RACS and its Fellows: a contribution to sustainable healthcare improvement in South East Asia.

The question of whether small non-government organizations with comparatively small budgets can make a substantial contribution to sustainable improvement in health care in low- and middle-income countries is crucial to funding global surgical projects. The Royal Australasian College of Surgeons and its Fellows have partnered with local organizations and clinicians to deliver a wide range of projects in South East Asia. These projects have proved sustainable and have increased healthcare capacity in these nations.

A CHIP fellow's transition into practice: Building a complex coronary therapeutics program.

Background: Both the prevalence and complexity of coronary artery disease are on the rise in the United States, leading to a resurgence in novel techniques and equipment utilized to treat complex coronary disease. However, declining percutaneous coronary intervention (PCI) volumes and lack of formal post-graduate education opportunities have created a gap in treatment delivery for this patient population. Several complex, high-risk, and indicated PCI (CHIP) fellowships have been developed in an attempt to bridge this disparity.

Effects of dietary inulin supplementation on the composition and dynamics of cecal microbiota and growth-related parameters in broiler chickens.

Inulin, a prebiotic, is an attractive alternative to antibiotic growth promoters in chickens. Dietary supplementation with inulin can improve growth performance, carcass yield, immune system activity, and serum biochemical parameters in chickens. A few studies investigated the impact of dietary inulin supplementation on chicken intestinal microbiota.

Effects of dietary supplementation with lysozyme on the structure and function of the cecal microbiota in broiler chickens.

Lysozyme is known to eliminate intestinal pathogens in poultry and improve their growth performance. However, whether it can replace antibiotic growth promoters without the associated risk of the emergence of antibiotic-resistant bacterial strains is not known, and the effects of lysozyme supplementation on the composition, biodiversity, and function of the chicken gut microbiota remain unclear. Here, we used the 16S rRNA gene and ITS fragment Illumina sequencing combined with transcriptomic analysis to address this issue.

Evaluating Information Quality of Revised Patient Education Information on Colonoscopy: It Is New But Is It Improved?

Background: Previous research indicates that patients and their families have many questions about colonoscopy that are not fully answered by existing resources. We developed revised forms on colonoscopy bowel preparation and on the procedure itself.

Objective: As the goal of the revised materials is to have improved information relative to currently available information, we were interested in how revised information compared with what is currently available in terms of information quality and patient preference.

Aqueous raw and ripe Pu-erh tea extracts alleviate obesity and alter cecal microbiota composition and function in diet-induced obese rats.

Pu-erh tea is attracting increased attention worldwide because of its unique flavor and health effects, but its impact on the composition and function of the gut microbiota remains unclear. The aim of this study was to investigate the effects of aqueous extracts of fermented (ripe) and non-fermented (raw) Pu-erh teas on the composition and function of the intestinal microbiota of rats with diet-induced obesity. We conducted a comparative metagenomic and meta-proteomic investigation of the microbial communities in cecal samples taken from obese rats treated with or without extracts of raw or ripe Pu-erh teas.

Collecting data for global surgical indicators: a collaborative approach in the Pacific Region.

In 2015, the Lancet Commission on Global Surgery (LCoGS) recommended six surgical metrics to enable countries to measure their surgical and anaesthesia care delivery. These indicators have subsequently been accepted by the World Bank for inclusion in the World Development Indicators. With support from the Royal Australasian College of Surgeons and the Pacific Islands Surgical Association, 14 South Pacific countries collaborated to collect the first four of six LCoGS indicators.

Effect of Ageratina adenophora invasion on the composition and diversity of soil microbiome.

In the present study, high throughput 16S rRNA gene sequencing was used to investigate soil invaded by the aggressive weed Ageratina adenophora to determine its effect on the species composition, distribution, and biodiversity of the bacterial communities. Soil samples from 12 micro-sites containing a monoculture of A. adenophora plants, mixtures of A.

Capacity building for emergency care: Training the first emergency specialists in Myanmar.

Objectives: The Myanmar Ministry of Health has formed a partnership with Australasian professional colleges and international medical specialists to deliver a comprehensive programme for emergency care training and development. We describe this programme, emphasising the training of the first emergency specialists for Myanmar.

Methods: Eighteen junior specialists (EM18) joined a new postgraduate diploma in emergency medicine (Dip EM) through the University of Medicine (1) (UM1), Yangon.

Transarterial embolisation with Guglielmi detachable coils in an infant with a vein of Galen aneurysmal malformation.

Vein of Galen aneurysmal malformation is a rare entity in the paediatric population. However, it is being recognised with increasing frequency due to better diagnostic techniques. Neonates usually present with congestive heart failure, while in older infants and children it tends to manifest with seizures, hydrocephalus, intracerebral or subarachnoid haemorrhages.

PGVL Hub: An integrated desktop tool for medicinal chemists to streamline design and synthesis of chemical libraries and singleton compounds.

PGVL Hub is an integrated molecular design desktop tool that has been developed and globally deployed throughout Pfizer discovery research units to streamline the design and synthesis of combinatorial libraries and singleton compounds. This tool supports various workflows for design of singletons, combinatorial libraries, and Markush exemplification. It also leverages the proprietary PGVL virtual space (which contains 10(14) molecules spanned by experimentally derived synthesis protocols and suitable reactants) for lead idea generation, lead hopping, and library design.

Coronary sinus to left atrial communication.

Congenital coronary sinus anomalies are rare in clinical practice, partly due to the lack of symptoms. We present a case of coronary sinus anomaly causing a right-to-left intracardiac shunt in a 46 years/old African American female with a past medical history of obstructive sleep apnea, diabetes mellitus, hypertension, coronary artery disease, and ischemic cardiomyopathy who presented with hypoxia. In the months prior to her presentation, she had suffered an inferior myocardial infarction with right ventricular involvement, as well as resulting severe tricuspid regurgitation.

Contemporary challenges in mastocytosis.

Mastocytosis denotes a wide range of disorders characterized by having abnormal growth and accumulation of mast cells. Mast cells contain histamine and other inflammatory mediators, which have diverse actions within the body, and play crucial roles in acquired and innate immunity. The diverse actions of these inflammatory mediators can lead to puzzling symptoms in individuals with mastocytosis.

The immunobiology of systemic sclerosis.

Objectives: Systemic sclerosis (SSc) is a chronic connective tissue disease characterized by vascular damage, autoimmunity, and excessive collagen deposition. Despite advances in disease-specific treatment of other rheumatologic diseases, disease-targeted treatment in SSc continues to be elusive. In this review, our goal was to place the contemporary immunobiology of SSc in the perspective of clinical medicine.

Aspirin and nonsteroidal anti-inflammatory drug hypersensitivity.

Acetylsalicylic acid (ASA) or aspirin and nonsteroidal anti-inflammatory drug (NSAID) sensitivities encompass a diverse group of both pharmacological and hypersensitivity reactions. Conventionally, hypersensitivities include aspirin-exacerbated respiratory disease (AERD), ASA-induced urticaria, and anaphylaxis. With an increasing prevalence of coronary artery disease in an aging population, aspirin continues to play a significant role in cardiac prophylaxis in a large patient population.

Potential adverse events with biologic response modifiers.

In recent years, an explosion of biologic response modifiers has entered the market to combat a variety of immune-mediated diseases. These can be in the form of recombinant cytokines, as in the case of interferon beta in the treatment of multiple sclerosis, or novel engineered antibodies constructed by combining non-human determinants with a human immunoglobulin scaffold, as in the case of omalizumab in the treatment of allergic asthma. More recently, completely human monoclonal antibodies have also been constructed.

Mastocytosis: the great masquerader.

Variants of mastocytosis can present with puzzling cutaneous and systemic symptoms and signs that can result in an erroneous diagnosis of idiopathic urticaria or idiopathic anayphylaxis. The molecular basis of mastocytosis is now better understood, with updated classification based on distinct growth factor and oncogene abnormalities. Elicitation of a full history and careful attention to the skin examination will usually provide the clinician enough information to deduce that the condition is not simply chronic idiopathic urticaria.

Safety of single versus multi-vessel angioplasty for patients with acute myocardial infarction and multi-vessel coronary artery disease: report from the New York State Angioplasty Registry.

Background: The conventional strategy for primary angioplasty during acute myocardial infarction is angioplasty of the infarct-related vessel, even in patients with multi-vessel disease. Patients, however, often have significant lesions in multiple coronary arteries and a strategy for multi-vessel angioplasty during acute myocardial infarction has not been explored. The purpose of this study was to examine whether multi-vessel angioplasty is as safe as infarct-related vessel angioplasty in patients with multi-vessel coronary artery disease during acute myocardial infarction.

Integrating images into the electronic patient record of the hospital authority of Hong Kong.

Over a period of 10 years the Hospital Authority has developed an integrated clinical information system (The Clinical Management System-CMS), including a territory-wide longitudinal electronic patient record (ePR). The CMS and ePR are used by over 4000 doctors and 20,000 other clinicians to document and review care. The ePR currently has nearly 3TB of data covering 44 million episodes for 6.

The Hong Kong Hospital Authority's information architecture.

Since 1994, the Hospital Authority has been developing and deploying clinical applications at its constituent 39 hospitals and clinics. The Clinical Management System (CMS) is now used by over 4000 doctors and 20000 other clinicians to document and review care. Since 1999, the territory-wide integrated Electronic Patient Record (ePR) has given clinicians a longitudinal view of the data collected through the CMS and its adjunct systems.

A clinical prediction rule for diagnosing severe acute respiratory syndrome in the emergency department.

Background: Accurate, objective models of triage for patients with suspected severe acute respiratory syndrome (SARS) could assess risks and improve decisions about isolation and inpatient treatment.

Objective: To develop and validate a clinical prediction rule for identifying patients with SARS in an emergency department setting.

Design: Retrospective analysis using a 2-step coefficient-based multivariable logistic regression scoring method with internal validation by bootstrapping.

How to use cuff suture instruments: the concept of "concave in and concave out".

Arthroscopic reconstructive surgery of the shoulder is extremely demanding. The advent of suture anchors and knot-tying instruments has greatly facilitated its development. Knowledge of the anatomy and surgical principles alone is not enough.