Leicester Royal Infirmary

About: Leicester Royal Infirmary is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Carotid endarterectomy. The organization has 5300 authors who have published 6204 publications receiving 208464 citations.

Can the Distress Thermometer be improved by additional mood domains? Part II. What is the optimal combination of Emotion Thermometers?

Abstract: Purpose: To examine the added value of an algorithmic combination of visual-analogue thermometers compared with the Distress Thermometer (DT) when attempting to detect depression, anxiety or distress in early cancer Methods: We report Classification and Regression Tree and logistic regression analyses of the new five-domain Emotion Thermometers tool This is a combination of five visual-analogue scales in the form of four mood domains (distress, anxiety, depression, anger) as well as need for help 130 patients attending for their first chemotherapy treatment were assessed We calculated optimal accuracy for each domain alone and in combination against several criterion standards Results: When attempting to diagnose depression the Depression Thermometer (DepT) used alone was the optimal approach, but when attempting to detect broadly defined distress or anxiety then a combination of thermometers was most accurate The DepT was significantly more accurate in detecting depression than the DT For broadly defined distress a combination of depression, anger and help thermometers was more accurate than the DT alone For anxiety, while the anxiety thermometer (AnxT) improves upon the DT alone, a combination of the DepT and AnxT are optimal In each case the optimal strategy allowed the detection of at least an additional 9% of individuals However, combinations are more laborious to score In settings where the simplest possible option is preferred the most accurate single thermometer might be preferable as a first stage assessment Conclusion: The DT can be improved by specific combinations of simple thermometers that incorporate depression, anxiety, anger and help Copyright © 2009 John Wiley & Sons, Ltd

Cervical necrotizing fasciitis : a distinct clinicopathological entity ?

Abstract: Necrotizing fasciitis of the head and neck has previously been classified as a homogeneous group. We present two cases of necrotizing fasciitis confined to the neck and demonstrate with a review of the literature that cervical necrotizing fasciitis and craniofacial necrotizing fasciitis are two distinct clinicopathological conditions.

Development of dietary phytochemical chemopreventive agents: biomarkers and choice of dose for early clinical trials.

Abstract: In view of safety concerns surrounding the use of pharmaceuticals such as nonsteroidal anti-inflammatory drugs and tamoxifen as cancer chemopreventive agents, potentially innocuous phytochemicals derived from the diet are considered attractive alternatives. However, results from cancer chemoprevention trials of dietary agents have been disappointing to date, as promising activities observed in rodent models and cells in vitro have not translated into clinical success. This may be partly due to the development process for these agents, which is complex for a number of reasons; the definitive end point, inhibition of carcinogenesis, requires large numbers of individuals followed-up over many years. Furthermore, whereas biomarkers are frequently used as surrogate efficacy end points to expedite the process, biomarker assessment and validation has proven difficult because dietary agents exert multiple actions with an unknown hierarchy of biological importance. These factors have made determining the dose for clinical investigation extremely challenging, and at present, there are no defined strategies for rationally identifying the most appropriate doses. In this commentary, the complexities involved in the development of dietary chemoprevention agents are discussed, and a tentative route towards selection of the optimal clinical dose is proposed. The approach highlights the need to conduct long-term preclinical studies with realistic concentrations that are achievable in human tissues and the importance of efficacy biomarkers that are intrinsically linked to the key mechanisms of action. A more logical design of studies should increase the likelihood that the encouraging preclinical results observed for many phytochemicals translate into tangible clinical benefit.

Endothelium-dependent relaxation in resistance vessels from the spontaneously hypertensive rats.

Abstract: The endothelium-dependent vasodilator acetylcholine was used to observe relaxation responses of noradrenaline-contracted mesenteric resistance vessels from 3-, 6-, 12- and 18-week-old spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY). Relaxation responses were greater than normal in the 3-week-old SHR but the pattern of response was different in the 6-18-week-old SHR compared with the WKY. In these older animals, low concentrations of acetylcholine relaxed SHR and WKY vessels to a similar extent, but high concentrations (greater than 10(-7) mol/l) caused the partially relaxed vessels to contract again. Indomethacin enhanced relaxation in the 12-week-old SHR and reduced the difference between the SHR and WKY. The reduction in acetylcholine-induced, endothelium-dependent relaxation in SHR suggested that a functional change occurred, causing the vessels to release a vasoconstrictor factor that opposes the action of endothelium-derived relaxing factor.

Bilateral patellar tendon rupture secondary to repeated local steroid injections

Abstract: A case is reported of bilateral patellar tendon rupture in a fit man after a fall. He had a history of repeated local steroid injections into both tendons and histology confirmed steroid-induced changes. The history of repeated local steroid administration has to be implicated as the cause of this extremely rare injury in this patient, which can also be associated with hyperparathyroidism, systemic lupus erythematosus, diabetes and rheumatoid arthritis. All doctors performing repeated local steroid injections into the patellar tendon should be aware of the possible dangers of inducing tendon rupture and should ensure that the steroids are not delivered into its substance.