Characteristics and Treatments of Patients with Peripheral Arterial Disease Referred to UK Vascular Clinics: Results of a Prospective Registry

BackgroundPeripheral arterial disease (PAD) is often associated with risk factors including cigarette smoking, hypertension and hypercholesterolaemia, and patients have a high risk of future vascular events. Good medical management results in improved outcomes and quality of life, but previous studies have documented sub-optimal treatment of risk factors. We assessed the management of cardiovascular risk factors in patients with PAD referred to specialist vascular clinics.MethodsThis was a prospective, protocol driven registry carried out in UK vascular clinics. Patients who were first-time referrals for evaluation of PAD were eligible if they had claudication plus ankle-brachial pressure index (ABPI) ≤0.9. Statistical associations between key demographic and treatment variables were explored using a chi-squared test.ResultsWe enrolled 473 patients from 23 sites. Mean age was 68 years (SD 10) and 66% were male. Mean estimated claudication distance was 100m, and ABPI was 0.74. Mean systolic blood pressure (SBP) was 155mmHg, and 42% had a SBP >160mmHg. Forty percent were current smokers and half had tried to give up in the prior 6 months, but there was no evidence of a systematic method of smoking cessation. Mean total cholesterol was 5.4 (SD1.2) mmol/l and 30% had levels >6mmol/l. Antiplatelet therapy had been given to 70% and statins to 44%. Prior CHD was present in 29% and these patients had significantly higher use of antiplatelet therapy, statins and ACE-inhibitors.ConclusionsIn spite of attempts to raise awareness about PAD as an important marker of cardiovascular risk, patients are still poorly treated prior to referral to a vascular clinic. In particular, the use of evidence-based treatments is sub-optimal, while hypertension and cigarette smoking are poorly managed. More work needs to be done to educate health professionals about the detection and optimal medical management of PAD

Quantum modulation of a coherent state wavepacket with a single electron spin

The interaction of quantum objects lies at the heart of fundamental quantum physics and is key to a wide range of quantum information technologies. Photon-quantum-emitter interactions are among the most widely studied. Two-qubit interactions are generally simplified into two quantum objects in static well-defined states . In this work we explore a fundamentally new dynamic type of spin-photon interaction. We demonstrate modulation of a coherent narrowband wavepacket with another truly quantum object, a quantum dot with ground state spin degree of freedom. What results is a quantum modulation of the wavepacket phase (either 0 or {\pi} but no values in between), a new quantum state of light that cannot be described classically.Comment: Supplementary Information available on reques

Curvature-induced phase transitions in the inflationary universe - Supersymmetric Nambu-Jona-Lasinio Model in de Sitter spacetime -

The phase structure associated with the chiral symmetry is thoroughly investigated in de Sitter spacetime in the supersymmetric Nambu-Jona-Lasinio model with supersymmetry breaking terms. The argument is given in the three and four space-time dimensions in the leading order of the 1/N expansion and it is shown that the phase characteristics of the chiral symmetry is determined by the curvature of de Sitter spacetime. It is found that the symmetry breaking takes place as the first order as well as second order phase transition depending on the choice of the coupling constant and the parameter associated with the supersymmetry breaking term. The critical curves expressing the phase boundary are obtained. We also discuss the model in the context of the chaotic inflation scenario where topological defects (cosmic strings) develop during the inflation.Comment: 29 pages, 6 figures, REVTe

10-Year axillary recurrence in the RACS SNAC1 randomised trial of sentinel lymph node-based management versus routine axillary lymph node dissection

Available online 23 June 2023Background: Sentinel node-based management (SNBM) is the international standard of care for early breast cancer that is clinically node-negative based on randomised trials comparing it with axillary lymph node dissection (ALND) and reporting similar rates of axillary recurrence (AR) without distant disease. We report all ARs, overall survival, and breast cancer-specific survival at 10-years in SNAC1. Methods: 1.088 women with clinically node-negative, unifocal breast cancers 3 cm or less in diameter were randomly assigned to either SNBM with ALND if the sentinel node (SN) was positive, or to SN biopsy followed by ALND regardless of SN involvement. Results: First ARs were more frequent in those assigned SNBM rather than ALND (11 events, cumulative risk at 10-years 1⋅85%, 95% CI 0⋅95–3.27% versus 2 events, 0⋅37%, 95% CI 0⋅08–1⋅26%; HR 5⋅47, 95% CI 1⋅21–24⋅63; p = 0⋅013). Disease-free survival, breast cancer-specific survival, and overall survival were similar in those assigned SNBM versus ALND. Lymphovascular invasion was an independent predictor of AR (HR 6⋅6, 95% CI 2⋅25–19⋅36, p < 0⋅001). Conclusion: First ARs were more frequent with SNBM than ALND in women with small, unifocal breast cancers when all first axillary events were considered. We recommend that studies of axillary treatment should report all ARs to give an accurate indication of treatment effects. The absolute frequency of AR was low in women meeting our eligibility criteria, and SNBM should remain the treatment of choice in this group. However, for those with higher-risk breast cancers, further study is needed because the estimated risk of AR might alter their choice of axillary surgery.Ian Campbell, Neil Wetzig, Owen Ung, David Espinoza, Gelareh Farshid, John Collins, James Kollias, Val Gebski, Rebecca Mister, R. John Simes, Martin R. Stockler, Grantley Gil

Strengthening Women's Trust in Social Capital in UIK

This study aims to find forms of strengthening women's social capital trust in small industrial enterprises (UIK). Strengthening social capital trust should be an important capital in small industrial business activities involving women who are the pillars of the family economy. This study uses a qualitative research method through a case study at UIK Kacang tore. The data collection technique used triangulation in the form of observation, interviews and documentation. In the data analysis using the Spradley step-forward model. The results found in the field are various forms of strengthening social capital trust, which can be seen in: (1) Increasing self-confidence through increasing human resources (2) Maintaining honesty (3) Having high integrity (4) Loyalty (5) Firm and tenacious in decision making ( 6) build communication with the environment and (7) be responsible. The role of trust in social capital is a reinforcement for the progress of small industrial businesses to survive in the midst of the increasingly stringent onslaught of modern large business products. This is also a recommendation for Indonesian women to remain a mainstay for family economic resilience. Because women have a strong ideal capital resources

Capsaicin induced cough in cryptogenic fibrosing alveolitis

BACKGROUND—Cough is a common and troublesome symptom in cryptogenic fibrosing alveolitis (CFA) but the mechanisms responsible are not known. The cough threshold to inhaled capsaicin is increased in asthma and chronic obstructive pulmonary disease (COPD) where lung volumes are increased, but the relationship between cough response and symptom intensity has not been studied in CFA where lung volumes are reduced.
METHODS—Capsaicin challenge tests were performed on 15 subjects with proven CFA and 96 healthy controls. Symptoms, as assessed by daily diary card cough score and by visual analogue scale (VAS), were related to the capsaicin sensitivity (C5) and compared with lung volumes. Volume restriction was produced in a group of 12normal healthy subjects by a plastic shell tightly strapped to the chest wall. Capsaicin challenge tests were performed in these subjects, both strapped and unstrapped, to determine whether volume restriction altered the cough reflex.
RESULTS—The median C5 response in normal subjects was more than 500 µM compared with 15.6 µM in those with CFA (p<0.001). The C5 response of the CFA patients was not related to symptoms of cough (whether measured by diary card or by VAS), nor was it related to percentage predicted total lung capacity (TLC) or forced vital capacity (FVC). Volume restriction of normal subjects with chest strapping successfully restricted lung volumes to levels similar to that of the CFA patients but did not change the sensitivity to capsaicin.
CONCLUSIONS—The cough reflex measured using capsaicin is markedly increased in patients with CFA. This increase is not the result of alterations in the deposition of inhaled particles of capsaicin brought about by volume restriction. It could be related to reduced lung compliance leading to sensitisation of rapidly adapting receptors, other mechanical changes, or to destruction of pulmonary C fibres secondary to interstitial inflammation. The capsaicin test may be a useful method of objectively monitoring cough propensity in CFA.


Capsaicin responsiveness and cough in asthma and chronic obstructive pulmonary disease

BACKGROUND—Chronic cough is associated with an increased sensitivity to inhaled capsaicin in a number of conditions but there are no data for patients with more severe asthma or chronic obstructive pulmonary disease (COPD). Moreover, the relationships between the capsaicin response (expressed as the concentration of capsaicin provoking five coughs, C5), self-reported cough, and routine medication is not known.
METHODS—The cough response to capsaicin in 53 subjects with asthma, 56 subjects with COPD, and 96 healthy individuals was recorded and compared with a number of subjective measures of self-reported cough, measures of airway obstruction, and prescribed medication. In asthmatic subjects the relationships between the cough response to capsaicin and mean daily peak flow variability and non-specific bronchial hyperresponsiveness to histamine were also examined.
RESULTS—Subjects with asthma (median C5 = 62 mM) and COPD (median C5 = 31 mM) were similarly sensitive to capsaicin and both were more reactive than normal subjects (median C5 >500 mM). Capsaicin sensitivity was related to symptomatic cough as measured by the diary card score in both asthma and COPD (r = -0.38 and r = -0.44, respectively), but only in asthma and not COPD when measured using a visual analogue score (r = -0.32 and r = -0.05, respectively). Capsaicin sensitivity was independent of the degree of airway obstruction and in asthmatics was not related to PEF variability or PC(20) for histamine. The response to capsaicin was not related to treatment with inhaled corticosteroids but was increased in those using anticholinergic agents in both conditions.
CONCLUSIONS—These data suggest that an increased cough reflex, as measured by capsaicin responsiveness, is an important contributor to the presence of cough in asthma and COPD, rather than cough being simply secondary to excessive airway secretions. The lack of any relationship between capsaicin responsiveness and airflow limitation as measured by the FEV(1) suggests that the mechanisms producing cough are likely to be different from those causing airways obstruction, at least in patients with COPD.