Radiofrequency-induced Thermo-chemotherapy Effect Versus a Second Course of Bacillus Calmette-Guérin or Institutional Standard in Patients with Recurrence of Non-muscle-invasive Bladder Cancer Following Induction or Maintenance Bacillus Calmette-Guérin Therapy (HYMN): A Phase III, Open-label, Randomised Controlled Trial.

Background: There is no effective intravesical second-line therapy for non-muscle-invasive bladder cancer (NMIBC) when bacillus Calmette-Guérin (BCG) fails.

Objective: To compare disease-free survival time (DFS) between radiofrequency-induced thermo-chemotherapy effect (RITE) and institutional standard second-line therapy (control) in NMIBC patients with recurrence following induction/maintenance BCG.

Design, Settings, And Participants: Open-label, phase III randomised controlled trial accrued across 14 centres between May 2010 and July 2013 (HYMN [ClinicalTrials.

Botulinum toxin for urogenital conditions.

Botulinum neurotoxin has been shown to be effective when used in the management of lower urinary tract dysfunction, prostatic disorders and more recently vaginismus in women suffering with pelvic floor muscle tension. Here we provide an overview of the use and efficacy of botulinum toxin in these conditions.

Older women with operable breast cancer are less likely to have surgery.

Background: Older women are less likely to receive standard management for breast cancer than younger postmenopausal women. Whether differences in general health explain variations in the rates of surgery is not known.

Methods: In this prospective cohort study, 76 women aged 65 years or more attending breast units in Greater Manchester completed a survey measuring functional status (Elderly Population Health Status Survey's Activity of Daily Living), generic health status (Short Form 12) and health-related quality of life (European Organization for Research on Treatment of Cancer Quality of Life Questionnaire C30).

Human microsporidial infection and possible animal sources.

Sources of human microsporidial infection remain speculative, but possible animal reservoirs are emerging. Of the common human microsporidial infections, Enterocytozoon bieneusi has now been identified in non-human primates, pigs, dogs and a cat; Encephalitozoon intestinalis in dogs, pigs, cows, goats and donkeys and Encephalitozoon hellem in budgerigars and parrots. Evidence of species heterogeneity is also emerging suggesting that some animal isolates may be distinctive.

Cost-effectiveness of screening with contrast enhanced magnetic resonance imaging vs X-ray mammography of women at a high familial risk of breast cancer.

Contrast enhanced magnetic resonance imaging (CE MRI) is the most sensitive tool for screening women who are at high familial risk of breast cancer. Our aim in this study was to assess the cost-effectiveness of X-ray mammography (XRM), CE MRI or both strategies combined. In total, 649 women were enrolled in the MARIBS study and screened with both CE MRI and mammography resulting in 1881 screens and 1-7 individual annual screening events.

Predicting compliance in a breast cancer prevention trial.

The impact of chemoprevention trials can be hampered by poor participant compliance with the study medication. We used medication monitoring systems and pill count data to try to establish factors that may predict compliance with the International Breast Intervention Study (IBIS) and whether the participants went on to complete or benefit the trial. Women who took their trial medication in a regular pattern rather than randomly were more likely to be of benefit to the study (p = 0.

Screening younger women with a family history of breast cancer--does early detection improve outcome?

Women with a family history are often offered mammographic surveillance at an earlier age and with greater frequency than those in the National Breast Screening Programme. In this study, we compared the survival of 62 breast cancer patients diagnosed in the context of a family history clinic offering 12-18 monthly mammographic screening with that of 1108 patients of the same age range but having no exposure to screening. We subtracted the expected additional observation time due to lead time from the survival of the screen-detected cases.

Vibration perception threshold--a valuable assessment of neural dysfunction in people with diabetes.

Diabetic peripheral neuropathy (DPN) has been identified as a key element in the causal pathway to foot ulceration and other lower-extremity complications, impaired quality of life and increased mortality. Early detection is essential to optimise effective risk management, including adequate foot care, patient education, and future pharmacological therapy. However, data suggest that screening has been mostly sub-optimal, and many physicians remain unfamiliar with non-invasive screening tests.

Can bedside assessment reliably exclude aspiration following acute stroke?

Objective: To investigate the ability of a bedside swallowing assessment to reliably exclude aspiration following acute stroke.

Subjects: Consecutive patients admitted within 24 h of stroke onset to two hospitals.

Methods: A prospective study.

Efficacy of multilayered hosiery in reducing in-shoe plantar foot pressure in high-risk patients with diabetes.

Objective: High plantar pressure is an acknowledged risk factor in the development of plantar ulcers in the diabetic neuropathic foot. This study examines the ability of preventive foot care (PFC) socks to reduce plantar foot pressures in a sample of high-risk patients with diabetes.

Research Design And Methods: Nineteen patients with established peripheral neuropathy attending a complications clinic of the Manchester Diabetes Centre were recruited to the study.

Real time measurement of RR intervals using a digital signal processor.

The accurate measurement of beat to beat intervals is essential for subsequent heart rate variability analysis. Where the ECG is used to derive the intervals, timing can be affected by artefacts such as muscle noise, electrode instability and also shape changes in the QRS complex. Identifying the QRS time by correlation methods can minimize the uncertainty but the method is computationally intensive.

Medication management in English National Health Service hospitals.

Purpose: The methods currently used by English National Health Service (NHS) hospitals to manage the use of medicines were studied.

Methods: A questionnaire was mailed to directors of pharmacy at all English NHS hospitals in May 2001.

Results: The response rate was 57% (157/ 275).

A prospective study of injuries sustained during competitive Muay Thai kickboxing.

Objective: To investigate prospectively the type and rate of injuries sustained during amateur Muay Thai competition.

Design: Prospective cohort study collection of data following clinical examination.

Setting: Amateur Muay Thai competitions in the United Kingdom organized by the International Amateur Muay Thai Federation.

The Cheshire Foot Pain and Disability Survey: a population survey assessing prevalence and associations.

Previous foot studies have consistently reported high prevalence estimates in self-reported foot disorders. Few population studies, however, have attempted to assess the impact of foot problems in terms of pain and disability so that the burden associated with foot pain is unknown. A cross-sectional postal survey was conducted on a random community sample of 4780 individuals with 3417 (84%) responding.

Immunogenicity of, and immunologic memory to, a reduced primary schedule of meningococcal C-tetanus toxoid conjugate vaccine in infants in the United kingdom.

It has been previously shown that one of the three meningococcal C conjugate (MCC) vaccines introduced in the United Kingdom proved highly immunogenic after the first dose of a three-dose schedule, with evidence of immune memory after dose 3. Thus, in infants a one- or two-dose schedule of this MCC vaccine, conjugated to tetanus toxoid (TT), may suffice. Healthy infants (n = 586) were randomized to receive either one (group 1), two (group 2), or three (group 3) doses of MCC-TT vaccine with a 10- micro g polysaccharide booster given at 13 to 14 months of age.

Measurement and interpretation of pneumococcal IgG levels for clinical management.

The detection of pneumococcal IgG antibodies is helpful for the evaluation of response to pneumococcal vaccination and need for revaccination. Results generated by the clinical assay which is currently used, in which the 23 valent polysaccharide vaccine is the antigen, were compared to those obtained by a capsular polysaccharide serotype-specific assay that measures IgG antibodies to 9 common serotypes causing invasive disease. Discrepancies in 21/47 (45%) of the results were observed in a direct comparison between the two assays.

Meeting the challenge of prescribing and administering medicines safely: structured teaching and assessment for final year medical students.

Objectives: To promote safe prescribing and administration of medicines in the pre-registration house officer (PRHO) year through a programme of structured teaching and assessment for final year medical students.

Design: Forty final year medical students from two medical schools were randomly allocated either to participate in a pharmacist facilitated teaching session or to receive no additional teaching. Teaching comprised five practical exercises covering seven skills through which students rotated in small groups.

Immunogenicity and immunological priming of the serogroup a portion of a bivalent meningococcal A/C conjugate vaccine in 2-year-old children.

Two-year-old children were vaccinated with 1 dose of meningococcal A/C conjugate (MACC) or meningococcal A/C polysaccharide (MACP) vaccine. Meningococcal serogroup A (MenA)-specific IgG geometric mean avidity indices (GMAIs) increased 1 month after vaccination with MACC (GMAI, 210; 95% confidence interval [CI], 140-300) and MACP (GMAI, 190; 95% CI, 120-310). One year after vaccination, the GMAI of the MACP-vaccinated cohort decreased to 130 (95%, CI 100-170), but a constant GMAI was maintained in the MACC-vaccinated cohort (210; 95% CI, 140-300), despite declining MenA-specific IgG antibody levels.

Genetic analysis of capsular status of meningococcal carrier isolates.

The meningococcal capsule is the primary virulence factor with systemic isolates requiring full expression of the capsule but with capability to down-regulate the capsule in order to invade. The meningococcal capsular operon is composed of a number of genes that are involved in capsular synthesis and transport. Differences in capsular synthesis genes may allow discrimination between meningococcal serogroups whereas absence of genes for either synthesis or transport imply that the meningococcus is unencapsulated.