Spatial resolution of drug crystallisation in the skin by X-ray micro-computed tomography

Drug crystallisation in the skin is recognised as a significant problem in topical and transdermal drug delivery. Our recent investigations provided new evidence of drug crystallisation in the skin, however, confirming the precise location of crystals remains challenging. Of note, most approaches used have required disruption of the membrane by tape stripping, with crystal detection limited to the superficial skin layers. Hence, a non-destructive method for complete spatial resolution of crystallised drug in skin is still lacking. In this communication, we report the application of X-ray micro-computed tomography (microCT) to examine drug crystallisation in mammalian skin ex vivo. Permeation studies of a saturated solution of diclofenac sodium were conducted in porcine skin; subsequently, tissue samples were scanned using microCT to generate 2D and 3D maps. A layer of drug crystals was observed on the skin surface; microCT maps also confirmed the distribution of drug crystals up to a skin depth of 0.2 – 0.3 mm. MicroCT also allowed the identification of drug crystallisation as a distinct and confirmed event in the skin and as an extension from drug crystals formed on the skin. These preliminary results confirm the potential of microCT to study this important phenomenon in topical and transdermal drug delivery

Case reports: A helping hand to generalists

Clinical decision making can be challenging for both generalists and specialists. Case reports may assist the decision making process either by providing guidance to generalists on identifying rarer conditions or a searchable database for looking up seemingly disparate symptoms. This editorial highlights the innovations being implemented by Journal of Medical Case Reports and Cases Journal in developing an educational resource to help clinicians in decision-making

Effects of environmental colour on mood: a wearable life colour capture device

Colour is everywhere in our daily lives and impacts things like our mood, yet we rarely take notice of it. One method of capturing and analysing the predominant colours that we encounter is through visual lifelogging devices such as the SenseCam. However an issue related to these devices is the privacy concerns of capturing image level detail. Therefore in this work we demonstrate a hardware prototype wearable camera that captures only one pixel - of the dominant colour prevelant in front of the user, thus circumnavigating the privacy concerns raised in relation to lifelogging. To simulate whether the capture of dominant colour would be sufficient we report on a simulation carried out on 1.2 million SenseCam images captured by a group of 20 individuals. We compare the dominant colours that different groups of people are exposed to and show that useful inferences can be made from this data. We believe our prototype may be valuable in future experiments to capture colour correlated associated with an individual's mood

Early evidence for cancer in Sudan: an advanced example of bone metastases from ancient Nubia (circa 2500–2050 BCE)

WHO reports that cancer is currently a leading cause of death worldwide. An increasing body of bioarchaeological research offers new insights into the past prevalence, epidemiology, and evolution of cancer. An archaeological example from the Northern Dongola Reach in Upper Nubia, Sudan, is presented in this Perspectives piece. In most ancient examples, only the skeleton remains, restricting the body of evidence to individuals with characteristic osseous changes. Such lesions can be primary (originating in the skeleton) or secondary (metastasising from bone or soft tissues). Each new archaeological case adds to this important body of evidence

DEveloping Tests for Endometrial Cancer deTection (DETECT): protocol for a diagnostic accuracy study of urine and vaginal samples for the detection of endometrial cancer by cytology in women with postmenopausal bleeding.

From Europe PMC via Jisc Publications RouterHistory: ppub 2021-07-01, epub 2021-07-28Publication status: PublishedFunder: Wellcome TrustFunder: Department of Health; Grant(s): NIHR300650Funder: Cancer Research UK; Grant(s): C147/A25254IntroductionPostmenopausal bleeding (PMB), the red flag symptom for endometrial cancer, triggers urgent investigation by transvaginal ultrasound scan, hysteroscopy and/or endometrial biopsy. These investigations are costly, invasive and often painful or distressing for women. In a pilot study, we found that voided urine and non-invasive vaginal samples from women with endometrial cancer contain malignant cells that can be identified by cytology. The aim of the DEveloping Tests for Endometrial Cancer deTection (DETECT) Study is to determine the diagnostic test accuracy of urine and vaginal cytology for endometrial cancer detection in women with PMB.Methods and analysisThis is a multicentre diagnostic accuracy study of women referred to secondary care with PMB. Eligible women will be asked to provide a self-collected voided urine sample and a vaginal sample collected with a Delphi screener before routine clinical procedures. Pairs of specialist cytologists, blinded to participant cancer status, will assess and classify samples independently, with differences settled by consensus review or involving a third cytologist. Results will be compared with clinical outcomes from standard diagnostic tests. A sample size of 2000 women will have 80% power to establish a sensitivity of vaginal samples for endometrial cancer detection by cytology of ≥85%±7%, assuming 5% endometrial cancer prevalence. The primary objective is to determine the diagnostic accuracy of urogenital samples for endometrial cancer detection by cytology. Secondary objectives include the acceptability of urine and vaginal sampling to women.Ethics and disseminationThis study has been approved by the North West-Greater Manchester West Research Ethics Committee (16/NW/0660) and the Health Research Authority. Results will be disseminated through publication in peer-reviewed scientific journals, presentation at conferences and via charity websites.Trial registration numberISRCTN58863784

Energy-windowed, pixellated X-ray diffraction using the Pixirad CdTe detector

X-ray diffraction (XRD) is a powerful tool for material identification. In order to interpret XRD data, knowledge is required of the scattering angles and energies of X-rays which interact with the sample. By using a pixellated, energy-resolving detector, this knowledge can be gained when using a spectrum of unfiltered X-rays, and without the need to collimate the scattered radiation. Here we present results of XRD measurements taken with the Pixirad detector and a laboratory-based X-ray source. The cadmium telluride sensor allows energy windows to be selected, and the 62 μm pixel pitch enables accurate spatial information to be preserved for XRD measurements, in addition to the ability to take high resolution radiographic images. Diffraction data are presented for a variety of samples to demonstrate the capability of the technique for materials discrimination in laboratory, security and pharmaceutical environments. Distinct diffraction patterns were obtained, from which details on the molecular structures of the items under study were determined

Medicines adherence: Involving patients in decisions about prescribed medicines and supporting adherence

It is thought that between a third and a half of all medicines1 There are many causes of non-adherence but they fall into two overlapping categories: intentional and unintentional. Unintentional non-adherence occurs when the patient wants to follow the agreed treatment but is prevented from doing so by barriers that are beyond their control. Examples include poor recall or difficulties in understanding the instructions, problems with using the treatment, inability to pay for the treatment, or simply forgetting to take it. prescribed for long-term conditions are not taken as recommended. If the prescription is appropriate, then this may represent a loss to patients, the healthcare system and society. The costs are both personal and economic. Adherence presumes an agreement between prescriber and patient about the prescriber’s recommendations. Adherence to medicines is defined as the extent to which the patient’s action matches the agreed recommendations. Non-adherence may limit the benefits of medicines, resulting in lack of improvement, or deterioration, in health. The economic costs are not limited to wasted medicines but also include the knock-on costs arising from increased demands for healthcare if health deteriorates. Non-adherence should not be seen as the patient’s problem. It represents a fundamental limitation in the delivery of healthcare, often because of a failure to fully agree the prescription in the first place or to identify and provide the support that patients need later on. Addressing non-adherence is not about getting patients to take more medicines per se. Rather, it starts with an exploration of patients’ perspectives of medicines and the reasons why they may not want or are unable to use them. Healthcare professionals have a duty to help patients make informed decisions about treatment and use appropriately prescribed medicines to best effec

Changes in appetite related gut hormones in intensive care unit patients: a pilot cohort study

INTRODUCTION: The nutritional status of patients in the intensive care unit (ICU) appears to decline not only during their stay in the ICU but also after discharge from the ICU. Recent evidence suggests that gut released peptides, such as ghrelin and peptide YY (PYY) regulate the initiation and termination of meals and could play a role in the altered eating behaviour of sick patients. The aim of this study was to assess the patterns of ghrelin and PYY levels during the stay of ICU patients in hospital. METHODS: Sixteen ICU patients (60 ± 4.7 years, body mass index (BMI) 28.1 ± 1.7 kg/m(2 )(mean ± standard error of the mean)) underwent fasting blood sample collections on days 1, 3, 5, 14, 21 and 28 of their stay at Hammersmith and Charing Cross Hospitals. Changes in appetite and biochemical and anthropometric markers of nutritional status were recorded. A comparison was made to a group of 36 healthy volunteers matched for age and BMI (54.3 ± 2.9 years, p = 0.3; BMI 25.8 ± 0.8 kg/m(2 )p = 0.2). RESULTS: Compared to healthy subjects, ICU patients exhibited a significantly lower level of ghrelin (day one 297.8 ± 76.3 versus 827.2 ± 78.7 pmol/l, p < 0.001) during their stay in the ICU. This tended to rise to the normal level during the last three weeks of hospital stay. Conversely, ICU patients showed a significantly higher level of PYY (day one 31.5 ± 9.6 versus 11.3 ± 1.0 pmol/l, p < 0.05) throughout their stay in the ICU and on the ward, with a downward trend to the normal level during the last three weeks of stay. CONCLUSIONS: Results from our study show high levels of PYY and low levels of ghrelin in ICU patients compared to healthy controls. There appears to be a relationship between the level of these gut hormones and nutritional intake