Comparison of homecare costs of local wound care in surgical patients randomized between occlusive and gauze dressings

Aims and objectives. To study the material and nursing costs and outcome of wound care at home comparing two dressing groups (occlusive vs. gauze‐based) in surgical patients after hospital dismissal. Background. The large variety in dressing materials and lack of convincing evidence make the choice for optimum local wound care at home cumbersome. Occlusive wound dressings require a lower change frequency than gauze‐based dressings, which appears especially useful for homecare patients and could save costs. Methods. We investigated a consecutive series of 76 patients with wounds, included in a randomized trial comparing occlusive vs. gauze dressings. Daily dressing change frequency, consumption of dressing materials and need for district nursing visits were recorded until wound closure by means of diaries and at outpatient visits. Costs were expressed as means and 95% confidence intervals (CI) after calculation using non‐parametric bootstrapping. Results. Patient groups were similar regarding age, wound size and aetiology. Dressing change frequency in the occlusive group (median: 0·6/day) was significantly (p = 0·008) lower than in the gauze group (1·1/day). Mean daily material costs of modern dressings were €5·31 vs. €0·71 in the gauze group. Mean difference; €4·60 (95% CI, €2·68–€6·83) while daily total (material plus nursing) costs showed no difference between the groups; mean €2·86 (95% CI, €?6·50–€10·25). Wound healing in the gauze‐treated group tended to be quicker than in the occlusive dressing group (medians: 30 vs. 48 days, respectively; log‐rank p = 0·060). Conclusions. The use of occlusive dressings does not lead to a reduction in costs and wound healing time as compared with gauze dressings for surgical patients receiving wound care at home. Relevance to clinical practice. District nurses should reconsider using gauze‐based dressings, particularly in surgical patients with exudating wounds.     

Inter- and intra-observer (dis)agreement among nurses and doctors to classify colour and exudation of open surgical wounds according to the Red-Yellow-Black scheme

Aim and objectives. Primary: to study the level of agreement among nurses and doctors in classifying the colour and exudation of open wounds according to the Red‐Yellow‐Black scheme. Secondary: to check their agreement with an international expert panel on whether their classification was correct. Background. Nurses and doctors classify open wounds to assess systemic and local treatment options. Nowadays, several classification schemes are being used. The Red‐Yellow‐Black‐scheme is commonly used for classifying open wounds or is part of other, more intricate, wound classification models. Methods. Eighteen representative photographs of red, yellow and black wounds were presented to 63 nurses and 79 doctors from the Department of Surgery. They classified these open wounds for colour and amount of exudation. Group kappa's (κ) were calculated to assess inter‐ and intra‐observer agreement and their agreement with an expert panel. Results. Agreement among the 63 nurses on wound colour (κ = 0·61; 95% CI: 0·49–0·74) and exudation (κ = 0·49; 95% CI: 0·29–0·68) was moderate to good. Agreement among the 79 doctors was similar: κ = 0·61; 95% CI 0·49–0·73 for wound colour and κ = 0·48; 95% CI: 0·36–0·61 for exudation. Nurses’ and doctors’ agreement with the expert panel was also moderate to good: κ‐values ranged between 0·48 and 0·77. Conclusion. Based on the good to moderate inter‐observer agreement as found in this study, the Red‐Yellow‐Black ‐scheme appears to be a reliable and accurate classification scheme to assess open (surgical) wounds. Such a scheme may enable nurses and doctors to select the appropriate treatment modalities and evaluate the progress of the healing process. Relevance to clinical practice. The Red‐Yellow‐Black scheme is a helpful tool to classify all kinds of wounds and can be used as stand‐alone classification method or as part of wound management concepts.     

Predictors of the intima‐media thickness of carotid artery in asymptomatic newly detected severe hypercholesterolemic patients

Background: Data about predictors of intima‐media thickness (IMT) of common carotid artery (CCA) in asymptomatic subjects with newly detected severe hypercholesterolemia is scarce. Aim: This research is aimed at studying the predictors of the IMT of CCA among basic atherogenic risk biomarkers – lipid [total cholesterol (TC), triglycerides, high‐density lipoprotein cholesterol, low‐density lipoprotein (LDL) cholesterol, Apolipoprotein‐B, Apolipoprotein‐Ai, Apolipoprotein‐B/A₁ index] and non‐lipid, [asymmetric dimethylarginine (ADMA), total homocysteine, cell adhesion molecules] in asymptomatic subjects with newly detected severe hypercholesterolemia. Methods: Two hundred and fifty asymptomatic patients with severe, newly hypercholesterolemia and 200 controls were evaluated. Hypercholesterolemia was defined as TC > 7·5 mm and LDL cholesterol > 4·9 mm . The ADMA and cell adhesion molecules were determined by ELISA and total homocysteine by high‐performance liquid chromatography. Results: There was significant difference between the two groups in respect to all lipid biomarkers (P<0·001). Hypercholesterolemic patients had significantly higher level of ADMA, sVCAM‐1, sICAM‐1, IMT (P<0·001), whereas no significant difference was found between two groups with respect to total homocysteine, P‐selectin and E‐selectin (P>0·05). A strong positive correlation between IMT mean and age (r_xy = 0·714; P<0·001), Apolipoprotein‐B (r_xy = 0·706; r_xy < 0·001), Apolipoprotein‐B/A₁ (r_xy = 0·324; P<0·001), ADMA (r_xy = 0·603; P<0·001) was found. The subsequent linear and multiple regression analysis selected age and Apolipoprotein‐B as most significant factors in relation to IMT mean. Apolipoprotein‐B is a better factor for assessment of risk, as LDL cholesterol underestimates the risk in asymptomatic subjects with newly detected severe hypercholesterolemia, until more rapid and feasible methods for measurement of small and dense LDL are available.     

Maximal explosive muscle power in obese and non‐obese prepubertal children

Objective: The objectives of the present study was to compare the maximal explosive muscle power developed by the lower limbs in obese and non‐obese prepubertal children. Design: Twenty‐five obese [mean body mass index (BMI) z‐score: 2·4] and 30 non‐obese (mean BMI z‐score: 0) children aged 8–12 years, participated in this study. Body composition was measured by bioelectrical impedance analysis and the maximal explosive power of the lower limbs was assessed by the Exercise‐Ergometer (a sledge dynamometer). Results: Absolute peak force (F_peak) was higher in obese than in non‐obese children by 18·2% (P<0·001). Peak speed (v_peak) was not significantly different between groups (P = 0·504). Consequently, absolute peak power (W′_peak) was higher in obese than in non‐obese children (+19·3%, P = 0·021). Considering gender differences, absolute F_peak and v_peak were higher in boys than in girls by +12·3 and +17·4% (P<0·05), respectively, thus yielding higher absolute W′_peak values in boys as compared to girls (+26·1%, P<0·001). Finally, W′_peak normalized for fat‐free mass (FFM) was not different between obese and non‐obese children but higher in boys than in girls (+24·5%, P<0·001). Conclusions: Power generation capability per unit of FFM was similar between obese and non‐obese children but was significantly higher in boys than girls. On the clinical practice it seems important to devote supplementary care to sustain and improve the motor function of obese and non‐obese girls.     

Comparison of SSRIs and SNRIs in major depressive disorder: a meta‐analysis of head‐to‐head randomized clinical trials

Context: Controversy exists whether serotonin–norepinephrine reuptake inhibitors (SNRIs) have improved efficacy compared with selective serotonin reuptake inhibitors (SSRIs). Objective: To compare clinical outcomes of adults treated with SSRIs or SNRIs for major depressive disorder (MDD) under ideal clinical condition, research design, and outcome measure. Data sources: Electronic databases searched were Medline, Embase and Cochrane Library from inception to July 2007. Study selection: Included studies were those head‐to‐head randomized trials comparing remission (HAMD‐17 ≤7–8, MADRS ≤10–12) after 8–12 weeks of therapeutic doses of SSRIs or SNRIs in patients diagnosed with MDD were targeted for analysis. Reviews, letters, commentaries, economic studies, etc. were excluded. Studies were reviewed by two independent researchers. Where disagreements occurred in study selection, a consensus approach was used. Data extraction and analysis: Targeted outcome data included number of patients achieving remission, withdrawing from therapy due to lack of efficacy (LoE) and/or adverse drug reactions (ADRs), and total patients in trial. A random effects model combined intent‐to‐treat (ITT) and per‐protocol (PP) odds ratio (OR), and remission and dropout rates. Chi‐square assessed heterogeneity. Quality assessment was done using Downs‐Black checklist. Results: Thirty‐three studies were identified; 18 were rejected (patients had co‐morbidities in 7, outcomes differed in 5, different follow‐up in 3, and three reviews). Fifteen head‐to‐head trials of 3094 patients, average age was 41·9 ± 11·9 years (for SNRIs) and 41·6 ± 12·1 years (for SSRIs), P = 0·941. All analyses displayed non‐heterogeneity (P > 0·05). The OR (under ITT) was 1·27 (1·06–1·52 95% CI) favoring SNRIs. Meta‐analytic remission rates were 48·5 ± 3·2% and 41·9 ± 4·2% for SNRIs and SSRIs, respectively. The meta‐analytic difference in remission rates between drugs was 5·7% (P = 0·007). Dropout rates due to ADRs were higher with SNRIs than SSRIs (3·2% difference, P < 0·001). Dropout rates due to LoE were non‐significant between studied groups (P > 0·05). Conclusions: Serotonin and norepinephrine reuptake inhibitors showed statistical but not clinical significance when compared with SSRIs in treating MDD.     

Evaluation of keratin biomaterial containing silver nanoparticles as a potential wound dressing in full‐thickness skin wound model in diabetic mice

Keratin is a cytoskeletal scaffolding protein essential for wound healing and tissue recovery. The aim of the study was to evaluate the potential role of insoluble fur keratin‐derived powder containing silver nanoparticles (FKDP‐AgNP) in the allogenic full‐thickness surgical skin wound model in diabetic mice. The scanning electron microscopy image evidenced that the keratin surface is covered by a single layer of silver nanoparticles. Data obtained from dynamic light scattering and micellar electrokinetic chromatography showed three fractions of silver nanoparticles with an average diameter of 130, 22.5, and 5 nm. Microbiologic results revealed that the designed insoluble FKDP‐AgNP dressing to some extent inhibit the growth of Escherichia coli and Staphylococcus aureus. In vitro assays showed that the FKDP‐AgNP dressing did not inhibit fibroblast growth or induce hemolysis. In vivo studies using a diabetic mice model confirmed biocompatible properties of the insoluble keratin dressings. FKDP‐AgNP significantly accelerated wound closure and epithelization at Days 5 and 8 (p < .05) when compared with controls. Histological examination of the inflammatory response documented that FKDP‐AgNP‐treated wounds contained predominantly macrophages, whereas their untreated variants showed mixed cell infiltrates rich in neutrophils. Wound inflammatory response based on macrophages favors tissue remodeling and healing. In conclusion, the investigated FKDP‐AgNP dressing consisting of an insoluble fraction of keratin, which is biocompatible, significantly accelerated wound healing in a diabetic mouse model.     

Functionalized PVA–silk blended nanofibrous mats promote diabetic wound healing via regulation of extracellular matrix and tissue remodelling

Chronic cutaneous ulcers, a complex pathophysiological diabetic condition, represent a critical clinical challenge in the current diabetes mellitus pandemic. Consequently, there is a compelling need for bioactive dressings that can trigger healing processes for complete wound repair. Silk fibroin (SF), a natural protein polymer from mulberry and non‐mulberry silkworms, has properties that support accelerated wound healing rate. SF from non‐mulberry variety possesses additional cell‐binding motifs (arginine, glycine, and aspartate), offering cell–material interactions. This study is aimed to investigate wound healing efficacy of dressings made up of various SF varieties blended with poly(vinyl alcohol) biopolymer in alloxan‐induced diabetic rabbit model. The nanofibrous mats have been developed using electrospinning and functionalized with growth factors and LL‐37 antimicrobial peptide for sustained delivery. Following post 14‐day treatment, non‐mulberry SF (NMSF)‐based dressings healed the wounds faster, in comparison with their mulberry Bombyx mori SF, poly(vinyl alcohol), and control counterparts (p < .01). NMSF‐based dressings also supported faster granulation tissue development, angiogenesis, and reepithelialization of wounds. Gene expression study of matrix metalloproteinases and collagen proteins affirmed higher extent of tissue remodelling during the repair process. Furthermore, there was organized extracellular matrix deposition (collagen type I, collagen type III, elastin, and reticulin) and higher wound breaking strength in NMSF compared with other groups after 4 weeks. These results validated the potential of NMSF‐based bioactive dressings to regulate extracellular matrix deposition leading to faster and complete repair of chronic diabetic cutaneous wounds.     

Interventions to reduce vasovagal reactions in blood donors: a systematic review and meta‐analysis

Vasovagal reactions (VVRs) in blood donors have significant implications for the welfare of donors, donor retention and the management of donor sessions. We present a systematic review of interventions designed to prevent or reduce VVRs in blood donors. Electronic databases were searched for eligible randomised trials to March 2015. Data on study design and outcomes were extracted and pooled using random effects meta‐analyses. Sixteen trials met the inclusion criteria: five trials (12 042 participants) of pre‐donation water, eight trials (3500 participants) of applied muscle tension (AMT) and one trial each of AMT combined with water, caffeine, audio‐visual distraction and/or social support. In donors receiving pre‐donation water, the relative risk (RR) compared with controls for VVRs was 0·79 [95% confidence interval (CI) 0·70–0·89, P < 0·0001] and the mean difference (MD) in severity of VVRs measured with the Blood Donation Reactions Inventory (BDRI) score was ?0·32 (95% CI ?0·51 to ?0·12, P < 0·0001). Excluding trials with a high risk of selection bias, the RR for VVRs was 0·70 (95% CI 0·45–1·11, P = 0·13). In donors who received AMT, there was no difference in the risk of chair recline in response to donor distress from controls (RR 0·76, 95% CI 0·53–1·10, P = 0·15), although the MD in BDRI score was ?0·07 (95% CI ?0·11 to ?0·03, P = 0·0005). There was insufficient data to perform meta‐analysis for other interventions. Current evidence on interventions to prevent or reduce VVRs in blood donors is indeed limited and does not provide strong support for the administration of pre‐donation water or AMT during donation. Further large trials are required to reliably evaluate the effect of these and other interventions in the prevention of VVRs.     

What is the relationship between nurses’ attitude to evidence based practice and the selection of wound care procedures?

Aim. To investigate qualified nurses’ attitudes to evidence‐based practice and whether this influenced their selection of wound care products. Background. The literature shows that previous studies on attitudes to evidence‐based practice tended to be part of a wider study. The general consensus was that there was a positive attitude to evidence‐based practice. However, there appeared to be no published studies specifically addressing nurses’ attitudes to evidence‐based wound care. Design. Survey design using a questionnaire completed by 156 qualified nurses working in three UK National Health Trusts. Results. A statistically significant difference was seen between those nurses with a tissue viability link nurse role (p = 0·002) and those without a link nurse role; those educated to first degree (p < 0·001) and those without a first degree; and those who had received formal tissue viability training (p < 0·001) and those with informal tissue viability training. There was also a highly statistically significant relationship between the clinical grade of staff and the overall attitude to evidence‐based practice (p < 0·001). Conclusions. Nurses who had attained a higher level academic qualification, had a tissue viability link nurse role and those who had received formal tissue viability training scored generally higher in the wound care knowledge tests and in attitude to evidence‐based practice. Relevance to clinical practice. The care received by patients in relation to wound care could be dependent upon factors that are related to the individual characteristics of the nurse providing the care and these factors, in turn, are related to education and training with respect to wound care. Better general education and better specific training in wound care could lead to better wound care.     

Temporal age‐related changes in spectral,fractal and complexity characteristics of heart rate variability

Cross‐sectional studies have suggested that heart rate (HR) variability, analysed using traditional time and frequency domain methods, is related to ageing, but no longitudinal studies have estimated the age dependence of HR fluctuation. This study evaluated temporal age‐related changes in 12‐h measures of HR variability among 109 patients with coronary artery disease (CAD), who underwent repeat Holter recordings at 32‐month intervals. Time and frequency domain measures, along with fractal and complexity measures of HR variability, were determined at the baseline and after 32 months. Changes in HR dynamics were compared with various laboratory variables, exercise data and angiographic progression of CAD. Traditional time and frequency domain measures of HR variability did not change significantly during the follow‐up, but the power‐law scaling slope decreased from ?1·29 ± 0·20 to ?1·36 ± 0·23 (P<0·01) and the short‐term fractal exponent (α₁) of HR dynamics from 1·29 ± 0·14–1·22 ± 0·18 (P<0·001). The approximate entropy value also decreased from 1·00 ± 0·19 to 0·95 ± 0·18 (P<0·05). The changes in HR behaviour were not related to demographic data, laboratory values or angiographic progression of CAD. Only a weak correlation was observed between the change in the power‐law slope and the baseline glucose value (P<0·05). This longitudinal study shows that the fractal characteristics of HR dynamics and the complexity properties of R‐R intervals undergo rapid changes along with ageing, and that fractal and complexity analysis techniques are more sensitive than traditional analysis methods in documenting temporal age‐related changes in HR behaviour.     

Whole‐body vibration dosage alters leg blood flow

The effect of whole‐body vibration dosage on leg blood flow was investigated. Nine healthy young adult males completed a set of 14 random vibration and non‐vibration exercise bouts whilst squatting on a Galileo 900 plate. Six vibration frequencies ranging from 5 to 30 Hz (5 Hz increments) were used in combination with a 2·5 mm and 4·5 mm amplitude to produce twelve 1‐min vibration bouts. Subjects also completed two 1‐min bouts where no vibration was applied. Systolic and diastolic diameters of the common femoral artery and blood cell velocity were measured by an echo Doppler ultrasound in a standing or rest condition prior to the bouts and during and after each bout. Repeated measures MANOVAs were used in the statistical analysis. Compared with the standing condition, the exercise bouts produced a four‐fold increase in mean blood cell velocity (P<0·001) and a two‐fold increase in peak blood cell velocity (P<0·001). Compared to the non‐vibration bouts, frequencies of 10–30 Hz increased mean blood cell velocity by approximately 33% (P<0·01) whereas 20–30 Hz increased peak blood cell velocity by approximately 27% (P<0·01). Amplitude was additive to frequency but only achieved significance at 30 Hz (P<0·05). Compared with the standing condition, squatting alone produced significant increases in mean and peak blood cell velocity (P<0·001). The results show leg blood flow increased during the squat or non‐vibration bouts and systematically increased with frequency in the vibration bouts.     

Forearm–finger skin temperature gradient as an index of cutaneous perfusion during steady‐state exercise

The purpose of this study was to examine whether the forearm–finger skin temperature gradient (T_{forearm–finger}), an index of vasomotor tone during resting conditions, can also be used during steady‐state exercise. Twelve healthy men performed three cycling trials at an intensity of ~60% of their maximal oxygen uptake for 75 min separated by at least 48 h. During exercise, forearm skin blood flow (BF_F) was measured with a laser‐Doppler flowmeter, and finger skin blood flow (PPG) was recorded from the left index fingertip using a pulse plethysmogram. T_{forearm–finger} of the left arm was calculated from the values derived by two thermistors placed on the radial side of the forearm and on the tip of the middle finger. During exercise, PPG and BF_F increased (P<0·001), and T_{forearm–finger} decreased (P<0·001) from their resting values, indicating a peripheral vasodilatation. There was a significant correlation between T_{forearm–finger} and both PPG (r = ?0·68; P<0·001) and BF_F (r = ?0·50; P<0·001). It is concluded that T_{forearm–finger} is a valid qualitative index of cutaneous vasomotor tone during steady‐state exercise.     

Comparing the cumulative incidences of add‐on therapy among the major antihypertensive classes in 2531 Asian patients: a cohort study

Background: Published literature addressing the efficacy of different antihypertensive drug classes among Asian patients is scarce. Methods: This cohort study included all patients prescribed their first‐ever antihypertensive monotherapy without concomitant use of chronic medications in two primary care clinics in Hong Kong during 1990–2002. The incidence of add‐on therapy within 48 weeks because of suboptimal blood pressure control was evaluated and compared among different age and gender groups. Results and discussion: Among the 2531 patients, the incidence of add‐on therapy among users of angiotensin converting enzyme inhibitors (ACEI) was highest in young females (31·1%, 95% CI 22·2%, 40·0%, P < 0·001) and elderly females (18·0%, 95% CI 11·3%, 24·7%, P = 0·049) as compared with thiazide diuretics, beta‐blockers and calcium channel blockers. The incidence of add‐on therapy among young males (20·3%, 95% CI 11·1%, 29·5%; P > 0·50) and elderly males (12·5%, 95% CI 3·8%, 21·2%) was also highest with the ACEI than other drug classes although statistical significance was not reached. Conclusion: The incidence of add‐on therapy among first‐time antiypertensives appear to be significantly different between drug classes. This deserves further investigation.     

Validation of a single‐stage fixed‐rate step test for the prediction of maximal oxygen uptake in healthy adults

Healthcare professionals with limited access to ergospirometry remain in need of valid and simple submaximal exercise tests to predict maximal oxygen uptake (VO_2max). Despite previous validation studies concerning fixed‐rate step tests, accurate equations for the estimation of VO_2max remain to be formulated from a large sample of healthy adults between age 18–75 years (n > 100). The aim of this study was to develop a valid equation to estimate VO_2max from a fixed‐rate step test in a larger sample of healthy adults. A maximal ergospirometry test, with assessment of cardiopulmonary parameters and VO_2max, and a 5‐min fixed‐rate single‐stage step test were executed in 112 healthy adults (age 18–75 years). During the step test and subsequent recovery, heart rate was monitored continuously. By linear regression analysis, an equation to predict VO_2max from the step test was formulated. This equation was assessed for level of agreement by displaying Bland–Altman plots and calculation of intraclass correlations with measured VO_2max. Validity further was assessed by employing a Jackknife procedure. The linear regression analysis generated the following equation to predict VO_2max (l min^?1) from the step test: 0·054(BMI)+0·612(gender)+3·359(body height in m)+0·019(fitness index)?0·012(HRmax)?0·011(age)?3·475. This equation explained 78% of the variance in measured VO_2max (F = 66·15, P<0·001). The level of agreement and intraclass correlation was high (ICC = 0·94, P<0·001) between measured and predicted VO_2max. From this study, a valid fixed‐rate single‐stage step test equation has been developed to estimate VO_2max in healthy adults. This tool could be employed by healthcare professionals with limited access to ergospirometry.     

Ultrasound measurements of carotid intima–media thickness by two semi‐automated analysis systems

Increased carotid intima–media thickness (cIMT) is associated with an increased risk of cardiac events and stroke. Several semi‐automated edge‐detection techniques for measuring cIMT are used for research and in clinical practice. Our aim was to compare two currently available semi‐automated techniques for the measurement of cIMT. Carotid ultrasound recordings were obtained from 99 subjects (mean age 54·4 ± 8·9 years, range 33–69) without known cardiovascular diseases using a General Electric (GE) Vivid 7 ultrasound scanner, 8‐MHz transducer. The far‐wall cIMT was evaluated 1–2 cm proximal to the carotid bulb. Three diastolic images (ECG R‐wave) from the left and three images from the right common carotid arteries were analysed using GE and Artery Measurement System (AMS) semi‐automated softwares. Mean systolic and diastolic blood pressures were 120 ± 13 and 76 ± 8 mmHg, respectively. The cIMT_mean (left + right)/2 by GE and cIMT_mean (left + right)/2 AMS were highly correlated (r = 0·92, P<0·001). Higher values were measured by GE (0·72 ± 0·12 mm) compared with AMS (0·69 ± 0·12 mm), and this was significant (P<0·001). The coefficients of variation for the intra‐observer variability of cIMT_mean (left + right)/2 were 1·0% (GE) and 2·2% (AMS). cIMT_mean measured by GE's semi‐automated edge‐detection method correlated well with that measured by AMS. However, there were small but significant systematic differences between the cIMT_mean values measured by the two techniques. Thus, the use of only one type of measurement program seems favourable in follow‐up studies and when evaluating treatment effects.     

Relationship between ultrasound muscle thickness and MRI‐measured muscle cross‐sectional area in the forearm: a pilot study

Previous studies have investigated the relationship between ultrasound‐measured muscle thickness (MT) and individual muscle cross‐sectional area (CSA); however, the forearm muscle had not yet been studied. The purpose of this study was to examine the relationship between forearm MT by ultrasound and the muscle CSA of the forearm obtained by magnetic resonance imaging (MRI). Ten young and middle‐aged adults had both ultrasound and MRI measurements at 30% the distance from the styloid process of the ulna to the head of the radius. Handgrip strength (HGS) was also measured. Strong correlations (P<0·001) were observed between MRI‐measured muscle CSA (total and flexor and extensor components) and MT‐ulna (ranged r = 0·937–0·946) and MT‐radius (ranged r = 0·884–0·891). HGS was also correlated (P<0·001) with forearm MT (MT‐ulna, r = 0·877; MT‐radius, r = 0·852) and MRI‐measured muscle CSA (flexor CSA, r = 0·910; extensor CSA, r = 0·923). Our results suggest that forearm MT is closely associated with MRI‐measured forearm muscle CSA in young and middle‐aged adults and suggest that ultrasound‐measured forearm muscle thickness may be a useful variable for evaluating muscle CSA and function in the forearm.     

Naloxone in the management of hepatic encephalopathy

Background/aim: This study aimed to assess the effectiveness and safety of naloxone in the management of hepatic encephalopathy (HE). Methods: Cochrane collaboration methodology was used in a meta‐analysis of randomized controlled trials of naloxone therapy for HE. Results: Seventeen randomized trials were identified with 15 studies involving 1054 patients meeting criteria for inclusion. Naloxone use was associated with a significant improvement in HE [relative risk (RR) 1·46; 95% confidence interval (CI) 1·27–1·67; P = 0·0005]. This comparison showed statistical heterogeneity (P < 0·10, and χ² = 44·93). Subgroup analysis indicated naloxone administered parenterally by intermittent or continuous infusions to be effective (RR 1·34; 95% CI 1·17–1·53; P < 0·0001). A significant in trials by infusion route (RR 1·42; 95% CI 1·19–1·69; P < 0·0001) interaction was observed. Conclusions: Naloxone may improve HE. However, published data are limited.     

A comparison of dynamic contrast‐enhanced CT and MR imaging‐derived measurements in patients with cervical cancer

This work is to compare the kinetic parameters derived from the DCE‐CT and ‐MR data of a group of 37 patients with cervical cancer. The modified Tofts model and the reference tissue method were applied to estimate kinetic parameters. In the MR kinetic analyses using the modified Tofts model for each patient data set, both the arterial input function (AIF) measured from DCE‐MR images and a population‐averaged AIF from the literature were applied to the analyses, while the measured AIF was used for the CT kinetic analysis. The kinetic parameters obtained from both modalities were compared. Significant moderate correlations were found in modified Tofts parameters [volume transfer constant(K^trans) and rate constant (k_ep)] between CT and MR analysis for MR with the measured AIFs (R = 0·45, P<0·01 and R = 0·40, P<0·01 in high‐K^trans region; R = 0·38, P<0·01 and R = 0·80, P<0·01 in low‐K^trans region) as well as with the population‐averaged AIF (R = 0·59, P<0·01 and R = 0·62, P<0·01 in high‐K^trans region; R = 0·50, P<0·01 and R = 0·63, P<0·01 in low‐K^trans region), respectively. In addition, from the Bland–Altman plot analysis, it was found that the systematic biases (the mean difference) between the modalities were drastically reduced in magnitude by adopting the population‐averaged AIF for the MR analysis instead of the measured ones (from 51·5% to 18·9% for K^trans and from 21·7% to 4·1% for k_ep in high‐K^trans region; from 73·0% to 29·4% for K^trans and from 63·4% to 24·5% for k_ep in low‐K^trans region). The preliminary results showed the feasibility in the interchangeable use of the two imaging modalities in assessing cervical cancers.     

Left ventricular diastolic function is enhanced after peak exercise in endurance‐trained adolescents as well as in their non‐trained controls

The aims of the study were to explore the temporal change of cardiac function after peak exercise in adolescents, and to investigate how these functional changes relate to maximal oxygen uptake (VO_2max). The cohort consisted of 27 endurance‐trained adolescents aged 13–19 years, and 27 controls individually matched by age and gender. Standard echocardiography and colour tissue Doppler were performed at rest, and immediately after as well as 15 min after a maximal cardio pulmonary exercise test (CPET) on a treadmill. The changes in systolic and diastolic parameters after exercise compared to baseline were similar in both groups. The septal E/e′‐ratio increased immediately after exercise in both the active and the control groups (from 9·2 to 11·0; P<0·001, and from 8·7 to 10·2; P = 0·008, respectively). In a comparison between the two groups after CPET, the septal E/e′‐ratio was higher in the active group both immediately after exercise and 15 min later compared to the control group (P = 0·007 and P = 0·006, respectively). We demonstrated a positive correlation between VO_2max and cardiac function including LVEF and E/e′ immediately after CPET, but the strongest correlation was found between VO_2max and LVEDV (r = 0·67, P<0·001) as well as septal E/e′ (r = 0·34, P = 0·013). Enhanced diastolic function was found in both groups, but this was more pronounced in active adolescents. The cardiac functional response to exercise, in terms of LVEF and E/e′, correlates with the increase in VO₂ uptake. These findings in trained as well as un‐trained teenagers have practical implications when assessing cardiac function.