Benzo-pyrones for reducing and controlling lymphoedema of the limbs.

Background Lymphoedema is the accumulation of excess fluid in the body caused by obstruction of the lymphatic drainage mechanisms. Treatment with Benzo-pyrones is thought to reduce fluid forming in the subcutaneous tissues and reduce pain and discomfort of the affected area. Objectives To assess the effectiveness of benzo-pyrones compared to placebo in the management of lymphoedema. Search strategy We searched the Cochrane Breast Cancer Group register (September 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4,2003), MEDLINE, EMBASE, CINAHL, UnCover, PASCAL, SIGLE, reference lists produced by The British Lymphology Society, the National Research Register (NRR) and The International Society of Lymphology congress proceedings. Selection criteria Randomised controlled trials comparing Benzo-pyrones with placebo. Data collection and analysis Trials were selected for eligibility and tested for quality by two blinded reviewers who independently extracted data. Meta-analysis was not performed due to the poor quality of the trials. Main results Fifteen trials were included. Three oxerutin trials tested the same dose over 6 months against placebo and included a total of 127 participants (data were available for 81). There were insufficient data from these to calculate the per cent reduction or increase in baseline excess limb volume. One trial testing Cyclo 3 Fort (approved name) was found (57 participants) but insufficient data was provided to allow a proper analysis of its findings. A single trial of Daflon (approved name) was found (104 participants) but this also provided insufficient information to reach a conclusion about the effectiveness of the drug. Three trials of coumarin combined with troxerutin were found which tested two different doses of the drug against each other with no placebo, however participant numbers and baseline data were not provided. Eight trials of coumarin were identified. Two of these reported the same trial and the other potentially also referred to the same trial but this could not be confirmed. A further two papers also appeared to refer to the same trial but again this was unconfirmed. Five studies added anti-filarial drugs to the interventions tested. Participant data could not be extracted and the reporting of outcome measures in most was unclear. Loprinzi's 1999 trial was reported in more detail but its conclusions were very much at odds with other findings. Authors' conclusions It is not possible to draw conclusions about the effectiveness of Benzopyrones in the management of lymphoedema from the current available trials

Integrative Whole Person Oncology Care in the UK

The term ‘whole person cancer care’ - an approach that addresses the needs of the person as well as treating the disease - is more widely understood in the UK than its synonym ‘integrative oncology”. The National Health Service (NHS), provides free access to care for all, which makes it harder to prioritise NHS funding of whole person medicine, where interventions may be multi-modal and lacking in cost-effectiveness data. Despite this, around 30% of cancer patients are known to use some form of complementary or alternative medicine (CAM). This is virtually never medically led, and usually without the support or even the knowledge of their oncology teams, with the exception of one or two large cancer centres. UK oncology services are, however, starting to be influenced from three sides; firstly, by well-developed and more holistic palliative care services; secondly, by directives from central government via the sustainable healthcare agenda; and thirdly, by increasing pressure from patient-led groups and cancer charities. CAM remains unlikely to be provided through the NHS, but nutrition, physical activity, mindfulness, and stress management are already becoming a core part of the NHS ‘Living With and Beyond Cancer’ agenda. This supports cancer survivors into stratified pathways of care, based on individual, self-reported holistic needs and risk assessments, which are shared between healthcare professionals and patients. Health and Wellbeing events are being built into cancer care pathways, designed to activate patients into self-management and support positive lifestyle change. Those with greater needs can be directed towards appropriate external providers, where many examples of innovative practice exist. These changes in policy and vision for the NHS present an opportunity for Integrative Oncology to develop further and to reach populations who would, in many other countries, remain underserved or hard-to-reach by whole person approaches

Sandstone intrusions along different types of faults and their effect on fluid flow in siliciclastic reservoirs

We are very grateful to companies sponsoring Phase 3 of the Sand InjectionResearch Group (SIRG). We acknowledge the continuing help provided by the Bureau of Land Management (BLM) in California.Peer reviewedPostprin

Evaluation of CEDES

"Based on a visit conducted from Dec. 3-8, 1978, to the Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina

Transverse jointing in foreland fold-and-thrust belts: a remote sensing analysis in the eastern Pyrenees

Joint systems in the eastern portion of the Ebro Basin of the eastern Pyrenees enjoy near continuous exposure from the frontal portion of the belt up to the external portion of its associated foredeep. Utilizing orthophoto mosaics of these world-class exposures, we have manually digitized over 30 000 joints within a 16 km×50 km study area. The mapped traces exhibit orientations that are dominantly perpendicular to the trend of the belt (transverse) and, subordinately, parallel to the belt (longitudinal). In particular, joints systematically orient perpendicular to the trend of the belt both in the frontal folds and in the inner and central portion of the foredeep basin. Longitudinal joints occur rarely with a disordered spatial distribution, exhibiting null difference in abundance between the belt and the foredeep. Joint orientations in the external portion of the foredeep become less clustered, with adjacent areas dominated by either transverse or oblique joints. Our data indicate that joints in the studied area formed in the foredeep in response to a foredeep-parallel stretching, which becomes progressively less intense within the external portion of the foredeep. There, the minimum stress direction becomes more variable, providing evidence of the poor contribution of the forebulge-perpendicular stretching on stress organization

‘Trying to pin down jelly’ - exploring intuitive processes in quality assessment for meta-ethnography

Background: Studies that systematically search for and synthesise qualitative research are becoming more evident in health care, and they can make an important contribution to patient care. However, there is still no agreement as to whether, or how we should appraise studies for inclusion. We aimed to explore the intuitive processes that determined the ‘quality’ of qualitative research for inclusion in qualitative research syntheses. We were particularly interested to explore the way that knowledge was constructed. Methods: We used qualitative methods to explore the process of quality appraisal within a team of seven qualitative researchers funded to undertake a meta-ethnography of chronic non-malignant musculoskeletal pain. Team discussions took place monthly between October 2010 and June 2012 and were recorded and transcribed. Data was coded and organised using constant comparative method. The development of our conceptual analysis was both iterative and collaborative. The strength of this team approach to quality came from open and honest discussion, where team members felt free to agree, disagree, or change their position within the safety of the group. Results: We suggest two core facets of quality for inclusion in meta-ethnography - (1) Conceptual clarity; how clearly has the author articulated a concept that facilitates theoretical insight. (2) Interpretive rigour; fundamentally, can the interpretation ‘be trusted?’ Our findings showed that three important categories help the reader to judge interpretive rigour: (ii) What is the context of the interpretation? (ii) How inductive is the interpretation? (iii) Has the researcher challenged their interpretation? Conclusions: We highlight that methods alone do not determine the quality of research for inclusion into a meta-ethnography. The strength of a concept and its capacity to facilitate theoretical insight is integral to meta-ethnography, and arguably to the quality of research. However, we suggest that to be judged ‘good enough’ there also needs to be some assurance that qualitative findings are more than simply anecdotal. Although our conceptual model was developed specifically for meta-ethnography, it may be transferable to other research methodologies

Comparative transcriptomic analysis of Porphyromonas gingivalis biofilm and planktonic cells

<p>Abstract</p> <p>Background</p> <p><it>Porphyromonas gingivalis </it>in subgingival dental plaque, as part of a mature biofilm, has been strongly implicated in the onset and progression of chronic periodontitis. In this study using DNA microarray we compared the global gene expression of a <it>P. gingivalis </it>biofilm with that of its planktonic counterpart grown in the same continuous culture.</p> <p>Results</p> <p>Approximately 18% (377 genes, at 1.5 fold or more, <it>P</it>-value < 0.01) of the <it>P. gingivalis </it>genome was differentially expressed when the bacterium was grown as a biofilm. Genes that were down-regulated in biofilm cells, relative to planktonic cells, included those involved in cell envelope biogenesis, DNA replication, energy production and biosynthesis of cofactors, prosthetic groups and carriers. A number of genes encoding transport and binding proteins were up-regulated in <it>P. gingivalis </it>biofilm cells. Several genes predicted to encode proteins involved in signal transduction and transcriptional regulation were differentially regulated and may be important in the regulation of biofilm growth.</p> <p>Conclusion</p> <p>This study analyzing global gene expression provides insight into the adaptive response of <it>P. gingivalis </it>to biofilm growth, in particular showing a down regulation of genes involved in growth and metabolic activity.</p

A randomised controlled trial to assess the effectiveness of a single session of nurse administered massage for short term relief of chronic non-malignant pain

Background: Massage is increasingly used to manage chronic pain but its benefit has not been clearly established. The aim of the study is to determine the effectiveness of a single session of nurse-administered massage for the short term relief of chronic non-malignant pain and anxiety. Methods: A randomised controlled trial design was used, in which the patients were assigned to a massage or control group. The massage group received a 15 minute manual massage and the control group a 15 minute visit to talk about their pain. Adult patients attending a pain relief unit with a diagnosis of chronic pain whose pain was described as moderate or severe were eligible for the study. An observer blind to the patients' treatment group carried out assessments immediately before (baseline), after treatment and 1, 2, 3 and 4 hours later. Pain was assessed using 100 mm visual analogue scale and the McGill Pain Questionnaire. Pain Relief was assessed using a five point verbal rating scale. Anxiety was assessed with the Spielberger short form State-Trait Anxiety Inventory. Results: 101 patients were randomised and evaluated, 50 in the massage and 51 in the control group. There were no statistically significant differences between the groups at baseline interview. Patients in the massage but not the control group had significantly less pain compared to baseline immediately after and one hour post treatment. 95% confidence interval for the difference in mean pain reduction at one hour post treatment between the massage and control groups is 5.47 mm to 24.70 mm. Patients in the massage but not the control group had a statistically significant reduction in anxiety compared to baseline immediately after and at 1 hour post treatment. Conclusion: Massage is effective in the short term for chronic pain of moderate to severe intensity