Progression from ocular hypertension to visual field loss in the English hospital eye service

Background There are more than one million National Health Service visits in England and Wales each year for patients with glaucoma or ocular hypertension (OHT). With the ageing population and an increase in optometric testing, the economic burden of glaucoma-related visits is predicted to increase. We examined the conversion rates of OHT to primary open-angle glaucoma (POAG) in England and assessed factors associated with risk of conversion. Methods Electronic medical records of 45 309 patients from five regionally different glaucoma clinics in England were retrospectively examined. Conversion to POAG from OHT was defined by deterioration in visual field (two consecutive tests classified as stage 1 or worse as per the glaucoma staging system 2). Cox proportional hazards models were used to examine factors (age, sex, treatment status and baseline intraocular pressure (IOP)) associated with conversion. Results The cumulative risk of conversion to POAG was 17.5% (95% CI 15.4% to 19.6%) at 5 years. Older age (HR 1.35 per decade, 95% CI 1.22 to 1.50, p<0.001) was associated with a higher risk of conversion. IOP-lowering therapy (HR 0.45, 95% CI 0.35 to 0.57, p<0.001) was associated with a lower risk of conversion. Predicted 5-year conversion rates for treated and untreated groups were 14.0% and 26.9%, respectively. Conclusion Less than one-fifth of OHT patients managed in glaucoma clinics in the UK converted to POAG over a 5-year period, suggesting many patients may require less intensive follow-up. Our study provides real-world evidence for the efficacy of current management (including IOP-lowering treatment) at reducing risk of conversion

Patients hospitalized abroad as importers of multiresistant bacteria - a cross-sectional study

Objectives: The pandemic spread of multidrug-resistant (MDR) bacteria poses a threat to healthcare worldwide, with highest prevalence in indigent regions of the (sub) tropics. As hospitalization constitutes a major risk factor for colonization, infection control management in low-prevalence countries urgently needs background data on patients hospitalized abroad. Methods: We collected data on 1122 patients who, after hospitalization abroad, were treated at the Helsinki University Hospital between 2010 and 2013. They were screened for methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), vancomycin-resistant enterococci, carbapenemase-producing Enterobacteriaceae (CPE), multiresistant Pseudomonas aeruginosa and multiresistant Acinetobacter baumannii. Risk factors for colonization were explored by multivariate analysis. Results: MDR colonization rates were higher for those hospitalized in the (sub) tropics (55%; 208/377) compared with temperate zones (17%; 125/745). For ESBL-PE the percentages were 50% (190/377) versus 12% (92/745), CPE 3.2% (12/377) versus 0.4% (3/745) and MRSA 6.6% (25/377) versus 2.4% (18/745). Colonization rates proved highest in those returning from South Asia (77.6%; 38/49), followed by those having visited Latin America (60%; 9/16), Africa (60%; 15/25) and East and Southeast Asia (52.5%; 94/179). Destination, interhospital transfer, short time interval to hospitalization, young age, surgical intervention, residence abroad, visiting friends and relatives, and antimicrobial use proved independent risk factors for colonization. Conclusions: Post-hospitalization colonization rates proved higher in the (sub) tropics than elsewhere; 11% (38/333) of carriers developed an MDR infection. We identified several independent risk factors for contracting MDR bacteria. The data provide a basis for infection control guidelines in low-prevalence countries (C) 2017 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.Peer reviewe

Soliton response to transient trap variations

The response of bright and dark solitons to rapid variations in an expulsive longitudinal trap is investigated. We concentrate on the effect of transient changes in the trap frequency in the form of temporal delta kicks and the hyperbolic cotangent functions. Exact expressions are obtained for the soliton profiles. This is accomplished using the fact that a suitable linear Schrodinger stationary state solution in time can be effectively combined with the solutions of non-linear Schrodinger equation, for obtaining solutions of the Gross-Pitaevskii equation with time dependent scattering length in a harmonic trap. Interestingly, there is rapid pulse amplification in certain scenarios

Damped Bogoliubov excitations of a condensate interacting with a static thermal cloud

We calculate the damping of condensate collective excitations at finite temperatures arising from the lack of equilibrium between the condensate and thermal atoms. We neglect the non-condensate dynamics by fixing the thermal cloud in static equilibrium. We derive a set of generalized Bogoliubov equations for finite temperatures that contain an explicit damping term due to collisional exchange of atoms between the two components. We have numerically solved these Bogoliubov equations to obtain the temperature dependence of the damping of the condensate modes in a harmonic trap. We compare these results with our recent work based on the Thomas-Fermi approximation.Comment: 9 pages, 3 figures included. Submitted to PR

Mermin-Ho vortex in ferromagnetic spinor Bose-Einstein condensates

The Mermin-Ho and Anderson-Toulouse coreless non-singular vortices are demonstrated to be thermodynamically stable in ferromagnetic spinor Bose-Einstein condensates with the hyperfine state F=1. The phase diagram is established in a plane of the rotation drive vs the total magnetization by comparing the energies for other competing non-axis-symmetric or singular vortices. Their stability is also checked by evaluating collective modes.Comment: 4 pages, 4 figure

Integrin α2β1 Expression Regulates Matrix Metalloproteinase-1-Dependent Bronchial Epithelial Repair in Pulmonary Tuberculosis.

Pulmonary tuberculosis (TB) is caused by inhalation of Mycobacterium tuberculosis, which damages the bronchial epithelial barrier to establish local infection. Matrix metalloproteinase-1 plays a crucial role in the immunopathology of TB, causing breakdown of type I collagen and cavitation, but this collagenase is also potentially involved in bronchial epithelial repair. We hypothesized that the extracellular matrix (ECM) modulates M. tuberculosis-driven matrix metalloproteinase-1 expression by human bronchial epithelial cells (HBECs), regulating respiratory epithelial cell migration and repair. Medium from monocytes stimulated with M. tuberculosis induced collagenase activity in bronchial epithelial cells, which was reduced by ~87% when cells were cultured on a type I collagen matrix. Matrix metalloproteinase-1 had a focal localization, which is consistent with cell migration, and overall secretion decreased by 32% on type I collagen. There were no associated changes in the specific tissue inhibitors of metalloproteinases. Decreased matrix metalloproteinase-1 secretion was due to ligand-binding to the α2β1 integrin and was dependent on the actin cytoskeleton. In lung biopsies, samples from patients with pulmonary TB, integrin α2β1 is highly expressed on the bronchial epithelium. Areas of lung with disrupted collagen matrix showed an increase in matrix metalloproteinases-1 expression compared with areas where collagen was comparable to control lung. Type I collagen matrix increased respiratory epithelial cell migration in a wound-healing assay, and this too was matrix metalloproteinase-dependent, since it was blocked by the matrix metalloproteinase inhibitor GM6001. In summary, we report a novel mechanism by which α2β1-mediated signals from the ECM modulate matrix metalloproteinase-1 secretion by HBECs, regulating their migration and epithelial repair in TB

A clinicopathological analysis of ovarian tumours

We performed a retrospective analysis of patients with ovarian tumors who were admitted to the Aga Khan University Hospital from January 1985 to December 1989. Sixty one cases were reviewed. Mean age of the whole group was 44 years. Majority of the patients presented with abdominal pain and distention. Most frequent physical finding was a palpable mass on pelvic or abdominal examination. Overall these patients had a higher incidence of breast cancer than expected in the general population. Two-thirds of the tumors were malignant. Comparison of the patients with malignancy against those with benign tumors failed to show any correlation with parity. Majority of the patients with malignant disease were above forty and had ultrasound showing a cystic mass over 10 cms in size. Cancer was mostly epithelial in origin, with widespread disease (stage III or IV) at the time of presentation. Benign tumors, mostly of germ cell type, were predominantly seen in patients under the age of forty with ultrasound showing cystic mass of any size from under 5 cms to over 10 cms

Dimensional and Temperature Crossover in Trapped Bose Gases

We investigate the long-range phase coherence of homogeneous and trapped Bose gases as a function of the geometry of the trap, the temperature, and the mean-field interactions in the weakly interacting limit. We explicitly take into account the (quasi)condensate depletion due to quantum and thermal fluctuations, i.e., we include the effects of both phase and density fluctuations. In particular, we determine the phase diagram of the gas by calculating the off-diagonal one-particle density matrix and discuss the various crossovers that occur in this phase diagram and the feasibility of their experimental observation in trapped Bose gases.Comment: One figure added, typos corrected, refernces adde

Exact calculation of the skyrmion lifetime in a ferromagnetic Bose condensate

The tunneling rate of a skyrmion in ferromagnetic spin-1/2 Bose condensates through an off-centered potential barrier is calculated exactly with the periodic instanton method. The prefactor is shown to depend on the chemical potential of the core atoms, at which level the atom tunnels. Our results can be readily extended to estimate the lifetime of other topological excitations in the condensate, such as vortices and monopoles.Comment: 16 pages, 4 figures, to appear Phys. Rev.

Local Anaesthetic Flush Reduces Postoperative Pain and Haematoma Formation After Great Saphenous Vein Stripping—A Randomised Controlled Trial

AbstractObjectivesTo observe the effect of local anaesthetic flush through the great saphenous vein (GSV) tunnel on postoperative pain and haematoma formation following saphenous vein stripping operations.DesignProspective, double-blind, randomised, control trial.MethodsOne hundred patients were randomized to receive 20ml of local anaesthetic (bupivacaine 0.25%+adrenaline) or saline control flush through the GSV tunnel after stripping in a double-blind study. Visual analogue pain scores were used to measure postoperative pain daily for the 1st week, then at 3 weeks and 6 weeks. Patients were examined during the 1st, 3rd and 6th week for haematoma formation.ResultsIn the control group the median postoperative pain score was 4 (range 0–7) in the immediate postoperative period compared to a median of 1 (range 0–4) in the LA group (p<0.001). The median pain score on day-4 was 4 (range 1–6) (control) vs. 1 (range 0–3) (LA group) (p<0.001, Mann–Whitney Utest) and on day-6 it was 1 (range 0–5) (control) vs. 0 (range 0–5) (LA group) (p<0.001, Mann–Whitney). Twelve patients (24%) developed a haematoma in the GSV tunnel in the control group compared to three patients (6%) in the LA group (p=0.007).ConclusionFlushing of the GSV tunnel with bupivacaine plus adrenaline significantly reduces postoperative pain and haematoma formation in patients undergoing GSV stripping for varicose veins