Liverpool Medical Institution

<bold>Background:</bold> A community airway diagnostics service was created to support access to spirometry and diagnosis in the North-West. This service evaluation aims to describe the patients diagnosed with asthma split by subtype. <bold>Methods:</bold> A retrospective analysis of referrals and reports for patients seen between 11/23-01/24 was conducted. Data included demographics, biomarkers and spirometry results. Patients were categorised into type 2 high (T2H) asthma (raised blood eosinophils (EC)>0.5x10⁹/L, raised FeNO>50ppb or both), and type 2 low (T2L, no raised biomarkers). <bold>Results:</bold> Of the 869 patients reviewed, 23.6% (205) were diagnosed with asthma. Patients with asthma were predominantly female (52.6%) and White (66.0%), with a median age of 55. 57.1% were T2L with no raised biomarkers. 37.6% were T2H, of which 44.1% had raised EC, 35.1% had raised FeNO, and 20.8% had both biomarkers raised. The T2L group had 2.9% more females and a median age 3 years older than the T2H group, but neither were significant at this sample size (p=0.11, p=0.50). There was no significant difference in sex, BMI, FEV1 reversibility or deprivation decile. T2H patients were significantly more likely to be started on inhalers prior to diagnosis (79.2% vs 63.2%, p=0.038). More patients were referred for asthma in the T2H group and more for COPD in the T2L group (p=0.003, p<0.01). Current smoking rate was significantly lower in the T2H group by 18.2% (p=0.004). Intrinsically, the T2H group had significantly higher EOS and FeNO (p<0.001 each). <bold>Conclusion:</bold> A high proportion of patients with confirmed asthma did not have any positive biomarkers. Expert review will continue to be valuable in providing a diagnosis for the T2L group under the new asthma guidelines.

ObjectiveTo generate estimates of comparative clinical effectiveness for interventions used in the treatment of anogenital warts (AGWs) through the systematic review, appraisal and synthesis of data from randomised controlled trials (RCTs).DesignSystematic review and network meta-analysis of RCTs. Search strategies were developed for MEDLINE, Embase, the Cochrane Library and the Web of Science. For electronic databases, searches were run from inception to March 2018. The systematic review was carried out following the general principles recommended in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.ParticipantsPeople aged ≥16 years with clinically diagnosed AGWs (irrespective of biopsy confirmation).InterventionsTopical and ablative treatments recommended by the British Association for Sexual Health and HIV for the treatment of AGWs, either as monotherapy or in combination versus each other.Outcome measuresComplete clearance of AGWs at the end of treatment and at other scheduled visits, and rate of recurrence.ResultsThirty-seven RCTs met inclusion criteria. Twenty studies were assessed as being at unclear risk of bias, with the remaining studies categorised as high risk of bias. Network meta-analysis indicates that, of the treatment options compared, carbon dioxide laser therapy is the most effective treatment for achieving complete clearance of AGWs at the end of treatment. Of patient-applied topical treatments, podophyllotoxin 0.5% solution was found to be the most effective at achieving complete clearance, and was associated with a statistically significant difference compared with imiquimod 5% cream and polyphenon E 10% ointment (p<0.05). Few data were available on recurrence of AGWs after complete clearance. Of the interventions evaluated, surgical excision was the most effective at minimising risk of recurrence.ConclusionOf the studies assessed, as a collective, the quality of the evidence is low. Few studies are available that evaluate treatment options versus each other.Trial registration numberCRD42013005457

Cardiovascular disease represents a significant portion of pregnancy-related complications and is associated with high rates of morbidity and mortality in this cohort. Cardiac valvulopathy, and aortic valve pathologies, in particular, pose a significant challenge to women who are pregnant and to the health care professionals who look after them. Depending on the type and severity of aortic valve pathology, pregnancy may exacerbate or accelerate the progression of valvulopathy sequelae because of the hemodynamic changes that occur from conception, throughout gestation, up to Labor and postpartum. Management of such patients ranges from basic conservative measures such as bed-rest, extending to high-risk emergency open heart surgery. This nonstructured review aims to highlight the current evidence available relating to the management of aortic valve disease in pregnancy, with a key focus on cases which requires intervention beyond that of medical therapy. In conclusion, the management of aortic valvulopathy in pregnancy is a challenging field with only a small amount of clinical experience and retrospective study supporting evidence-based decisions in this field. A greater understanding of the most recent advances is recommended to support decision making in this specialist field of clinical medicine.

Evidence is starting to emerge indicating that tumorigenesis in metazoans involves a soma-to-germline transition, which may contribute to the acquisition of neoplastic characteristics. Here, we have meta-analyzed gene expression profiles of the human orthologs of Drosophila melanogaster germline genes that are ectopically expressed in l(3)mbt brain tumors using gene expression datasets derived from a large cohort of human tumors. We find these germline genes, some of which drive oncogenesis in D. melanogaster, are similarly ectopically activated in a wide range of human cancers. Some of these genes normally have expression restricted to the germline, making them of particular clinical interest. Importantly, these analyses provide additional support to the emerging model that proposes a soma-to-germline transition is a general hallmark of a wide range of human tumors. This has implications for our understanding of human oncogenesis and the development of new therapeutic and biomarker targets with clinical potential.

SUMMARY Four large-sample methods are proposed for testing the equality of the variances of a p-variate normal population. Two of the methods are asymptotically distribution robust against departures from the multinormality assumption of the parent population. In applying the tests no restrictive assumptions are made about the off-diagonal structure of the covariance matrics and no random splitting of the sample into subsamples is required. An example of the use of the tests is provided.

"Miching Mallicho" Get access H. A. Strong H. A. Strong 1UniversityLiverpool Search for other works by this author on: Oxford Academic Google Scholar Notes and Queries, Volume s10-III, Issue 63, 11 March 1905, Page 184, https://doi.org/10.1093/nq/s10-III.63.184d Published: 11 March 1905