Medical downgrading, self-perception of health, and psychological symptoms in the British Armed Forces.

Objective: To investigate the contribution of psychological symptoms to limited employability for medical reasons in the British Armed Forces.

Methods: A sample of 4500 military personnel was randomly selected to receive either a full or an abridged questionnaire. The questionnaires asked whether the participant was medically downgraded and if yes, the reason for it.

The history of robotics in urology.

Despite being an ancient surgical specialty, modern urology is technology driven and has been quick to take up new minimally invasive surgical challenges. It is therefore no surprise that much of the early work in the development of surgical robotics was pioneered by urologists. We look at the relatively short history of robotic urology, from the origins of robotics and robotic surgery itself to the rapidly expanding experience with the master-slave devices.

International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease: the NMSQuest study.

Nonmotor symptoms (NMS) of Parkinson's disease (PD) are not well recognized in clinical practice, either in primary or in secondary care, and are frequently missed during routine consultations. There is no single instrument (questionnaire or scale) that enables a comprehensive assessment of the range of NMS in PD both for the identification of problems and for the measurement of outcome. Against this background, a multidisciplinary group of experts, including patient group representatives, has developed an NMS screening questionnaire comprising 30 items.

Single cell PCR amplification of microsatellites flanking the COL7A1 gene and suitability for preimplantation genetic diagnosis of Hallopeau-Siemens recessive dystrophic epidermolysis bullosa.

Background: Hallopeau-Siemens recessive dystrophic epidermolysis bullosa (HS-RDEB) is a severe inherited blistering skin disorder caused by mutations in the anchoring fibril type VII collagen gene, COL7A1. There is currently no effective treatment but DNA-based prenatal testing in families at risk of recurrence is possible, mostly involving chorionic villus sampling at 10-11 weeks' gestation.

Objectives: An alternative method, for avoiding recurrence of HS-RDEB, is preimplantation genetic diagnosis (PGD).

End-of-life care: lessons from other nations.

Palliative care and hospice services have evolved across the globe in different contexts and in different ways, although many of the challenges faced are similar. Comparison between countries helps to identify the best solutions for individual patients and their families, who have complex needs and problems. This paper describes the globally shared challenges and beginnings in hospice and palliative care.

Non-motor symptoms of Parkinson's disease: diagnosis and management.

The clinical diagnosis of Parkinson's disease rests on the identification of the characteristics related to dopamine deficiency that are a consequence of degeneration of the substantia nigra pars compacta. However, non-dopaminergic and non-motor symptoms are sometimes present before diagnosis and almost inevitably emerge with disease progression. Indeed, non-motor symptoms dominate the clinical picture of advanced Parkinson's disease and contribute to severe disability, impaired quality of life, and shortened life expectancy.

Involvement of the nicotinamide adenosine dinucleotide phosphate oxidase isoform Nox2 in cardiac contractile dysfunction occurring in response to pressure overload.

Objectives: This study sought to examine the role of Nox2 in the contractile dysfunction associated with pressure-overload left ventricular hypertrophy (LVH).

Background: Reactive oxygen species (ROS) production is implicated in the pathophysiology of LVH. The nicotinamide adenosine dinucleotide phosphate oxidase isoform, Nox2, is pivotally involved in angiotensin II-induced hypertrophy but is not essential for development of pressure-overload LVH.

Diurnal excretion of urinary cortisol, cortisone, and cortisol metabolites in chronic fatigue syndrome.

Objective: The aim of this study was to obtain comprehensive information on basal hypothalamic-pituitary-adrenal (HPA) axis activity in chronic fatigue syndrome (CFS) patients who were not affected by medication or comorbid psychiatric disorder likely to influence the HPA axis.

Method: Steroid analysis of urine collections from 0600 to 2100 h at 3-h intervals in CFS patients and in controls.

Results: Urinary free cortisol and cortisone concentrations showed a significant normal diurnal rhythm, but levels were lower across the cycle in CFS.

Intravenous immunoglobulin for Guillain-Barré syndrome.

Background: Guillain-Barré syndrome is an acute, paralysing, inflammatory peripheral nerve disease. Intravenous immunoglobulin is beneficial in other autoimmune diseases.

Objectives: We aimed to determine the efficacy of intravenous immunoglobulin for treating Guillain-Barré syndrome.

Advantages of ProSeal and SLIPA airways over tracheal tubes for gynecological laparoscopies.

Purpose: To compare the efficacy of the ProSeal LMA and SLIPA supralaryngeal airways (SLA) with the standard tracheal tube (TT) in 150 consecutive day-case laparoscopic gynecological surgery procedures requiring general anesthesia.

Methods: One hundred and fifty patients were randomized into three groups. An identical general anesthesia technique was used in all patients apart from the addition of muscle relaxants and reversal drugs in the TT group.

Lessons from developing and running a clinical database for colorectal cancer.

Background: Recent policy developments in the UK require the routine monitoring of the performance of cancer services. Developing and using clinical databases is one approach to meet this objective, but to date their implementation has been challenging.

Objective: To describe the development of the Thames Cancer Registry clinical database for colorectal cancer, and to present the lessons learnt in the first five years since its establishment.

HIV/AIDS mitigation strategies and the State in sub-Saharan Africa--the missing link?

Background: The HIV/AIDS pandemic in sub-Saharan Africa is widely recognised as a development disaster threatening poverty reduction, economic growth and not merely a health issue. Its mitigation includes the societal-wide adoption and implementation of specific health technologies, many of which depend on functional institutions and State.

Discussion: Donor and International Institutions' strategies to mitigate HIV/AIDS in sub-Saharan Africa are premised on a single optimal model of the State, one which focuses on the decentralised delivery of public goods alone (such as healthcare) - the service delivery state.

Bullous pemphigoid antigen II (BP180) and its soluble extracellular domains are major autoantigens in mucous membrane pemphigoid: the pathogenic relevance to HLA class II alleles and disease severity.

Background: Mucous membrane pemphigoid (MMP), a chronic autoimmune subepithelial blistering disease, is associated with circulating IgG and/or IgA autoantibodies against several basement membrane zone antigens. The heterogeneity of clinical presentation and diversity of target autoantigens have contributed to difficulties in characterizing this condition immunologically.

Objectives: To analyse serum autoantibody profile and HLA class II alleles in MMP patients and to correlate this with the clinical presentation of disease.

The long-term effects of tibolone on aortic stiffness and endothelial function.

Objective: To investigate the effect of 10 years of treatment with tibolone on aortic stiffness and endothelial function.

Design: Cross-sectional study of women currently participating in an open-label, non-randomized study of the long-term efficacy of tibolone. A total of 113 recently postmenopausal women were recruited in 1988.

Chronic manifestations of respiratory syncytial virus infection in premature infants.

Background: Respiratory syncytial virus (RSV) infection in healthy infants born at term results in long term sequelae. Infants born prematurely are at increased risk of severe acute RSV infection; thus it would seem likely that such infants would be at increased risk of long term respiratory sequelae.

Methods: Methods of assessing the long term outcome of RSV infection are discussed and the results of retrospective and prospective studies investigating chronic respiratory morbidity after RSV infection in premature infants are reviewed.

Comparison of effective dose to children and adults from dual X-ray absorptiometry examinations.

Dual X-ray absorptiometry (DXA) is increasingly used to measure bone density in children. If the system software does not include pediatric scan modes, then child examinations must be performed using adult scan modes that give a higher radiation dose to children than adults. This report describes a study to compare the effective dose to children and adults from DXA scans performed on the Hologic Discovery and QDR4500 models.

Silent aspiration: what do we know?

Although clinically evident aspiration is common in subjects with dysphagia, a significant proportion may aspirate silently, i.e., without any outward signs of swallowing difficulty.

Predicting the risk of fracture at any site in the skeleton: are all bone mineral density measurement sites equally effective?

The ability to assess a patient's risk of fracture is fundamental to the clinical role of bone densitometry. Fracture discrimination is quantified by the relative risk (RR), defined as the increased risk of fracture for a 1 standard deviation decrease in bone mineral density (BMD). The larger the value of RR, the more effective measurements are at identifying patients at risk of fracture.

A systematic review of treatments for electromagnetic hypersensitivity.

Background: Electromagnetic hypersensitivity (EHS) is a poorly understood condition in which patients report symptoms following perceived exposure to weak electromagnetic fields (EMFs) such as those produced by mobile phones or visual display units. Little is known about the aetiology of the condition although experimental data suggest that EMFs are an unlikely causal agent. In this systematic review we assessed the efficacy of any treatment for people reporting EHS.

Effects of folic acid supplementation on psychomotor performance and hemorheology in healthy elderly subjects.

Cognitive impairment is associated with increased blood concentrations of homocysteine and high blood viscosity. Previous studies have shown that vitamin B supplementation reduces homocysteine and enhances cognitive function in patients with mild dementia and low serum folic acid. However, whether folic acid enhances cognitive function in elderly subjects without dementia and normal serum folic acid is unknown.

Role of oxidative stress in cardiac remodelling after myocardial infarction.

Recovery from myocardial infarction is associated with a series of alterations in heart structure and function, collectively known as cardiac remodelling, which play a major role in the subsequent development of heart failure. Early remodelling involves infarct scar formation in the ischaemic zone whereas subsequent ventricular remodelling affects mainly the viable non-infarcted myocardium with especially profound alterations in the extracellular matrix. There is growing evidence for a role of oxidative stress and redox signalling in the processes underlying cardiac remodelling.

Pulsed radiofrequency applied to dorsal root ganglia causes a selective increase in ATF3 in small neurons.

Background: This is a "proof of concept study" to test the hypothesis that pulsed radiofrequency, PRF, produces cell stress at the primary afferent level without signs of overt thermal damage. We assumed that cell stress would result in impairment of normal function, and used the expression of activating transcription factor 3, ATF3, as an indicator of cellular "stress".

Methods: PRF (20 ms of 500-kHz RF pulses, delivered at a rate of 2 Hz; maximum temperature 42 degrees C) was delivered either to the sciatic nerve of adult rats in mid thigh, or to the L4 anterior primary ramus just distal to the intervertebral foramen.

Metabolic biotinylation of lentiviral pseudotypes for scalable paramagnetic microparticle-dependent manipulation.

Nonviral, host-derived proteins on lentiviral vector surfaces can have a profound effect on the vector's biology as they can both promote infection and provide resistance to complement inactivation. We have exploited this to engineer a specific posttranslational modification of a "nonenvelope," virally associated protein. The bacterial biotin ligase (BirA) and a modified human DeltaLNGFR have been introduced into HEK293T cells and their protein products directed to the lumen of the endoplasmic reticulum.