate (+6 bpm; P=0.01) and in CSS (+0.2; P=0.001) than ATM. The results were not affected by operator type. In conclusion, RTM should remain the standard method to obtain accurate temperatures in cats.