Trends in Demand for Acute Medical Care at Two Football Clubs over an Eighteen-Year Period

Introduction. Following the Hillsborough disaster, there is a requirement for crowd doctors to be present during football matches. However, there are little data on long-term trends in utilisation of crowd doctor services at sporting events. Methods. A retrospective service evaluation of presentations to the crowd doctor for 18 consecutive English Football League seasons: 13 seasons at Northampton Town Football Club (NTFC) followed by five seasons at Leicester City Football Club (LCFC). Data were analysed to determine the reason for, and severity of, presentation and the magnitude of the intervention required. Results. There were 429 recorded presentations to the crowd doctor over the 18 seasons. Patients’ age ranged from 3 to 93 years. 76% of presentations were due to an injury or illness arising at the match. The majority of presentations were with minor ailments (76%) requiring only minor intervention (88%); there were a small number of life-threatening presentations (1%) including three cardiac arrests. Conclusion. Crowd doctors may see patients in all age groups, presenting in a variety of ways. Most patients will have minor symptoms, but occasionally patients present with life-threatening problems. The crowd doctor must be competent assessing and treating all of these potential patient groups and pathologies.</jats:p

Postoperative sore throat: a systematic review*

Introduction Postoperative sore throat is a common complaint with an incidence of up to 62%. While anaesthetists often perceive this as a minor and self-limiting complication, postoperative sore throat is one of the leading causes of postoperative anaesthesia-related discomfort. Preventative strategies for postoperative sore throat have been studied extensively, but well-evidenced recommendations are lacking. Methods We performed a systematic review to summarise interventions which may prevent postoperative sore throat. Two independent reviewers assessed studies against inclusion criteria and completed a Cochrane Risk of Bias 2 assessment for randomised controlled trials. The results were synthesised narratively due to extensive methodological heterogeneity (populations, interventions and outcomes). Results We identified 1883 studies, of which 162 met the inclusion criteria (enrolling 21,199 patients). The pooled incidence of postoperative sore throat at 1 h was 32.4% (95%CI 26.9–38.5%) in 43 studies involving tracheal intubation and 29.4% (95%CI 20.5–40.2%) in 18 studies that used a supraglottic airway device. At 24 h, the pooled incidence of postoperative sore throat was 16.4% (95%CI 13.6–19.8%) in 93 studies involving tracheal intubation and 9.9% (95%CI 6.7–14.4%) in 23 studies that used supraglottic airway devices. Interventions with evidence of benefit included maintaining cuff pressure ≤ 60 cmH2O for supraglottic airway devices and ≤ 30 cmH2O for tracheal tubes. For tracheal tubes only, other interventions with benefit included use of topical ketamine; intravenous or topical steroids; and topical non-steroidal anti-inflammatory drugs. Discussion Despite the high incidence of postoperative sore throat, the current literature lacks high-quality randomised controlled trials on treatments that prevent a complication that is of importance to patients and their recovery. New research will only add value to this area if studies adequately control for confounders

Improved functionalization of oleic acid-coated iron oxide nanoparticles for biomedical applications

Superparamagnetic iron oxide nanoparticles can providemultiple benefits for biomedical applications in aqueous environments such asmagnetic separation or magnetic resonance imaging. To increase the colloidal stability and allow subsequent reactions, the introduction of hydrophilic functional groups onto the particles’ surface is essential. During this process, the original coating is exchanged by preferably covalently bonded ligands such as trialkoxysilanes. The duration of the silane exchange reaction, which commonly takes more than 24 h, is an important drawback for this approach. In this paper, we present a novel method, which introduces ultrasonication as an energy source to dramatically accelerate this process, resulting in high-quality waterdispersible nanoparticles around 10 nmin size. To prove the generic character, different functional groups were introduced on the surface including polyethylene glycol chains, carboxylic acid, amine, and thiol groups. Their colloidal stability in various aqueous buffer solutions as well as human plasma and serum was investigated to allow implementation in biomedical and sensing applications.status: publishe

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Editorial commitment to trust and integrity in science: implications for pain and anesthesiology research

International audienc

Placental 11-Beta Hydroxysteroid Dehydrogenase Methylation Is Associated with Newborn Growth and a Measure of Neurobehavioral Outcome

Background: There is growing evidence that the intrauterine environment can impact the neurodevelopment of the fetus through alterations in the functional epigenome of the placenta. In the placenta, the HSD11B2 gene encoding the 11-beta hydroxysteroid dehydrogenase enzyme, which is responsible for the inactivation of maternal cortisol, is regulated by DNA methylation, and has been shown to be susceptible to stressors from the maternal environment. Methodology/Principal Findings: We examined the association between DNA methylation of the HSD11B2 promoter region in the placenta of 185 healthy newborn infants and infant and maternal characteristics, as well as the association between this epigenetic variability and newborn neurobehavioral outcome assessed with the NICU Network Neurobehavioral Scales. Controlling for confounders, HSD11B2 methylation extent is greatest in infants with the lowest birthweights (P = 0.04), and this increasing methylation was associated with reduced scores of quality of movement (P = 0.04). Conclusions/Significance: These results suggest that factors in the intrauterine environment which contribute to birth outcome may be associated with placental methylation of the HSD11B2 gene and that this epigenetic alteration is in turn associated with a prospectively predictive early neurobehavioral outcome, suggesting in some part a mechanism for th

Secretory carcinoma of the salivary gland, a rare entity : An international multi-institutional study

Background: Secretory carcinoma (SC) of the salivary gland is a rare entity with limited published literature on cytomorphology. The authors present the largest cohort to date of SC fine-needle aspiration (FNA) cases. Methods: FNA cases of histologically confirmed SC were retrospectively retrieved from 12 academic institutions in the United States, Italy, Finland, and Brazil. The collated data included patient demographics, imaging findings, cytopathologic diagnoses according to the Milan System for Reporting Salivary Gland Cytopathology, cytomorphologic characteristics, and immunohistochemical/molecular profiles. Results: In total, 40 SCs were identified (male-to-female ratio, 14:26) in patients with a mean age of 52 years (age range, 13-80 years). Ultrasound imagining revealed a hypoechoic, ovoid, poorly defined, or lobulated mass. The most common primary site was the parotid gland (30 of 40 tumors). Regional lymph node metastasis (9 patients) and distant metastasis (4 patients; brain, liver, lungs, and mediastinum) were noted. Two patients died of disease. FNA smears were cellular and demonstrated mainly large, round cells with intracytoplasmic vacuoles or granules and round-to-oval nuclei with smooth nuclear contour, minimal irregularities, and prominent nucleoli arranged predominantly in clusters, papillary formations, and single cells. The background was variable and contained inflammatory cells, mucin, or proteinaceous material. The diagnoses were malignant (19 of 38 tumors; 50%), suspicious for malignancy (10 of 38 tumors; 26%), salivary gland neoplasm of uncertain malignant potential (7 of 38 tumors; 18%), and atypia of undetermined significance (2 of 38 tumors; 6%) according to the Milan System for Reporting Salivary Gland Cytopathology. Two malignant cases (2 of 40 tumors; 5%) were metastases. The neoplastic cells were immunoreactive for S100 (23 of 24 tumors), mammaglobin (18 of 18 tumors), GATA-3 (13 of 13 tumors), AE1/AE3 (7 of 7 tumors), and vimentin (6 of 6 tumors). ETV6-NTRK3 fusion was detected in 32 of 33 tumors by fluorescence in situ hybridization (n = 32) and next-generation sequencing (n = 1). Conclusions: Familiarity with cytomorphologic features and the immunohistochemical/molecular profile of SC can enhance diagnostic accuracy.publishedVersionPeer reviewe