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Larbert, Germany

Paterson S.,Forth Valley Royal Hospital | Duthie F.,Royal Infirmary | Stanley A.J.,Royal Infirmary
World Journal of Gastroenterology

AIM: To assess quantitative endoscopic ultrasound (EUS)-guided elastography in the nodal staging of oesophago-gastric cancers. METHODS: This was a single tertiary centre study assessing 50 patients with established oesophago-gastric cancer undergoing EUS-guided fine needle aspiration biopsy (FNAB) of lymph nodes between July 2007 and July 2009. EUS-guided elastography of lymph nodes was performed before EUS-FNAB. Standard EUS characteristics were also described. Cytological determination of whether a lymph node was malignant or benign was used as the gold standard for this study. Comparisons of elastography and standard EUS characteristics were made between the cytologically benign and malignant nodes. The main outcome measure was the accuracy of elastography in differentiating between benign and malignant lymph nodes in oesophageal cancers. RESULTS: EUS elastography and FNAB were performed on 53 lymph nodes. Cytological malignancy was found in 23 nodes, one was indeterminate, one was found to be a gastrointestinal stromal tumor and 25 of the nodes were negative for malignancy. On 3 occasions insufficient material was obtained for analysis. The area under the curve for the receiver operating characteristic curve for elastography strain ratio was 0.87 (P < 0.0001). Elastography strain ratio had a sensitivity 83%, specificity 96%, positive predictive value 95%, and negative predictive value 86% for distinguishing between malignant and benign nodes. The overall accuracy of elastography strain ratio was 90%. Elastography was more sensitive and specific in determining malignant nodal disease than standard EUS criteria. CONCLUSION: EUS elastography is a promising modality that may complement standard EUS and help guide EUS-FNAB during staging of upper gastrointestinal tract cancer. © 2012 Baishideng. All rights reserved. Source

Clarke C.L.,Glasgow Caledonian University | Holdsworth R.J.,Forth Valley Royal Hospital | Ryan C.G.,University of Teesside | Granat M.H.,Glasgow Caledonian University
European Journal of Vascular and Endovascular Surgery

Objective: To develop a method of event-based analysis that quantifies the fragmented nature of walking bouts in individuals with intermittent claudication [IC] and compare outcomes with age and gender-matched healthy controls. Design: Cross-sectional. Materials: The activPAL™ physical activity monitor. Methods: 7-day physical activity patterns were compared between individuals with IC (n = 30) and controls matched for age and gender (n = 30). The ratio of the number of walking events to upright events was calculated to provide an event-based claudication index (EBCI) that represented the fragmented nature of walking bouts commonly reported in those with IC. Results: Individuals with IC had a greater EBCI than age matched controls indicating a more fragmented walking pattern (5.8 ± 2.0 vs. 7.7 ± 3.1, p < 0.01). The difference between groups was more pronounced when the EBCI was calculated from upright events that included >400 steps (23.4 ± 11.3 vs. 35.8 ± 14.2, p < 0.01). Conclusion: The classic fragmented stop/start walking pattern universally described by individuals with IC can be quantified using the EBCI. This method of measurement potentially provides a novel method of assessing the effectiveness of clinical interventions for this patient group. © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. Source

Hartley E.L.,Royal Alexandra Hospital | Alcock R.,Forth Valley Royal Hospital
Prehospital and Disaster Medicine

Introduction Prehospital anaesthesia in the United Kingdom (UK) is provided by Helicopter Emergency Medical Service (HEMS) and British Association for Immediate Care (BASICS), a road-based service. Muscle relaxation in rapid sequence induction (RSI) has been traditionally undertaken with the use of suxamethonium; however, rocuronium at higher doses has comparable intubating conditions with fewer side effects. Hypothesis/Problem The aim of this survey was to establish how many prehospital services in the UK are now using rocuronium as first line in RSI. Methods An online survey was constructed identifying choice of first-line muscle relaxant for RSI and emailed to lead clinicians for BASICS and HEMS services across the UK. If rocuronium was used, further questions regarding optimal dose, sugammadex, contraindications, and difference in intubating conditions were asked. Results A total of 29 full responses (93.5%) were obtained from 31 services contacted. Suxamethonium was used first line by 17 prehospital services (58.6%) and rocuronium by 12 (41.4%). In 11 services (91.7%), a dose of 1 mg/kg of rocuronium was used, and in one service, 1.2 mg/kg (8.3%) was used. No services using rocuronium carried sugammadex. In five services, slower relaxation time was found using rocuronium (41.7%), and in seven services, no difference in intubation conditions were noted (58.3%). Contraindications to rocuronium use included high probability of difficult airway and anaphylaxis. Conclusion Use of rocuronium as first-line muscle relaxant in prehospital RSI is increasing. Continued auditing of practice will ascertain which services have adopted change and identify if complications of failed intubation increase as a result. Hartley EL, Alcock R. Copyright © World Association for Disaster and Emergency Medicine 2015. Source

Eastick K.,Scottish Bacterial Sexually Transmitted Infections Reference Laboratory | Winter A.,Sandyford Sexual Health Services | Jamdar S.,Forth Valley Royal Hospital

Three isolates of Neisseria gonorrhoeae have been identified in Scotland in 2010 and 2011, which lack sequences in the porA pseudogene commonly used as the target for confirmatory gonorrhoea polymerase chain reaction assays. Two isolates were clustered temporally and geographically and have the same sequence type and porA sequence. A similar strain was reported in Australia during early 2011. The other Scottish isolate was identified separately and is different in sequence type and porA sequence. Source

Hanlon P.,Forth Valley Royal Hospital | Hanlon P.,University of Aberdeen | Avenell A.,University of Aberdeen | Aucott L.,University of Aberdeen | And 2 more authors.
Arthritis Research and Therapy

Introduction: Infection with Epstein-Barr virus (EBV) has been suggested to contribute to the pathogenesis of systemic lupus erythematosus (SLE). We sought to determine whether prior infection with the virus occurs more frequently in patients with SLE compared to matched controls.Methods: We performed a systematic review and meta-analyses of studies that reported the prevalence of anti-EBV antibodies in the sera from cases of SLE and controls by searching Medline and Embase databases from 1966 to 2012, with no language restriction. Mantel-Haenszel odds ratios (OR) for the detection of anti-EBV antibodies were calculated, and meta-analyses conducted. Quality assessments were performed using a modified version of the Newcastle-Ottawa scale.Results: Twenty-five case-control studies were included. Quality assessment found most studies reported acceptable selection criteria but poor description of how cases and controls were recruited. There was a statistically significant higher seroprevalence of anti-viral capsid antigen (VCA) IgG (OR 2.08; 95% confidence interval (CI) 1.15 - 3.76, p = 0.007) but not anti-EBV-nuclear antigen1 (EBNA1) (OR 1.45; 95% CI 0.7 to 2.98, p = 0.32) in cases compared to controls. The meta-analyses for anti-early antigen (EA) /D IgG and anti-VCA IgA also showed significantly high ORs (4.5; 95% CI 3.00 to 11.06, p < 0.00001 and 5.05 (95% CI 1.95 - 13.13), p = 0.0009 respectively). However, funnel plot examination suggested publication bias.Conclusions: Overall, our findings support the hypothesis that infection with EBV predisposes to the development of SLE. However, publication bias cannot be excluded and the methodological conduct of studies could be improved, with regard to recruitment, matching and reporting of blinded laboratory analyses. © 2014 Hanlon et al.; licensee BioMed Central Ltd. Source

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