Fasting and surgery timing (FaST) audit.

Background & Aims: International guidance advocates the avoidance of prolonged preoperative fasting due to its negative impact on perioperative hydration. This study aimed to assess the adherence to these guidelines for fasting in patients undergoing elective and emergency surgery in the East Midlands region of the UK.

Methods: This prospective audit was performed over a two-month period at five National Health Service (NHS) Trusts across the East Midlands region of the UK.

Vitamin D Signaling in Inflammation and Cancer: Molecular Mechanisms and Therapeutic Implications.

Vitamin D and its active metabolites are important nutrients for human skeletal health. UV irradiation of skin converts 7-dehydrocholesterol into vitamin D3, which metabolized in the liver and kidneys into its active form, 1α,25-dihydroxyvitamin D3. Apart from its classical role in calcium and phosphate regulation, scientists have shown that the vitamin D receptor is expressed in almost all tissues of the body, hence it has numerous biological effects.

Hyperosmolar dehydration: A predictor of kidney injury and outcome in hospitalised older adults.

Background & Aims: Hospitalised older adults are vulnerable to dehydration. However, the prevalence of hyperosmolar dehydration (HD) and its impact on outcome is unknown. Serum osmolality is not measured routinely but osmolarity, a validated alternative, can be calculated using routinely measured serum biochemistry.

A randomized, controlled, double-blind crossover study on the effects of isoeffective and isovolumetric intravenous crystalloid and gelatin on blood volume, and renal and cardiac hemodynamics.

Background & Aims: Blood volume expanding properties of colloids are superior to crystalloids. In addition to oncotic/osmotic properties, the electrolyte composition of infusions may have important effects on visceral perfusion, with infusions containing supraphysiological chloride causing hyperchloremic acidosis and decreased renal blood flow. In this non-inferiority study, a validated healthy human subject model was used to compare effects of colloid (4% succinylated gelatin) and crystalloid fluid regimens on blood volume, renal function, and cardiac output.

Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility.

Background: Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years.

Results: The IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE.

Winter cancellations of elective surgical procedures in the UK: a questionnaire survey of patients on the economic and psychological impact.

Objectives: To quantify the economic and psychological impact of the cancellation of operations due to winter pressures on patients, their families and the economy.

Design: This questionnaire study was designed with the help of patient groups. Data were collected on the economic and financial burden of cancellations.

The Influence of Mechanical Rubbing on the Dissolution of Blood Clots.

Mechanical rubbing of blood clots is a potential minimally-invasive method for clearing clogged blood vessels. In this work, we investigate the influence of the interaction of the tip of a helical robot with blood clots. This interaction enables the dissolution of the blood clot and the release of the entrapped red blood cells and platelets from its three-dimensional fibrin fiber network.

Epstein-Barr Virus-Associated Malignancies: Roles of Viral Oncoproteins in Carcinogenesis.

The Epstein-Barr virus (EBV) is the first herpesvirus identified to be associated with human cancers known to infect the majority of the world population. EBV-associated malignancies are associated with a latent form of infection, and several of the EBV-encoded latent proteins are known to mediate cellular transformation. These include six nuclear antigens and three latent membrane proteins (LMPs).

Antitumor Activities of the Novel Isosteviol Derivative 10C Against Liver Cancer.

Background/aim: Hepatocellular carcinoma (HCC) is the most common type of liver cancer and the fifth most common primary malignancy with worldwide increasing incidence. The current study aimed to investigate the anticancer activities of novel isosteviol derivatives towards human HepG2 hepatocellular cancer cells and in an animal model of hepatocellular carcinoma.

Materials And Methods: Twelve isosteviol derivatives were screened for their anti-proliferative activities against HepG2 and IC was calculated for all designed derivatives.

Daclatasvir combined with sofosbuvir or simeprevir in liver transplant recipients with severe recurrent hepatitis C infection.

Daclatasvir (DCV) is a potent, pangenotypic nonstructural protein 5A inhibitor with demonstrated antiviral efficacy when combined with sofosbuvir (SOF) or simeprevir (SMV) with or without ribavirin (RBV) in patients with chronic hepatitis C virus (HCV) infection. Herein, we report efficacy and safety data for DCV-based all-oral antiviral therapy in liver transplantation (LT) recipients with severe recurrent HCV. DCV at 60 mg/day was administered for up to 24 weeks as part of a compassionate use protocol.

Hydration and outcome in older patients admitted to hospital (The HOOP prospective cohort study).

Background: Older adults are susceptible to dehydration due to age-related pathophysiological changes. We aimed to investigate the prevalence of hyperosmolar dehydration (HD) in hospitalised older adults, aged ≥65 years, admitted as an emergency and to assess the impact on short-term and long-term outcome.

Methods: This prospective cohort study was performed on older adult participants who were admitted acutely to a large U.

Acute and chronic effects of hydration status on health.

Maintenance of fluid and electrolyte balance is essential to healthy living as dehydration and fluid overload are associated with morbidity and mortality. This review presents the current evidence for the impact of hydration status on health. The Web of Science, MEDLINE, PubMed, and Google Scholar databases were searched using relevant terms.

Hydration amongst nurses and doctors on-call (the HANDS on prospective cohort study).

Background & Aims: Dehydration of as little 2% of total body weight may impair physical and cognitive performance. The aim of this study was to investigate the prevalence of dehydration at the start and end of shifts in nurses and doctors on-call. The secondary aims were to assess the relation between hydration status and cognitive function.

Postoperative ileus: Recent developments in pathophysiology and management.

Background & Aims: Postoperative ileus (POI) is a frequent occurrence after abdominal and other types of surgery, and is associated with significant morbidity and costs to health care providers. The aims of this narrative review were to provide an update of classification systems, preventive techniques, pathophysiological mechanisms, and treatment options for established POI.

Methods: The Web of Science, MEDLINE, PubMed and Google Scholar databases were searched using the key phrases 'ileus', 'postoperative ileus' and 'definition', for relevant studies published in English from January 1997 to August 2014.

Effect of metformin on sleep disorders in adolescent girls with polycystic ovarian syndrome.

Objective: Patients with polycystic ovarian syndrome (PCOS) have a high prevalence of sleep disorders. Metformin is an antidiabetic drug that may have a role in treatment of the manifestations of PCOS. The aim of this study was to assess the presence of sleep disorders in adolescent girls with PCOS and to study the effects of using metformin on sleep disorders in these girls.

The pathophysiology of fluid and electrolyte balance in the older adult surgical patient.

Background & Aims: Age-related physiological changes predispose even the healthy older adult to fluid and electrolyte abnormalities which can cause morbidity and mortality. The aim of this narrative review is to highlight key aspects of age-related pathophysiological changes that affect fluid and electrolyte balance in older adults and underpin their importance in the perioperative period.

Methods: The Web of Science, MEDLINE, PubMed and Google Scholar databases were searched using key terms for relevant studies published in English on fluid balance in older adults during the 15 years preceding June 2013.

Arteriovenous fistula formations: key to vascular surgical training.

Purpose: To highlight missed training opportunities in daycase surgery for trainees to acquire competency in vascular anastomosis by performing arteriovenous fistula (AVF) formations.

Methods: Operative Room Management Information System records were reviewed for AVF procedures in daycase and general theatres at a UK Foundation Trust between 2007 and 2012. Data collected included procedure, procedure time (PT), patient length of stay (LOS), readmissions within 30 days of procedure and lead and assistant surgeons involved.

Management of Rolando fracture by modified dynamic external fixation: a new technique.

Rolando fracture is one of the most difficult fractures facing hand surgeons. It can be described as a Y- or T-shaped fracture line that runs longitudinally through the metaphyseal area, with an intra-articular fracture splitting the metacarpal base fragment into a volar and a dorsal fragment. In this study, we introduce our technique used in the management of 7 cases, which were treated by our dynamic external fixation.

Cognitive impairment in primary biliary cirrhosis: symptom impact and potential etiology.

Unlabelled: Qualitative studies suggest that patients with primary biliary cirrhosis (PBC) experience significant problems with memory and concentration. Studies of nonhepatic disease have linked hypotension and cognitive impairment. In this study, we determined the prevalence of cognitive symptoms in PBC, examined the relationship between symptoms and overt cognitive impairment and structural brain lesions, and explored the role of autonomic dysfunction.