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"Holt, P. J."
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The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis
Aims/hypothesis
It is well established that diabetes mellitus increases the risk of cardiovascular disease (CVD) and all-cause mortality. Observational studies suggest that a history of diabetic foot ulceration (DFU) may increase this risk further still. We sought to determine to what extent DFU is associated with excess risk over and above diabetes.
Methods
We identified studies reporting on associations of DFU with CVD and all-cause mortality. We obtained data on incident events of all-cause mortality, fatal myocardial infarction and fatal stroke. Study-specific estimates were pooled using a random-effects meta-analysis and the statistical heterogeneity of included studies was assessed using the
I
2
statistic.
Results
The eight studies included reported on 3,619 events of all-cause mortality during 81,116 person-years of follow-up. DFU was associated with an increased risk of all-cause mortality (RR 1.89, 95% CI 1.60, 2.23), fatal myocardial infarction (2.22, 95% CI 1.09, 4.53) and fatal stroke (1.41, 95% CI 0.61, 3.24). CVD mortality accounted for a similar proportion of deaths in DFU and non-DFU patients.
Conclusions/interpretation
Patients with DFU have an excess risk of all-cause mortality, compared with patients with diabetes without a history of DFU. This risk is attributable, in part, to a greater burden of CVD. If this result is validated in other studies, strategies should evaluate the role of further aggressive CVD risk modification and ulcer prevention in those with DFU.
Journal Article
Seven myths of the Crusades
\"This book is an effort to explode (or at least modify) seven popular myths or misconceptions of the Ccrusades. Despite the seemingly ever-expanding outpouring of first-rate books on the Crusades that has taken place over the past half century, including some fine surveys intended for general audiences, distortions of the crusades seem to be proliferating in all the popular media. These include pseudo-documentaries for TV, big- and small-budget movies, novels, mainstream news reporting, editorials, political speeches by highly visible and influential politicians, the sermons and writings of radical clerics and zealous laity of all three Abrahamic religions (Judaism, Christianity, and Islam), and textbooks prepared for collegiate and high school students enrolled in Western civilization and world history courses\"-- Provided by publisher.
Book
Effects of a high-fiber diet and frequent feeding on behavior, reproductive performance, and nutrient digestibility in gestating sows
A study was conducted to determine the effects of feeding a corn-soybean meal (control) diet vs. a corn-soybean meal-40% soybean hulls (high fiber) diet, as well as the frequency of feeding (once vs. twice daily), on the welfare and performance of gestating sows. Two hundred thirty-nine mixed-parity sows were assigned to a 2 x 2 factorial arrangement of treatments. Sows fed once daily received their entire meal at 0730, whereas sows fed twice daily received one-half of their feed allotment at 0730 and the other half at 1430. The behavior of 68 focal sows ([>/=]16 sows per treatment combination) was observed on d 1 postweaning, and on d 40 and d 80 of gestation. The percentage of time standing, lying, sitting, feeding, inactive, and performing stereotypic behaviors was determined. Saliva samples were collected to determine cortisol concentrations. Sow BW and backfat depth were determined on d 0, 40, and 80 of gestation, within 24 h of farrowing, and at weaning. An energy and nitrogen digestibility study was conducted using 36 sows assigned to each of the 4 treatment combinations. Over a 24-h period, the sows fed the high-fiber diet spent less time lying (P < 0.05) than the sows fed the control diet. The frequency of feeding did not affect sow behavior measured over a 24-h period. During mealtimes, sows fed the high-fiber diet spent more time feeding (P < 0.05) than sows fed the control diet. Feeding the high-fiber diet did not affect stereotypic behavior measured over 24 h or during mealtimes. Neither diet nor feeding frequency affected salivary cortisol concentration. Sows fed the high-fiber diet gained less BW and lost backfat (P < 0.05) during gestation compared with sows fed the control diet, whereas sows fed once daily gained less BW and lost backfat (P < 0.05) compared with sows fed twice daily. Sows fed the high-fiber diet had fewer pigs born (P < 0.05) compared with sows fed the control diet. Feeding frequency had no effect on size or weight gain of litters. Sows fed the high-fiber diet exhibited lower digestibility of DM, energy, and N (P < 0.05) compared with sows fed the control diet. Feeding a high-fiber diet utilizing soybean hulls or increasing feeding frequency did not enhance the welfare of sows by reducing stereotypic behaviors nor did it improve reproductive performance.
Journal Article
Managing perioperative risk in patients undergoing elective non-cardiac surgery
SUMMARY POINTS Non-cardiac surgery has a low overall mortality but is associated with a large number of deaths because so many procedures are performed Most deaths occur in a group of patients who are at high risk because of advanced age, comorbid disease, or major surgery (hospital mortality rate 12%) More effective systems can improve quality of perioperative care and may improve survival while reducing healthcare costs Further research is needed to identify the most effective approaches to perioperative medicine for high risk patients Routine audit of outcomes after all non-cardiac surgery is urgently needed
Journal Article
The diagnosis and management of aortic dissection
SUMMARY POINTS Aortic dissection is diagnosed and managed according to its anatomical extent and chronicity White men aged over 40 years with hypertension, or those under 40 with Marfan's syndrome or bicuspid aortic valves, are at highest risk Patients often present with acute onset sharp chest pain, sometimes with loss of consciousness or poor perfusion of end organs Computed tomography aortography is the first line diagnostic investigation, followed by transoesophageal echocardiography; magnetic resonance angiography is preferred for surveillance Manage proximal (type A) dissection surgically if possible Uncomplicated distal (type B) dissection is best managed with intensive drug treatment; complicated type B dissection requires surgical intervention All patients need lifelong antihypertensive therapy and surveillance imaging
Journal Article
A comparison of the effect of different surgical gloves on objective measurement of fingertip cutaneous sensibility
The prudent selection of surgical gloves can deliver significant efficiency savings. However, objective data are lacking to compare differences in cutaneous sensibility between competing gloves. Therefore, the present study examined the use of a single comparable model of sterile surgical glove from two competing providers, Gammex PF HyGrip(®) (Ansell Limited, Red Bank, NJ, USA) with Biogel(®) (Mölnlycke Health Care AB, Göteborg, Sweden).
Cutaneous pressure threshold, static and moving two-point discrimination were measured as indices of objective surgical glove performance in 52 blinded healthcare professionals.
The mean cutaneous pressure threshold was 0.0680 ± 0.0923 g for skin, 0.411 ± 0.661 g for Ansell gloves and 0.472 ± 0.768 g for Biogel gloves. Skin was significantly more sensitive than Ansell (P < 0.0001) or Biogel (P < 0.0001) gloves (Wilcoxon signed rank test). There was no statistical difference between Biogel and Ansell gloves (P = 0.359). There was no significant difference between static or moving 2-point discrimination of skin and Ansell gloves (P = 0.556, P = 0.617; Wilcoxon signed rank test), skin and Biogel gloves (P = 0.486, P = 0.437; Wilcoxon signed rank test) or Ansell and Biogel gloves (P = 0.843, P = 0.670; Wilcoxon signed rank test).
No demonstrable objective difference was found between competing gloves in the outcome measures of cutaneous sensibility and two-point discrimination. However, a difference in subjective preference was noted. Untested factors may underlie this discrepancy, and further research should employ more sophisticated measurements of surgical performance using competing models of surgical glove.
Journal Article
Cloning, sequencing and expression in Escherichia coli of the primary alcohol dehydrogenase gene from Thermoanaerobacter ethanolicus JW200
Abstract
The structural gene, adhA, for a thermostable primary alcohol dehydrogenase was cloned from Thermoanaerobacter ethanolicus JW200. Constitutive expression from its own promoter was observed in Escherichia coli. The nucleotide sequence of adhA corresponded to an open reading frame of 1197 bp, encoding a polypeptide of 399 amino acids with a calculated Mr of 43 192. Amino acid sequence analysis showed 67–69% identity with alcohol dehydrogenases from two archaeal species and 29–37% identity with bacterial type III alcohol dehydrogenases. This represents the first reported cloning of an alcohol dehydrogenase from a bacterial species that is both thermostable and active against primary long-chain alcohols.
Journal Article