When is urgent revascularisation unnecessary for acute lower limb ischaemia?

Objectives:To predict the risk of gangrene by the use of simple clinical parameters available on admission.Design:Retrospective comparison using logistic regression and x2 analyses of prospectively registered data from two patients series.Methods:One group of patients with acute lower limb ischaemia, (n = 61) was managed by selective initial non-operative treatment (NO) in a university hospital. The other group (n = 173) contained patients managed by early revascularisation in a multicentre (MC) study from 10 university, county and district hospitals. Gangrene and death within one month were recorded.Results:57% of patients in the NO group were initially managed by intravenous heparin followed by surgery when necessary. Impaired motor function and skin cyanosis in the ischaemic limb predicted gangrene. Patients without this combination were low risk (LR) patients and constituted 62% (NO) and 67% (MC). Non-operatively managed LR patients did not develop gangrene, whereas 14% of those undergoing early revascularisation in the two series did (p < 0.05).Conclusions:The results suggest that patients without motor disturbance and cyanosis are at low risk of gangrene and may benefit from initial non-operative treatment, irrespective of the presumed aetiology

Intermodulation electrostatic force microscopy for imaging surface photo-voltage

We demonstrate an alternative to Kelvin Probe Force Microscopy for imaging surface potential. The open-loop, single-pass technique applies a low-frequency AC voltage to the atomic force microscopy tip while driving the cantilever near its resonance frequency. Frequency mixing due to the nonlinear capacitance gives intermodulation products of the two drive frequencies near the cantilever resonance, where they are measured with high signal to noise ratio. Analysis of this intermodulation response allows for quantitative reconstruction of the contact potential difference. We derive the theory of the method, validate it with numerical simulation and a control experiment, and we demonstrate its utility for fast imaging of the surface photo-voltage on an organic photo-voltaic material.Comment: 4 pages, 3 figures, peer-reviewed, preprin

Differences in presentation of symptoms between women and men with intermittent claudication

<p>Abstract</p> <p>Background</p> <p>More women than men have PAD with exception for the stage intermittent claudication (IC). The purpose of this study was to evaluate differences in disease characteristics between men and women when using current diagnostic criteria for making the diagnosis IC, defined as ABI < 0.9 and walking problems.</p> <p>Study Design</p> <p>Cohort study</p> <p>Methods</p> <p>5040 elderly (median age 71) subjects participated in a point-prevalence study 2004. They had their ABI measured and filled out questionnaires covering medical history, current medication, PAD symptoms and walking ability. The prevalence of IC was 6.5% for women and 7.2% for men (P = 0.09). A subset of subjects with IC (N = 56) was followed up four years later with the same procedures. They also performed additional tests aiming to determine all factors influencing walking ability.</p> <p>Results</p> <p>Men with IC had more concomitant cardiovascular disease and a more profound smoking history than women. Women, on the other hand, reported a lower walking speed (P < 0.01) and more joint problems (P = 0.018). In the follow up cohort ABI, walking ability and amount of atherosclerosis were similar among the sexes, but women more often reported atypical IC symptoms.</p> <p>Conclusion</p> <p>Sex differences in the description of IC symptoms may influence diagnosis even if objective features of PAD are similar. This may influence accuracy of prevalence estimates and selection to treatment.</p

Fractionation of mixed grass and clover stands using a leaf stripper

Leys are an important part of northern European livestock production, particularly for ruminants since monogastric animals are limited in their ability to digest the fibres of the forage. Crop fractionation methods are a promising option to make forages more beneficial for monogastric animals and decrease the amount of imported protein feed. A leaf stripping harvesting technique was evaluated at Robacksdalen in northern Sweden in mixed grass-clover leys over 2 years. The PremAlfa Mini leaf stripper (Trust'ing-Alf'ing, Nantes, France) worked well in mixed stands, harvesting on average a third of the available forage biomass, primarily in the form of leaves and soft stems from the clover plants. It proved successful in producing a forage fraction that had a significantly higher crude protein (CP) concentration (+39.1%) and lower neutral detergent fibre (aNDFom) concentration (-21.4%) than the pre-harvest mixed sward (all significant at p < .05 level). Due to the remaining high level of aNDFom in the leaf stripper fraction, it is more suited for use as an energy source for monogastrics rather than as a protein supplement. Alternatively, the leaf stripper fraction could be used to increase digestibility and CP content in the feed rations of high producing dairy cows

Time-related anticoagulation after regional and systemic administration of heparin in patients undergoing aortoiliac surgery

Heparin anticoagulation during cardiovascular surgical procedures remains poorly investigated and understood. The objective of this investigation was to assess the effectiveness of three methods of heparin administration. Heparin sulfate (75 IU/kg) administered to patients undergoing aortoiliac surgery was randomised to one of three methods: Group I (n = 9) heparin was injected into a central venous line 5 minutes before infrarenal aortic clamping; Group II (n = 9) heparin was injected into the distal aneurysm immediately after infrarenal aortic clamping; and Group III (n = 8) heparin was injected into a central venous line immediately after infrarenal aortic clamping. Blood samples were analysed for anticoagulant activity from both the upper and lower extremities at 5, 15, 30, 60, and 120 minutes after heparin administration. Anticoagulation, as measured by aPTT, antifactor Xa levels, and ACT, was achieved in all three groups by 5 minutes, but initially with lower heparin activity (measured as antifactor Xa) in the upper extremity (Group II) and lower extremity (Group III), respectively. These differences were also evident in ACT and aPTT determinations. Intravenous heparin administration prior to aortic cross-clamping achieves excellent anticoagulation (anti-factor Xa ~ 1 U/ml) in both upper and lower extremities after 5 minutes. With regional administration, rapid heparin redistribution occurs, but it takes longer to achieve the same level of anticoagulation distant from the site of administration. Nevertheless, from a practical perspective the method of administration does not appear to have a great influence on the eventual achievement of adequate anticoagulation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31338/1/0000248.pd

Psychosocial health in adolescent unmarried motherhood in rural Uganda: implications for community based collaborative mental health education, and empowerment strategies in the prevention of depression and suicide

Teenage pregnancy rates in Uganda are among the highest in Sub-Saharan Africa. Child marriage is often the result of unmarried teenage pregnancy and recognised by Uganda’s government as a form of sexual violence and an outcome of inequality. However, unmarried motherhood incurs stigma and shame within traditionally-living rural communities. Using co-produced Open Space and ethnographic methods, we examined the psychosocial impact of unmarried motherhood on girls and their communities, and explored problem-solving with key local stakeholders. Findings indicate that girls experience extreme stress and social exclusion and rejection by their families, and experience bereavement from school expulsion and the loss of their career aspirations. Depressive symptoms and suicidal behaviour are reportedly not uncommon amongst this population group. Community and family efforts to promote marriage for these mothers to avoid social stigma increased the mothers’ feelings of depression, while mothers who became independent appeared to fare better psychologically. Community members and local stakeholders demonstrated willingness to act locally to reduce the negative impacts of unmarried motherhood but lacked the knowledge and support resources. Our findings indicate that mental health promotion for teenage mothers is likely to be better served through empowerment strategies rather than marriage, and, in a context of poor mental health service access, there is a substantial role for community mobilisation and promotion of self-help strategies to support teenage mothers. This study raises important points regarding different community understandings of depression and indicates collaboration between professionals and communities for a values-based approach