Psychological Factors in chronic edema: a case–control study

Objective: To examine psychological health and perceived social support in patients with chronic oedema (CO). Methods: A random sample of patients who had been previously identified within a chronic oedema (CO) service in an urban area of south west London were group matched for age and gender with community controls in a case control study. Results: One hundred and seven cases and 102 controls (women 82%) were identified. CO was caused by cancer or its treatment in 51 (48%) of cases and affected the leg in 65 (61%); the arm 41(38%) and the limb and midline in 15 (14%). Length of time with CO was long with 50 (47%) suffering for > 10 years. Cases were more likely to be single or divorced/separated (p=0.041) and have reduced mobility (p <0.001). SF36 scores showed cases had significantly poorer overall HRQOL in particular: physical functioning (p=0.003); role physical (p <0.001) general health (p=0.026); vitality (p=0.015); social function (p=0.007) and role emotional (p=0.041). EQ5D health index scores were significantly reduced in cases by 13 points (P= <0.001, 95% CI 5.8, 21.6) compared with controls with a similar pattern for the VAS scale (p< 0.00 95% CI 7.6, 17.1). The MOS scale showed cases had similar size social networks to the control group (5.8/6.6 p=0.49) but had lower total perceived social support scores (67.8/76.1 p=0.018). Cases had reduced support in all 5 domains with tangible and affectionate support significantly reduced for cases compared to controls. Cases used significantly fewer coping strategies (COPE scale) than controls with regard to: active coping (p=0.024); planning (p<0.001) and use of instrumental support (p=0.006). Significantly higher levels of coping were used by cases for the following domains: restraint (p=0.031), positive reinterpretation and growth (p<0.001); acceptance (<0.001); denial (p<0.001); mental disengagement (p<0.001); 3 behavioural disengagement (<0.001): substance abuse (p=0.010) and humour (p<0.001). Conclusions: Patients with CO have poorer health and greater impact on many aspects of HRQOL. While the size of social networks they report appear preserved, the levels of perceived social support are reduced. The pattern of use of coping strategies was complex with evidence of reduced problem solving combined with enhanced emotion focused coping such as acceptance and reinterpretation indicating illness adjustment. Deficits in the ability to function socially combined with perceived reduction in support and reduced mental health and emotional scores within the SF36 scale indicate the risk of developing psychological issues such as depression. Systems of care should offer an environment to address these issues

Selection, Sizing, and Testing of Stream Traps in Commercial Buildings

For maximum effectiveness in steam systems, steam traps should have operating characteristics which closely match the requirements of the applications for which they are used. A trap which holds back condensate until it is subcooled and some of the sensible heat has been utilized is unsuitable where the need is to get maximum output from an exchanger by discharging condensate as soon as it forms. Equally, a trap discharging condensate at steam temperature can exacerbate flash steam problems in cases where surplus heat exchange area exists and a subcooling trap might be more suitable. In all cases, undersized traps simply cannot drain condensate from the steam equipment at the required rate, while oversized traps which cost more will usually wear faster and begin leaking expensive steam. This emphasizes the need for carefully selecting trap sizes that are properly engineered for maximum system efficiency. And, of course, the ability of a trap to cope with varying loads and to discharge noncondensible gases is often important. The recommended procedure is to first select the trap type which has performance capabilities that satisfy specific application needs, and then to choose a size which handles the condensate load without any unnecessary excess capacity. The Selection Guide, Table 1, is not comprehensive but helps in many applications where no unusual operating conditions or severe corrosion problems exist. Choosing the correct trap size then implies estimating the steam consumption rate, which of course equals the condensate load. Sometimes the load has already been measured, or the rated output of the steam equipment is known or can be obtained from the original manufacturer. In other cases, an estimate must be made and a Table o f Load Formulas will help although it, too, cannot be comprehensive. After making the best possible estimate of the load, a safety factor is applied. This allows for any inaccuracies in the estimating, for increased condensation rates at start-up, and for lower than anticipated pressure differentials across the trap

Modelling the impact of changes to abdominal aortic aneurysm screening and treatment services in England during the COVID-19 pandemic.

BackgroundThe National Health Service (NHS) abdominal aortic aneurysm (AAA) screening programme (NAAASP) in England screens 65-year-old men. The programme monitors those with an aneurysm, and early intervention for large aneurysms reduces ruptures and AAA-related mortality. AAA screening services have been disrupted following COVID-19 but it is not known how this may impact AAA-related mortality, or where efforts should be focussed as services resume.MethodsWe repurposed a previously validated discrete event simulation model to investigate the impact of COVID-19-related service disruption on key outcomes. This model was used to explore the impact of delayed invitation and reduced attendance in men invited to screening. Additionally, we investigated the impact of temporarily suspending scans, increasing the threshold for elective surgery to 7cm and increasing drop-out in the AAA cohort under surveillance, using data from NAAASP to inform the population.FindingsDelaying invitation to primary screening up to two years had little impact on key outcomes whereas a 10% reduction in attendance could lead to a 2% lifetime increase in AAA-related deaths. In surveillance patients, a 1-year suspension of surveillance or increase in the elective threshold resulted in a 0.4% increase in excess AAA-related deaths (8% in those 5-5.4cm at the start). Longer suspensions or a doubling of drop-out from surveillance would have a pronounced impact on outcomes.InterpretationEfforts should be directed towards encouraging men to attend AAA screening service appointments post-COVID-19. Those with AAAs on surveillance should be prioritised as the screening programme resumes, as changes to these services beyond one year are likely to have a larger impact on surgical burden and AAA-related mortality

GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients

© 2019 Elsevier Inc. Objectives: To evaluate the incidence and risk factors for lymphedema associated with surgery for gynecologic malignancies on GOG study 244. Methods: Women undergoing a lymph node dissection for endometrial, cervical, or vulvar cancer were eligible for enrollment. Leg volume was calculated from measurements at 10-cm intervals starting 10 cm above the bottom of the heel to the inguinal crease. Measurements were obtained preoperatively and postoperatively at 4–6 weeks, and at 3-, 6-, 9-, 12-, 18-, and 24- months. Lymphedema was defined as a limb volume change (LVC) ≥10% from baseline and categorized as mild: 10–19% LVC; moderate: 20–40% LVC; or severe: \u3e40% LVC. Risk factors associated with lymphedema were also analyzed. Results: Of 1054 women enrolled on study, 140 were inevaluable due to inadequate measurements or eligibility criteria. This left 734 endometrial, 138 cervical, and 42 vulvar patients evaluable for LVC assessment. Median age was 61 years (range, 28–91) in the endometrial, 44 years (range, 25–83) in the cervical, and 58 years (range, 35–88) in the vulvar group. The incidence of LVC ≥10% was 34% (n = 247), 35% (n = 48), and 43% (n = 18), respectively. The peak incidence of lymphedema was at the 4–6 week assessment. Logistic regression analysis showed a decreased risk with advanced age (p = 0.0467). An exploratory analysis in the endometrial cohort showed an increased risk with a node count \u3e8 (p = 0.033). Conclusions: For a gynecologic cancer, LVC decreased with age greater than 65, but increased with a lymph node count greater than 8 in the endometrial cohort. There was no association with radiation or other risk factors

New acute treatments for headache

Although we have several acute care medications for the treatment of migraine, we are always looking for new medications to treat our patients. Patients often say that their headaches are not under optimal control and would be happy to try another medication. Patients look for faster onset of relief, more complete relief, no recurrent headache and no adverse events. This article will cover some new and some anticipated acute care products, CGRP antagonists, sumatriptan by iontophoretic patch, sumatriptan by needle-free injections, DHE by oral inhalation and diclofenac potassium in a sachet. Botulinum toxin therapy, although a preventive measure, will be mentioned at the end

Ecological compatibility of GM crops and biological control

Insect-resistant and herbicide-tolerant genetically modified (GM) crops pervade many modern cropping systems (especially field-cropping systems), and present challenges and opportunities for developing biologically based pest-management programs. Interactions between biological control agents (insect predators, parasitoids, and pathogens) and GM crops exceed simple toxicological relationships, a priority for assessing risk of GM crops to non-target species. To determine the compatibility of biological control and insect-resistant and herbicide-tolerant GM crop traits within integrated pest-management programs, this synthesis prioritizes understanding the bi-trophic and prey/host-mediated ecological pathways through which natural enemies interact within cropland communities, and how GM crops alter the agroecosystems in which natural enemies live. Insect-resistant crops can affect the quantity and quality of non-prey foods for natural enemies, as well as the availability and quality of both target and non-target pests that serve as prey/hosts. When they are used to locally eradicate weeds, herbicide-tolerant crops alter the agricultural landscape by reducing or changing the remaining vegetational diversity. This vegetational diversity is fundamental to biological control when it serves as a source of habitat and nutritional resources. Some inherent qualities of both biological control and GM crops provide opportunities to improve upon sustainable IPM systems. For example, biological control agents may delay the evolution of pest resistance to GM crops, and suppress outbreaks of secondary pests not targeted by GM plants, while herbicide-tolerant crops facilitate within-field management of vegetational diversity that can enhance the efficacy of biological control agents. By examining the ecological compatibility of biological control and GM crops, and employing them within an IPM framework, the sustainability and profitability of farming may be improved

Urinary Ethyl Glucuronide Can Be Used as a Biomarker of Habitual Alcohol Consumption in the General Population

BACKGROUND: Alcohol consumption is a frequently studied risk factor for chronic diseases, but many studies are hampered by self-report of alcohol consumption. The urinary metabolite ethyl glucuronide (EtG), reflecting alcohol consumption during the past 72 h, is a promising objective marker, but population data are lacking. OBJECTIVE: The objective of this study was to assess the reliability of EtG as a marker for habitual alcohol consumption compared with self-report and other biomarkers in the general population. METHODS: Among 6211 participants in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) cohort, EtG concentrations were measured in 24-h urine samples. EtG was considered positive when concentrations were ≥100 ng/mL. Habitual alcohol consumption was self-reported by questionnaire (categories: no/almost never, 1-4 units per month, 2-7 units per week, 1-3 units per day or ≥4 units per day). Plasma HDL cholesterol concentration, erythrocyte mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ-glutamyltransferase (GGT) were determined as indirect biomarkers of alcohol consumption. Sensitivity, specificity, positive and negative predictive value, and proportions of agreement between reported consumption and EtG were calculated. To test the agreement of EtG concentration and alcohol consumption in categories, linear regression analysis was performed. In addition, the association between EtG concentrations and indirect biomarkers was analyzed. RESULTS: Mean age was 53.7 y, and 52.9% of participants men. Of the self-reported abstainers, 92.3% had an EtG concentration <100 ng/mL. Sensitivity was 66.3%, positive predictive value was 96.3%, and negative predictive value was 47.4%. The proportion of positive agreement was 78.5%, and the proportion of negative agreement was 62.7%. EtG concentrations were linearly associated with higher categories of alcohol consumption (P-trend < 0.001), adjusted for age, sex, and renal function. EtG was positively related to MCV, HDL cholesterol, and GGT but not to AST and ALT concentrations. CONCLUSIONS: This study shows that urinary EtG is in reasonable agreement with self-reported alcohol consumption and therefore can be used as an objective marker of habitual alcohol consumption in the general population

Imaging Transient Blood Vessel Fusion Events in Zebrafish by Correlative Volume Electron Microscopy

The study of biological processes has become increasingly reliant on obtaining high-resolution spatial and temporal data through imaging techniques. As researchers demand molecular resolution of cellular events in the context of whole organisms, correlation of non-invasive live-organism imaging with electron microscopy in complex three-dimensional samples becomes critical. The developing blood vessels of vertebrates form a highly complex network which cannot be imaged at high resolution using traditional methods. Here we show that the point of fusion between growing blood vessels of transgenic zebrafish, identified in live confocal microscopy, can subsequently be traced through the structure of the organism using Focused Ion Beam/Scanning Electron Microscopy (FIB/SEM) and Serial Block Face/Scanning Electron Microscopy (SBF/SEM). The resulting data give unprecedented microanatomical detail of the zebrafish and, for the first time, allow visualization of the ultrastructure of a time-limited biological event within the context of a whole organism

Lymphatic vessel density and function in experimental bladder cancer

<p>Abstract</p> <p>Background</p> <p>The lymphatics form a second circulatory system that drains the extracellular fluid and proteins from the tumor microenvironment, and provides an exclusive environment in which immune cells interact and respond to foreign antigen. Both cancer and inflammation are known to induce lymphangiogenesis. However, little is known about bladder lymphatic vessels and their involvement in cancer formation and progression.</p> <p>Methods</p> <p>A double transgenic mouse model was generated by crossing a bladder cancer-induced transgenic, in which SV40 large T antigen was under the control of uroplakin II promoter, with another transgenic mouse harboring a <it>lacZ </it>reporter gene under the control of an NF-κB-responsive promoter (κB-<it>lacZ</it>) exhibiting constitutive activity of β-galactosidase in lymphatic endothelial cells. In this new mouse model (SV40-<it>lacZ</it>), we examined the lymphatic vessel density (LVD) and function (LVF) during bladder cancer progression. LVD was performed in bladder whole mounts and cross-sections by fluorescent immunohistochemistry (IHC) using LYVE-1 antibody. LVF was assessed by real-time <it>in vivo </it>imaging techniques using a contrast agent (biotin-BSA-Gd-DTPA-Cy5.5; Gd-Cy5.5) suitable for both magnetic resonance imaging (MRI) and near infrared fluorescence (NIRF). In addition, IHC of Cy5.5 was used for time-course analysis of co-localization of Gd-Cy5.5 with LYVE-1-positive lymphatics and CD31-positive blood vessels.</p> <p>Results</p> <p>SV40-<it>lacZ </it>mice develop bladder cancer and permitted visualization of lymphatics. A significant increase in LVD was found concomitantly with bladder cancer progression. Double labeling of the bladder cross-sections with LYVE-1 and Ki-67 antibodies indicated cancer-induced lymphangiogenesis. MRI detected mouse bladder cancer, as early as 4 months, and permitted to follow tumor sizes during cancer progression. Using Gd-Cy5.5 as a contrast agent for MRI-guided lymphangiography, we determined a possible reduction of lymphatic flow within the tumoral area. In addition, NIRF studies of Gd-Cy5.5 confirmed its temporal distribution between CD31-positive blood vessels and LYVE-1 positive lymphatic vessels.</p> <p>Conclusion</p> <p>SV40-<it>lacZ </it>mice permit the visualization of lymphatics during bladder cancer progression. Gd-Cy5.5, as a double contrast agent for NIRF and MRI, permits to quantify delivery, transport rates, and volumes of macromolecular fluid flow through the interstitial-lymphatic continuum. Our results open the path for the study of lymphatic activity <it>in vivo </it>and in real time, and support the role of lymphangiogenesis during bladder cancer progression.</p