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Randomized clinical trial of four-layer and short-stretch compression bandages for venous leg ulcers (VenUS I).

BACKGROUND: A randomized clinical trial was undertaken to determine the relative effectiveness of four-layer and short-stretch bandaging for venous ulceration. METHODS: A total of 387 adults with a venous ulcer, who were receiving leg ulcer treatment either in primary care or as a hospital outpatient, were recruited to this parallel-group open study and randomized to either four-layer or short-stretch bandages. Follow-up continued until the patient's reference leg was ulcer free or for a minimum of 12 months. The primary endpoint was time to complete healing of all ulcers on the reference leg. Secondary outcomes included proportion of ulcers healed, health-related quality of life, withdrawals and adverse events. Analysis was by intention to treat. RESULTS: Unadjusted analysis identified no statistically significant difference in median time to healing: 92 days for four-layer and 126 days for short-stretch bandages. However, when prognostic factors were included in a Cox proportional hazards regression model, ulcers treated with the short-stretch bandage had a lower probability of healing than those treated with the four-layer bandage: hazard ratio 0.72 (95 per cent confidence interval 0.57 to 0.91). More adverse events and withdrawals were reported with the short-stretch bandage. CONCLUSION: Venous leg ulcers treated using a four-layer bandage healed more quickly than those treated with a short-stretch bandage.

Adult↗

Airburst origin of dark shadows on Venus.

A simple analytic model for the catastrophic disruption and deceleration of impactors in a thick atmosphere is used to (1) reproduce observed Venusian cratering statistics and (2) generate radar-dark disks by the impact of atmospheric shock waves with the surface. When used as input to Monte Carlo simulations of Venusian cratering, the model nicely reproduces the observed low diameter cutoff. Venusian craters are found to be more consistent with an asteroidal rather than a cometary source. The radar-dark "shadows" of the title are surface features, usually circular, that have been attributed to airbursting impactors. A typical craterless airburst is the equivalent of a approximately 10(6) megaton explosion. The airburst is treated as a massive, extended explosion using a thin-shell, isobaric cavity approximation. The strong atmospheric shock waves excited by the airbust are then coupled to surface rock using the usual impedance matching conditions. Peak shock pressures experienced by surface rock typically exceed 0.2 GPa for distances 15-30 km from ground zero (the place on the surface immediately beneath the site of the airburst), and 1 GPa for 10-20 km. These high shock pressures are felt to considerable depth, often more than a kilometer. Beneath the airburst the shock could reduce surface rocks to fine rubble, while at greater distance the weaker shock would leave fields of broken blocks, perhaps in part accounting for radar-bright halos that often surround the dark shadows.

Astronomy↗

Stimulation and sensitization of the isolated Venus heart by cerebrospinal fluid.

5-Hydroxytryptamine was not detected in animal cerebrospinal fluid after amine oxidase inhibitors, reserpine, or both. Both human and animal cerebrospinal fluid can produce a stimulating effect on the clam heart which is not due to 5-hydroxytryptamine. Cerebrospinal fluid also has the property of increasing the sensitivity of the clam heart to 5-hydroxytryptamine.

Animals↗

VenUS I: a randomised controlled trial of two types of bandage for treating venous leg ulcers.

OBJECTIVES: To compare the clinical and cost-effectiveness of two different compression bandages for the healing of venous leg ulcers. DESIGN: A pragmatic, randomised controlled trial with an economic evaluation. SETTING: Community, district nurse-led services; community leg ulcer clinics; hospital leg ulcer clinics with community outreach. A range of urban and rural settings in England and Scotland. PARTICIPANTS: Patients with a venous leg ulcer of at least 1-week's duration, at least 1 cm in length or width and an ankle:brachial pressure index of at least 0.8. INTERVENTIONS: The four-layer bandage (4LB) (which is multilayer elastic compression) compared with the short-stretch bandage (SSB) (multilayer, inelastic compression). MAIN OUTCOME MEASURES: The primary end-point was complete healing of all the ulcers on the trial leg. Secondary outcomes were the proportion of patients healed at 12 and 24 weeks, rate of recurrence, costs of leg ulcer treatment and quality of life. RESULTS: Between April 1999 and December 2000 the trial recruited 387 people aged from 23 to 97 years at trial entry. The majority of patients in this trial (82%; 316/387) had a reference ulcer of area </=10 cm(2). To test the difference over time of Kaplan--Meier curves for the two bandage groups, the distribution of the cumulative times to healing of individuals in the two trial groups was compared using the log-rank test. The difference in the distribution of cumulative healing times between the individuals in the two groups was not statistically significant at the 5% level. Adjusting for the effects of variables which may influence healing (centre, baseline ulcer area, duration, episodes, ankle mobility, weight) in a Cox proportional hazards model, a statistically significant treatment effect in favour of the 4LB was identified. At any point in time, the probability of healing for individuals in the SSB treatment arm is significantly lower than that for people treated with the 4LB. Our base case economic analysis showed that the 4LB is the dominant strategy, that is, it is associated with a greater health benefit and lower costs than the SSB, although the differences are not statistically significant. This result is explained largely by the greater number of community nurse visits required by participants in the short-stretch arm. CONCLUSIONS: The 4LB, which is currently the UK standard compression bandage for people with venous leg ulcers, was more clinically and cost-effective than the SSB. The bandage costs were less important than the costs of treatment visits, and patients in SSBs required more treatment overall. Generally, this trial supports the use of the 4LB in preference to the SSB. Recommendations for future research include: exploration of the relationship between bandager skill, application technique and ulcer healing; the relative cost-effectiveness of community leg ulcer clinics; and the study of nurse decision-making in venous ulcer management.

Adult↗