Making Scents: Improvement of Olfactory Profile after Botulinum Toxin-A Treatment in Healthy Individuals

BACKGROUND The axilla is particularly associated with body odor and putative pheromone production in humans. Although botulinum toxin type A (BT-A) is injected increasingly into the axillary skin to stop excessive sweating, its potential to control body odor is largely unexplored.
OBJECTIVE The objective was to measure the impact of BT-A on human axillary odor in an objective and reproducible fashion.
METHODS This study was a randomized, double-blind, placebo-controlled trial with 51 healthy volunteers receiving 50 U of BOTOX (Allergan, Inc.) in one axilla and placebo in the other. Odor quality was assessed by treated subjects (questionnaire) as well as by independent raters who were exposed to blinded T-shirt samples.
RESULTS No major side effects occurred, and no subject withdrew from the study for medical reasons. Samples from the BT-A–treated side smelled less intense ( p <.001) and better ( p <.001) according to self-assessments. Likewise, independent raters found the BT-A–treated samples to smell less intense and better ( p <.001). They preferred "to work together with the respective person" and found the odor "more erotic" ( p <.001).
CONCLUSION Side-by-side comparison of odor samples (T-shirt sniff test) by independent raters showed that axillary odor in healthy individuals is significantly more appealing after BT-A injection.     

Predictors and survival in hepatitis B-related hepatocellular carcinoma in New South Wales, Australia

Background and Aim: Incidence and mortality of hepatocellular carcinoma (HCC) has increased markedly over the last three decades in Australia. An increasing proportion of HCC cases is related to chronic viral hepatitis including hepatitis B virus (HBV) infection. However, there is very limited data on HBV‐related HCC survival. Methods: Data on HBV‐related HCC cases was obtained from a community‐based linkage study. HCC cases notified to the New South Wales (NSW) Central Cancer Registry (CCR) during the period 1994–2002 were linked to HBV notifications from the NSW Health Department. Age, sex, country of birth, year of diagnosis, tumor stage were extracted from the CCR database. Survival analysis was conducted to determine median survival and identify predictors of survival. Results: Over the 9‐year study period, 278 HCC cases were linked to chronic HBV infection. The majority of cases were male (83.5%) and overseas‐born (93.6%); Asian‐born cases accounted for 72.1%. Median survival following HCC diagnosis was 15.0 months. HCC survival was poorer among older age groups (P < 0.0001), and among cases with regional spread (hazard ratio, 3.23; 95% confidence interval, 1.83–5.69; P < 0.0001) and distant metastases (hazard ratio, 3.85; 95% confidence interval, 2.44–6.08; P < 0.0001). Sex, region of birth and study period (1994–1997 vs 1998–2002) were not associated with HCC survival. Conclusion: The vast majority of HBV‐related HCC were overseas‐born, however, region of birth was unrelated to HCC survival. The continued extremely poor HCC survival, including lack of improvement in HCC survival in more recent years, suggests low uptake of HCC screening programs. Public health strategies including early diagnosis and appropriate referral for antiviral therapy assessment and increased HCC screening among high‐risk populations are required to reduce HCC incidence and improve HCC survival.     

Dengue as a cause of acute undifferentiated fever in Vietnam

Background  

Dengue is a common cause of fever in the tropics but its contribution to the total burden of febrile illnesses that is presented to primary health facilities in endemic regions such as Vietnam, is largely unknown. We aimed to report the frequency of dengue as a cause of fever in Binh Thuan Province, to describe the characteristics of dengue patients, and analyze the diagnostic accuracy of the health care workers and the determinants of the diagnostic process.     

The predictors of red cell transfusions in total hip arthroplasties

BACKGROUND: Most blood crossmatched in a hospital blood bank is for surgical patients, and the majority is never transfused. The maximal standard blood order schedule is used to promote efficient ordering practices for surgical patients. STUDY DESIGN and METHODS: To ascertain the predictors of red cell transfusions for patients undergoing total hip arthroplasty, the charts of 299 adult patients undergoing primary and revision total hip arthroplasty were reviewed. A surgical blood order equation was developed for calculating the number of units of red cells that should be ordered. Stepwise regression analysis was used to determine which patient-and-case-related variables should be considered in the surgical blood order equation. RESULTS: The significant indicators for allogeneic red cell transfusion to patients on the day of total hip arthroplasty were preoperative hemoglobin concentration, weight, age, estimated blood loss, and aspirin use. The surgical blood order equation would result in a lower crossmatch-to-transfusion ratio than would the maximal standard blood order schedule (1.23 vs. 3.14). Costs were also lower with the surgical blood order equation. CONCLUSION: Incorporation of patient factors resulted in increased efficiency of blood-ordering practices in total hip arthroplasty.     

老年充血性心力衰竭患者血浆脑钠肽前体水平与长期预后的关系

目的:血浆脑钠肽水平对于充血性心力衰竭的预后评估均具有重要意义,但脑钠肽前体的敏感性和特异性更高。分析血浆脑钠肽前体水平对老年充血性心力衰竭患者长期预后的预测价值。方法:选择2003-05/2005-07在桂林医学院附属医院心内科住院的心力衰竭患者208例及本科同期收住院的急性冠状动脉综合征组患者26例,另外选择正常对照组30例,为本院的医学生,以上观察对象均自愿参加观察。分别测定各组观察对象的血浆脑钠肽前体水平,均在入院的第1天完成,患者出院后不再测定脑钠肽前体。使用惠普500型心动图检测心力衰竭组患者的心脏各腔室直径及射血指数。对所有出院的心力衰竭患者均进行电话随访,每3个月随访1次,平均随访2年,只电话询问死亡还是健在。结果:心力衰竭患者208例、急性冠状动脉综合征患者26例及正常对照组30例全部进入结果分析,无脱落。①各组观察对象的血浆脑钠肽前体水平比较:心力衰竭组是正常对照组的150倍[(4.82±0.75)μg/L,(31.38±29.28)ng/L(P<0.01)],是急性冠脉综合征组的23倍[(208.80±120.13)ng/L(P<0.01)]。②不同年龄、性别、病种、心功能分级心力衰竭患者血浆脑钠肽前体水平比较:心力衰竭患者脑钠肽前体的水平随年龄的增加而升高(P<0.05～0.01);女性显著高于男性(P<0.01);心功能不同级别间脑钠肽前体的水平呈倍数增加(P<0.01),死亡者显著高于生存者(P<0.01)。③心力衰竭患者血浆脑钠肽前体水平与各临床指标的相关性分析:心力衰竭患者血浆脑钠肽前体水平与年龄、左心室直径及纽约心脏协会心功能分级呈正相关(r=0.310,0.283,0.647,P<0.05～0.01),与射血指数呈负相关(r=-0.327,P<0.01)。结论:老年心力衰竭患者的血浆脑钠肽前体水平明显增高,与之相关的预后不良危险因素包括心功能分级增高、射血分数降低、左心室直径扩大、老年及女性心力衰竭患者等。     

Superoxide generation and cytotactic response of irradiated neutrophils

Irradiation of blood components has been used to prevent transfusion-related graft-versus-host disease (GVHD) in immunocompromised patients. This study was designed to determine the effect of irradiation on neutrophil aggregation, chemotaxis, and superoxide generation. Purified neutrophils were irradiated with a Cesium source at four doses ranging from 0 to 17,500 rads. Formyl-methionyl-leucyl-phenylalanine (FMLP) and zymosan-treated serum (ZTS) cytotaxin-induced chemotaxis and migration were determined in the agarose assay. Neutrophil aggregation to FMLP was determined by aggregometry. Superoxide generation and random migration were not affected by irradiation at doses up to 17,500 rads. When compared to nonirradiated controls, the chemotactic response to ZTS remained normal, with an insignificant decline from 174 +/- 31.0 to 150 +/- 42.3 (mean +/- SD) units. The chemotactic response to FMLP declined insignificantly, from 228 +/- 31.3 at 0 rad to 207 +/- 26.4 at 17,500 rads. The aggregation response to FMLP remained within the normal range but declined from 0.78 +/- 0.11 to 0.61 +/- 0.18. At the radiation doses currently used to reduce the risk of transfusion-related GVHD, neutrophil superoxide generation and chemotactic response remain essentially normal.     

Fusion of dispatching centres into one entity: effects on performance

Background: Dispatching centres were fused into one of the 112 entity, which caused concerns regarding whether the medical calls could be processed effectively also in the new centre. We evaluated the effects of the reform on key performance criteria in medical calls. Methods: This observational study in the Helsinki Dispatching Centre consisted of two periods: Period I 2 years before the reform and Period II 2 years after. The main outcome measures were answering and call processing times, accuracy of risk assessment and appropriate use of ambulances. Results: In Period I (n=574,276), 92.2% of all incoming phone calls were answered within 10 s and in Period II (n=758,022) 82.8% (P<0.0001). Time to dispatch a first responding fire unit increased from 98 to 113 s (P<0.0001) and an advanced life support unit in category A calls increased from 73 to 84 s (P<0.0001). In Period I 47.7%, 34.8% and 17.5% of phone calls were completed in <3, 3–5 and >5 min and in Period II 29.8%, 36.1% and 34.1% (P<0.0001). The number of three studied non‐transportation call types and unnecessary lights‐and‐siren responses increased significantly (P<0.0001 and 0.0001, respectively). Neither the accuracy of risk assessment in the three studied call types nor the rate of telephone‐guided cardiopulmonary resuscitation changed. Conclusions: The reform increased the total number of ambulance dispatches, prolonged answering and call processing times and had a negative effect on the appropriate use of ambulances. The accuracy of risk assessment was not affected. Evidence‐based data should be the basis for the future as dispatching centre processes are shown to be vulnerable during organisational reforms.     

Inhibition of experimental caries by plaque prevention

abstract – The purpose of this study was to test the hypothesis that a frequent intake of sucrose does not produce caries if the teeth are regularly treated with an antibacterial agent. Twenty-four students with clean teeth and normal gingivae were assigned to one of the following three groups: (1) eight individuals ceased all active oral hygiene measures and rinsed 9 times daily with 50% sucrose, (2) eight students refrained from all active oral hygiene procedures, rinsed 9 times daily with sucrose and twice daily with 10 ml 0.2% chlorhexidine gluconate, (3) the third group consisted of two subgroups each comprising 4 students. One subgroup ceased all oral hygiene procedures and rinsed twice daily with 0.2% chlorhexidine gluconate. The other was instructed to practice meticulous tooth brushing twice daily. The experiment lasted for 22 days. The group who rinsed with sucrose showed heavy plaque accumulation, those who rinsed with sucrose + chlorhexidine showed a drastic reduction in the formation of plaque. In the subgroup rinsing with chlorhexidine only and in that performing good oral hygiene, plaque was non-existent. The gingival state essentially paralleled the plaque formation. The sucrose group showed a definite increase in Caries Index. No significant changes occurred in the group rinsing with sucrose + chlorhexidine, with chlorhexidine only, or in the group performing good oral hygiene. It is concluded that prevention of plaque formation inhibits the development of gingivitis and dental caries, even with frequent rinses of sucrose.