The dietary approaches to stop hypertension (DASH) dietary pattern in childhood in relation to cardiometabolic risk in adolescence and early adulthood in the ALSPAC birth cohort

OBJECTIVE

To investigate the relationship between the dietary approaches to stop hypertension (DASH)-style dietary patterns in childhood and cardiometabolic risk (CMR) in adolescence/early adulthood.

DESIGN

Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective cohort. Diet diary data collected at 7, 10 and 13 years were used to calculate DASH-style diet scores (DDS). Multivariable linear regression models were used to investigate the associations between the DDS at 7, 10 and 13 years and CMR scores, calculated at 17 and 24 years.

SETTING

The ALSPAC cohort included children born in south-west England in 1991-1992.

PARTICIPANTS

Children with complete dietary, covariate and cardiometabolic data at 17 (n 1,526) and 24 years (n 1,524).

RESULTS

A higher DDS at 7 and 10 years was negatively associated with CMR scores at 17 years (β = -0·64 (95 % CI -1·27, -0·006), Ptrend=0·027 for fifth v. first DDS quintile at 7 years; β = -0·73 (95 % CI -1·35, -0·12) and Ptrend=0·037 for fifth v. first DDS quintile at 10 years) and at 24 years (β = -0·92 (95 % CI -1·49, -0·34) Ptrend = 0·001 for fifth v. first DDS quintile at 7 years; β = -0·60 (95 % CI -1·20, -0·05) Ptrend = 0·092 for fifth v. first DDS quintile at 10 years). No associations were found between the DDS at 13 years and CMR score at 17 and 24 years.

CONCLUSION

Greater adherence with a DASH-style diet during childhood was associated with better cardiometabolic health in adolescence/adulthood in the ALSPAC cohort. The components of the DASH diet could be recommended to improve children's cardiometabolic health.

1371 “The Nosebleed Effect”: Advice Given to Epistaxis Patients Discharged from The Emergency Department

Introduction

Many patients with epistaxis are seen in the A&E department. A significant number are discharged without need for inpatient admission due to minor bleeds. Many are given limited information on management of further bleeds and even fewer are advised on the prevention of bleeds.

Aim

To evaluate the advice given to patients with epistaxis who are seen and discharged from A+E, to instigate an improvement in advice and to examine the subsequent effect on re-attendance rates

Method

Epistaxis patients discharged from A+E were audited over a 6-week period looking at advice given on discharge. A questionnaire was distributed to all A&E and ENT doctors probing current practice. A presentation on the management and prevention of epistaxis and the appropriate verbal/written advice to give was delivered and epistaxis advice sheets were made available. The practice regarding advice and the re-attendance rates were re-audited.

Results

53 patients presented to the A&E department with epistaxis. 31 patients presenting with epistaxis were seen and discharged by A&E doctors. The remaining seen by ENT. Only 9 patients received verbal advice and 1 received written advice. There were 13 re-attenders. After re-audit showed a significant increase in the proportion of patients receiving advice by A&E doctors. Verbal and written advice increased from 18% to 61% and 1% to 60% respectively. The number of re-attenders was reduced to 13 to 6.

Improved representation of particle size and solubility in model simulations of atmospheric dispersion and wet-deposition from Fukushima

Radionuclides released into the atmosphere following the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident were detected by ground-based monitoring stations worldwide. The inter-continental dispersion of radionuclides provides a unique opportunity to evaluate the ability of atmospheric dispersion models to represent the processes controlling their transport and deposition in the atmosphere. Co-located measurements of radioxenon (¹³³Xe) and caesium (¹³⁷Cs) concentrations enable individual physical processes (dispersion, dry and wet deposition) to be isolated. In this paper we focus on errors in the prediction of ¹³⁷Cs attributed to the representation of particle size and solubility, in the process of modelling wet deposition. Simulations of ¹³³Xe and ¹³⁷Cs concentrations using the UK Met Office NAME (Numerical Atmospheric-dispersion Modelling Environment) model are compared with CTBTO (Comprehensive Nuclear-Test-Ban Treaty Organisation) surface station measurements. NAME predictions of ¹³⁷Cs using a bulk wet deposition parameterisation (which does not account for particle size dependent scavenging or solubility) significantly underestimate observed ¹³⁷Cs. When a binned wet deposition parameterisation is implemented (which accounts for particle size dependent scavenging) the correlations between modelled and observed air concentrations improve at all 9 of the Northern Hemisphere sites studied and the respective RMSLE (root-mean-square-log-error) decreases by a factor of 7 due to a decrease in the wet-deposition of Aitken and Accumulation mode particles. Finally, NAME simulations were performed in which insoluble submicron particles are represented. Representing insoluble particles in the NAME simulations improves the RMSLE at all sites further by a factor of 7. Thus NAME is able to predict ¹³⁷Cs with good accuracy (within a factor of 10 of observed ¹³⁷Cs values) at distances greater than 10,000 km from FDNPP only if insoluble submicron particles are considered in the description of the source. This result provides further evidence of the presence of insoluble Cs-rich microparticles in the release following the accident at FDNPP and suggests that these small particles travelled across the Pacific Ocean to the US and further across the North Atlantic Ocean towards Europe.

Fournier Gangrene in a patient receiving chemo-radiation for rectal cancer

We herein present a case of a 24-year-old patient with a cT4N+ rectal cancer who developed Fournier's gangrene (FG) 1 week after the completion of preoperative chemoradiotherapy. The patient was promptly referred to the surgical department where she was treated with antibiotics and repeated surgical debridement. FG is a rare and life-threatening situation that needs to be managed aggressively with no delay. The clinical image above is unique and characteristic of this clinical entity.

High HbF in pregnancy is associated with the Xmn I polymorphism at the -158bp of the G gamma-globin gene

HbF was measured in the peripheral blood of 354 women during the first trimester of pregnancy. In those (n = 6) with HbF > 3% and in 30 randomly selected pregnant women with normal HbF values, analysis of the G gamma content and the Xmn I polymorphism was performed. The frequency of the Xmn I polymorphism was significantly higher (P < 0.001) in the group with high HbF (0.67) compared to the control group (0.10). The G gamma chain content evaluation revealed a newborn ratio in all 6 high HbF subjects. Six months after delivery, HbF was measured in all women with high HbF during pregnancy, revealing normal values. These results suggest that the presence of the Xmn I polymorphism is a strong inducer for the elevation of HbF during pregnancy.

Automatic recognition of syllable-final nasals preceded by /epsilon/

In this paper, it is shown how an automatic recognition algorithm, based on hidden Markov models (HMM), can benefit by properly utilizing findings from perceptual experiments on nasals. Perceptual studies on nasal consonants have shown that both nasal murmurs and formant transitions are important in the identification of place of articulation. Thus both acoustic segments bordering the nasal release were incorporated into this HMM-based system. A 7% improvement in alveolar recognition was obtained by explicitly modeling the vowel-nasal transition segments. Further overall improvement (6%) was realized by making the HMM recognizer "focus" more on the vowel-nasal transition segments bordering the nasal release, and less on the nasal murmur and vowel portion of the /epsilon m/ and /epsilon n/ syllables. An overall average [m]-[n] recognition of 95% was obtained when testing this technique on 60 speakers outside the training set.

Amniotic fluid prealbumin as a potential marker of fetal abnormalities

Normal amniotic fluid prealbumin (PAB) levels between 16 and 41 weeks of pregnancy are demonstrated in 175 samples from various gestational ages. PAB was measured quantitatively by immunonephelometry and qualitatively estimated by electrophoresis while total protein content was measured by colorimetry. The percent of PAB values in the total protein content is inversely correlated to the gestational age. Fetal abnormalities and abnormal conditions in pregnancy diagnosed in the second trimester and early third trimester (16-32 weeks) show significantly (p < 0.01) higher than expected PAB values (25.9 +/- 4.6 mg/l, range 19.5-35.6, n = 23) in comparison to normal fetuses and normal pregnancies of the same age (13.6 +/- 3.6 mg/l, range 4.3-19.8, n = 87). The remaining 65 samples of normal third trimester amniotic fluid were evaluated in comparison to the second trimester normal values, and inverse correlation in respect to advancing pregnancy was observed. PAB values were corrected for the total protein content and the resulting ratio had the lowest variation compared to PAB and total protein values. It is proposed that PAB, although not specific for a particular disorder, expressed as a ratio of the total protein content is a potential biochemical marker for certain fetal defects and complications of pregnancy.

Rapid fetal hemoglobin estimation assay during cordocentesis

A method for rapid estimation of fetal blood content during cordocentesis is described. This procedure gives an opportunity to determine the contamination of the fetal sample by maternal blood as soon as possible. The method is based on the ability of fetal hemoglobin to resist denaturation in alkaline conditions, and can be used routinely. Fetal blood samples show a lower degradation rate (range 1.2-8.2%) compared to the maternal samples (range 25.0-52.5%). The method has the capacity to discriminate fetal and maternal samples with regard to their fetal hemoglobin content.