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    Utility of the stop and stop-bang questionnaires in a pre-screened population presenting for overnight polysomnography
    Lavercombe, M ; Hocking, V ; Clarence, M ; Thien, F (Wiley, 2009)
    Obstructive Sleep Apnoea (OSA) is a common condition, the diagnosis of which is often delayed by prolonged waiting lists at the point of referral or in the sleep laboratory. Clinical prediction tools may become useful in triaging assessment and management of this condition.Recent publications have proposed and validated two new pre-opera-tive screening tools for Obstructive Sleep Apnoea (OSA) in surgical patients (STOP and STOP-BANG). These screening tools have not been examined in a general sleep population.Methods: All patients attending for in-laboratory polysomnography at Box Hill Hospital during the study period were asked to complete the STOP questionnaire, and sleep scientists recorded the biometric data required for the BANG component. Polysomnography proceeded with sleep staging and event scoring performed according to the Chicago Criteria.Risk stratification by the STOP and STOP-BANG tools was combined with total Respiratory Disturbance Index from polysomnogram reports.Results: 69 patients have been recruited, although data continues to be collected. As expected, there is a predominance of moderate and severe OSA in this cohort (45/69, 65%).The STOP-BANG tool maintains higher sensitivity, negative predic-tive value and odds ratios than the STOP tool at each degree of OSA severity examined. Receiver operating characteristic curves demonstrate superiority of the STOP-BANG tool for RDI > 15, when compared with STOP-BANG for RDI > 30 and STOP at both RDI cut-offs.Conclusions: With ongoing data collection we hope to confirm trends seen in predictive values with these tools. Removal of less discrimina-tory criteria may improve their statistical usefulness, perhaps allowing development into risk stratification tools that will assist in triaging investigation and management of patients with suspected OSA.
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    Phase II study of SPI-77 (sterically stabilised liposomal cisplatin) in advanced non-small-cell lung cancer.
    White, SC ; Lorigan, P ; Margison, GP ; Margison, JM ; Martin, F ; Thatcher, N ; Anderson, H ; Ranson, M (Springer Science and Business Media LLC, 2006-10-09)
    To determine the efficacy and tolerability of SPI-77 (sterically stabilised liposomal cisplatin) at three dose levels in patients with advanced non-small-cell lung cancer (NSCLC). Patients had Stage IIIB or IV NSCLC and were chemo-naïve, and Eastern Oncology Cooperative Group 0-2. The first cohort received SPI-77 at 100 mg m-2, the second 200 mg m-2 and the final cohort 260 mg m-2. Patients had also pharmacokinetics and analysis of leucocyte platinum (Pt)-DNA adducts performed. Twenty-six patients were treated, with 22 patients being evaluable for response. Only one response occurred at the 200 mg m-2 dose level for an overall response rate of 4.5% (7.1% at >or=200 mg m-2). No significant toxicity was noted including nephrotoxicity or ototoxicity aside from two patients with Grade 3 nausea. No routine antiemetics or hydration was used. The pharmacokinetic profile of SPI-77 was typical for a liposomally formulated drug, and the AUC appeared to be proportional to the dose of SPI-77. Plasma Pt levels and leucocyte DNA adduct levels did not appear to rise with successive doses. SPI-77 demonstrates only modest activity in patients with NSCLC.
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    Late recovery of renal failure after autologous haematopoietic stem cell transplantation for multiple myeloma: a report of two cases.
    Bigé, N ; Guéry, B ; Delarue, R ; Noël, L-H ; Fakhouri, F (Oxford University Press (OUP), 2009-06)
    Acute renal failure is a frequent feature in patients with multiple myeloma (MM). MM-related renal insufficiency may improve after autologous haematopoietic stem cell transplantation (autoHSCT) even in patients initially requiring dialysis. Herein, we report on two unusual cases of late improvement in renal function occurring over more than 5 years after autoHSCT for MM. Clinicians must be aware that slow and progressive improvement in renal function may occur over years in patients with MM-associated renal failure. Our data underline the need for an aggressive treatment, including autoHSCT, in MM patients presenting with severe renal dysfunction.
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    Breast size, bra fit and thoracic pain in young women: a correlational study.
    Wood, K ; Cameron, M ; Fitzgerald, K (Springer Science and Business Media LLC, 2008-03-13)
    INTRODUCTION: A single sample study was undertaken to determine the strength and direction of correlations between: a) breast size and thoracic spine or posterior chest wall pain; b) bra fit and thoracic spine or posterior chest wall pain and; c) breast size and bra fit, in thirty nulliparous women (18-26 years), with thoracic spine or posterior chest wall pain, who wore bras during daytime. MEASURES: Pain (Short Form McGill Pain Questionnaire), bra size (Triumph International), bra fit (Triumph International). RESULTS: Most (80%) women wore incorrectly sized bras: 70% wore bras that were too small, 10% wore bras that were too large. Breast size was negatively correlated with both bra size (r = -0.78) and bra fit (r = -0.50). These results together indicate that large breasted women were particularly likely to be wearing incorrectly sized and fitted bras. Negligible relationships were found between pain and bra fit, and breast size and pain. Menstrual cycle stage was moderately positively correlated with bra fit (r = 0.32). CONCLUSION: In young, nulliparous women, thoracic pain appears unrelated to breast size. Bra fit is moderately related to stage of menstrual cycle suggesting that this research may be somewhat confounded by hormonal changes or reproductive stage. Further research is needed to clarify whether there is a relationship between breast size or bra fit and thoracic pain in women during times of hormonal change.
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    Functional magnetic resonance imaging (fMRI) of attention processes in presumed obligate carriers of schizophrenia: preliminary findings.
    Filbey, FM ; Russell, T ; Morris, RG ; Murray, RM ; McDonald, C (Springer Science and Business Media LLC, 2008-10-03)
    BACKGROUND: Presumed obligate carriers (POCs) are the first-degree relatives of people with schizophrenia who, although do not exhibit the disorder, are in direct lineage of it. Thus, this subpopulation of first-degree relatives could provide very important information with regard to the investigation of endophenotypes for schizophrenia that could clarify the often contradictory findings in schizophrenia high-risk populations. To date, despite the extant literature on schizophrenia endophenotypes, we are only aware of one other study that examined the neural mechanisms that underlie cognitive abnormalities in this group. The aim of this study was to investigate whether a more homogeneous group of relatives, such as POCs, have neural abnormalities that may be related to schizophrenia. METHODS: We used functional magnetic resonance imaging (fMRI) to collect blood oxygenated level dependent (BOLD) response data in six POCs and eight unrelated healthy controls while performing under conditions of sustained, selective and divided attention. RESULTS: The POCs indicated alterations in a widely distributed network of regions involved in attention processes, such as the prefrontal and temporal (including the parahippocampal gyrus) cortices, in addition to the anterior cingulate gyrus. More specifically, a general reduction in BOLD response was found in these areas compared to the healthy participants during attention processes. CONCLUSION: These preliminary findings of decreased activity in POCs indicate that this more homogeneous population of unaffected relatives share similar neural abnormalities with people with schizophrenia, suggesting that reduced BOLD activity in the attention network may be an intermediate marker for schizophrenia.
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    The relevance of ligament balancing in total knee arthroplasty: how important is it? A systematic review of the literature
    Babazadeh, S ; Stoney, JD ; Lim, K ; Choong, PFM (PAGEPRESS PUBL, 2009)
    Ligament balancing affects many of the postoperative criteria for a successful knee replacement. A balanced knee contributes to improved alignment and stability. Ligament balancing helps reduce wear and loosening of the joint. A patient with a balanced knee is more likely to have increased range of motion and proprioception, and decreased pain. All these factors help minimize the need for revision surgery. Complications associated with ligament balancing can include instability caused by over-balancing and the possibility of neurovascular damage during or as a result of ligament balancing. This article attempts to summarize the literature, to define a balanced knee, and outline the benefits and possible complications of ligament balancing. Different techniques, sequences, and tools used in ligament balancing, and their relevance in correcting various deformities are reviewed.
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    Improved cardiac arrest outcomes: as time goes by?
    Morley, PT (BMC, 2007)
    In a recent issue of Critical Care, Mally and colleagues reported outcomes from an observational study of out-of-hospital cardiac arrests in Slovenia. Multivariable analysis identified independent predictors for hospital discharge, including higher end-tidal carbon dioxide (ETCO2) levels, higher mean arterial pressure (MAP) and the recency (years) of the arrest. ETCO2 has been previously demonstrated to correlate with cardiac index, and predict successful resuscitation. Initial ETCO2 reflects the initial adequacy of resuscitation, and the ETCO2 on admission to hospital reflects a number of factors, including the adequacy of ventilation. During resuscitation, coronary perfusion pressure appears important for survival, but there are limited human data to guide hemodynamic management after cardiac arrest. A higher blood pressure could represent more vasoconstriction, less vasodilation, avoidance of hyperventilation, or a better cardiac output. Improved hospital discharge was also observed during the later years of the study. During this period a number of factors could have contributed to the improved outcome. These include new guidelines, the awareness of the importance of good CPR (including avoidance of hyperventilation), and better post-resuscitation care (including therapeutic hypothermia). It is hard to unravel the actual contribution of these factors to the final outcome, but the authors should be commended for their excellent overall results, and their thought provoking manuscript.
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    Risk Factors forMycobacterium ulceransInfection, Southeastern Australia
    Quek, TYJ ; Athan, E ; Henry, MJ ; Pasco, JA ; Redden-Hoare, J ; Hughes, A ; Johnson, PDR (Centers for Disease Control and Prevention (CDC), 2007-11)
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    Liver disease and the renin–angiotensin system: Recent discoveries and clinical implications
    Lubel, JS ; Herath, CB ; Burrell, LM ; Angus, PW (Wiley, 2008-09)
    Abstract The renin–angiotensin system (RAS) is a key regulator of vascular resistance, sodium and water homeostasis and the response to tissue injury. Historically, angiotensin II (Ang II) was thought to be the primary effector peptide of this system. Ang II is produced predominantly by the effect of angiotensin converting enzyme (ACE) on angiotensin I (Ang I). Ang II acts mainly through the angiotensin II type‐1 receptor (AT1) and, together with ACE, these components represent the ‘classical’ axis of the RAS. Drug therapies targeting the RAS by inhibiting Ang II formation (ACE inhibitors) or binding to its receptor (angiotensin receptor blockers) are now in widespread clinical use and have been shown to reduce tissue injury and fibrosis in cardiac and renal disease independently of their effects on blood pressure. In 2000, two groups using different methodologies identified a homolog of ACE, called ACE2, which cleaves Ang II to form the biologically active heptapeptide, Ang‐(1–7). Conceptually, ACE2, Ang‐(1–7), and its putative receptor, the mas receptor represent an ‘alternative’ axis of the RAS capable of opposing the often deleterious actions of Ang II. Interestingly, ACE inhibitors and angiotensin receptor blockers increase Ang‐(1–7) production and it has been proposed that some of the beneficial effects of these drugs are mediated through upregulation of Ang‐(1–7) rather than inhibition of Ang II production or receptor binding. The present review focuses on the novel components and pathways of the RAS with particular reference to their potential contribution towards the pathophysiology of liver disease.
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    Use of ibandronate in the prevention of skeletal events in metastatic breast cancer.
    Devitt, B ; McLachlan, S-A (Informa UK Limited, 2008-04)
    Bone metastasis from breast cancer often cause significant morbidity including pain, impaired mobility, pathological fracture, and spinal cord compression. Bisphosphonates play an important role in preventing these skeletal related events and are the standard of care for patients with bone metastasis from breast cancer. Ibandronate is a highly potent bisphosphonate available in both intravenous and oral preparations. It has been shown in clinical trials to be effective in reducing skeletal complications and also significantly improve quality of life up to 96 weeks. Unlike other intravenous bisphosphonates, ibandronate has minimal renal toxicity, allowing safe outpatient administration, reducing the need for hospital attendance and safety monitoring. Early trials have shown ibandronate may also be effective in high doses for palliation of opioid-resistant pain from bone metastasis, and as a second-line agent in patients developing a skeletal complication whilst receiving another bisphosphonate.