Systematic review of preoperative and intraoperative colorectal Anastomotic Leak Prediction Scores (ALPS).

Objective: To systematically review preoperative and intraoperative Anastomotic Leak Prediction Scores (ALPS) and validation studies to evaluate performance and utility in surgical decision-making. Anastomotic leak (AL) is the most feared complication of colorectal surgery. Individualised leak risk could guide anastomosis and/or diverting stoma.

Implementation of a batched stepped wedge trial evaluating a quality improvement intervention for surgical teams to reduce anastomotic leak after right colectomy.

Background: Large-scale quality improvement interventions demand robust trial designs with flexibility for delivery in different contexts, particularly during a pandemic. We describe innovative features of a batched stepped wedge trial, ESCP sAfe Anastomosis proGramme in CoLorectal SurgEry (EAGLE), intended to reduce anastomotic leak following right colectomy, and reflect on lessons learned about the implementation of quality improvement programmes on an international scale.

Methods: Surgical units were recruited and randomised in batches to receive a hospital-level education intervention designed to reduce anastomotic leak, either before, during, or following data collection.

Altered anal slow-wave pressure activity in low anterior resection syndrome: short case series in two independent specialist centres provide new mechanistic insights.

Aim: Conventional parameters (anal resting and squeeze pressures) measured with anorectal manometry (ARM) fail to identify anal sphincter dysfunction in many patients with low anterior resection syndrome (LARS). We aimed to assess whether there are differences in anal canal slow-wave pressure activity in LARS patients and healthy individuals.

Method: High-resolution ARM (HR-ARM) traces of 21 consecutive male LARS patients referred to the Royal London Hospital, UK (n = 12) and Aarhus University Hospital, Denmark (n = 9) were compared with HR-ARM data from 37 healthy men.

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

Purpose: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway.

Patients And Methods: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2.

Postoperative narcotic use in patients with ovarian cancer on an Enhanced Recovery After Surgery (ERAS) pathway.

Objectives: To determine the impact of an ERAS pathway on post-discharge narcotic use for patients with ovarian cancer undergoing open surgery.

Methods: This was a retrospective cohort study of women who underwent open ovarian cancer surgeries in 2014 prior to ERAS ("pre-ERAS") and in 2016/2018 after ERAS was instituted ("ERAS"). Patients taking chronic narcotics were excluded.

Current margin practice and effect on re-excision rates following the publication of the SSO-ASTRO consensus and ABS consensus guidelines: a national prospective study of 2858 women undergoing breast-conserving therapy in the UK and Ireland.

Introduction: There is variation in margin policy for breast conserving therapy (BCT) in the UK and Ireland. In response to the Society of Surgical Oncology and American Society for Radiation Oncology (SSO-ASTRO) margin consensus ('no ink on tumour' for invasive and 2 mm for ductal carcinoma in situ [DCIS]) and the Association of Breast Surgery (ABS) consensus (1 mm for invasive and DCIS), we report on current margin practice and unit infrastructure in the UK and Ireland and describe how these factors impact on re-excision rates.

Methods: A trainee collaborative-led multicentre prospective study was conducted in the UK and Ireland between 1st February and 31st May 2016.

Defining our destiny: trainee working group consensus statement on the future of emergency surgery training in the United Kingdom.

The United Kingdom National Health Service treats both elective and emergency patients and seeks to provide high quality care, free at the point of delivery. Equal numbers of emergency and elective general surgical procedures are performed, yet surgical training prioritisation and organisation of NHS institutions is predicated upon elective care. The increasing ratio of emergency general surgery consultant posts compared to traditional sub-specialities has yet to be addressed.

Augmented locomotor recovery after spinal cord injury in the athymic nude rat.

The immune response contributes to ongoing secondary tissue destruction following spinal cord injury (SCI). Although infiltrating neutrophils and monocytes have been well studied in this process, T-cells have received less attention. The objective of this study was to assess locomotor recovery and tissue morphology after SCI in athymic (nude) rats, in which T-cell numbers are reduced.

Survival and migration of human and rat olfactory ensheathing cells in intact and injured spinal cord.

Increasing evidence indicates the potential of olfactory ensheathing cells (OECs) for treating spinal cord injuries. The present study compared proliferation and migration of adult rat and human OECs transplanted into the spinal cord of athymic (immunodeficient) rats. OECs were purified from the nasal lamina propria and prelabeled with a cytoplasmic dye.

Effect of a barley breakfast cereal on blood glucose and insulin response in normal and diabetic patients.

Prowashonupana (Prowash) is a shrunken-endosperm, short awn, waxy starch, hulless barley with low starch, high fiber, high protein, and a relatively high concentration of free sugars. The study was designed to compare equivalent breakfast meals (w/w) of Prowash and oatmeal for glycemic response in diabetic and non-diabetic subjects. A commercial liquid meal replacer (LMR) was included as a reference standard.

A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit.

Objective: To evaluate dexmedetomidine for sedation of patients in the medical ICU.

Design And Setting: Prospective observational study in an intensive care unit of a university hospital. PATIENTS.

Localization of mRNA for the apoptosis-linked gene ALG-2 in young and aged rat brain.

ALG-2 is a recently described pro-apoptosis gene that codes for a Ca2+-binding protein involved in T-cell receptor-, Fas- and glucocorticoid-induced cell death. We have used in situ hybridization histochemistry to examine the regional distribution of ALG-2 mRNA in the brain of 3- and 24-month old rats. There was widespread, predominantly neuronal distribution of ALG-2 mRNA throughout the brain.

The experience and impact of contacting a cancer information service.

Our objective was to review the quality of service delivered by a national cancer information service--the British Association of Cancer United Patients (BACUP)--and to consider the implications for future policy and practice. We used a sample of callers over a 10-day period, responding to a structured postal questionnaire. The sample included patients, relatives, friends, and general public who called the service with any concern relating to cancer.

The influence of timing and suppository use on efficiency and effectiveness of bowel training after a stroke.

This study was designed to determine the efficiency and effectiveness of four bowel training protocols for stroke patients (N = 46) differing in two variables: (a) consistent use of suppositories, and (b) time of day scheduled for the bowel training program. Eighty-five percent of the subjects (n = 39) achieved effective bowel training within 1 month. Patients assigned to morning bowel training groups were significantly more efficient than those in evening groups in establishing effective bowel regimens.

Studies of hydration and swelling pressure in normal and osteoarthritic cartilage.

An experimental study was carried out which involved comparing cartilage from normal and osteoarthritic joints with respect to (a) swelling pressure and (b) variation of hydration with applied pressure. The main conclusion was that whilst osteoarthritic cartilage is undoubtedly less able to resist water loss under a given applied pressure than normal cartilage, this is not due to a change in the "quality" of the proteoglycans, resulting in a change in the osmotic pressure of the latter, but simply to a decreased fixed charge density. The latter decrease is either caused by an increase in the water content - and this we attribute to a weakened collagen network - and/or to a loss of part of the proteoglycans from the tissue.

Structure of proteoglycans from different layers of human articular cartilage.

Full-depth plugs of adult human articular cartilage were cut into serial slices from the articular surface and analysed for their glycosaminoglycan content. The amount of chondroitin sulphate was highest in the mid-zone, whereas keratan sulphate increased progressively through the depth. Proteoglycans were isolated from each layer by extraction with 4M-guanidinium chloride followed by centrifugation in 0.

Further studies on the composition of human femoral head cartilage.

This report continues our previous studies on the composition and swelling of articular cartilage. When the protein part of the proteoglycan moiety has been taken into consideration, there is no longer a large fraction of the tissue which is not accounted for. In fact, the collagen, proteoglycans, and free electrolyte represent over 92% of the dry weight of adult femoral head cartilage, the remainder consisting most probably of other glycoproteins.

Chemical composition of human femoral and head cartilage: influence of topographical position and fibrillation.

Topographical variations in the composition of cartilage have been described in post-mortem femoral head cartilage. Weight bearing cartilage of the superior region was considerably thicker and had a higher glycosaminoglycan content and lower water and collagen content than cartilage at the periphery and below the fovea. These topographical variations in composition may result both from variations in thickness of the cartilage and from regional areas of degeneration.

Variation of chemical composition with age in human femoral head cartilage.

The chemical composition of intact femoral head cartilage was investigated with age. Full-depth cartilage showed a decrease in water content and an increase in keratan sulphate and noncollagenous material with age. When analyzed through the depth of the cartilage, keratan sulphate was shown to appear first in the deep zones and later in the surface, while water content was lost mainly in the deep zones.

Digestion of native collagen in the gut.

The digestion and absorption of collagen, native and artificially cross-linked, has been examined in the rat and the Gaboon viper, by feeding known quantities and measuring the hydroxy-proline content of the faeces and of the contents of the gut at different levels, and comparing with an unabsorbable marker (polyethylene glycol). Incubation of collagen in vitro with pepsin at 37 degrees C at pH 1.5 followed by trypsin or chymotrypsin converted about 40% into dialysable material.

Chemical composition and swelling of normal and osteoarthrotic femoral head cartilage. II. Swelling.

Studies of the equilibrium, partition, and diffusion of tritiated water were carried out on normal and osteoarthrotic cartilage as well as on cartilage from which proteoglycans had been extracted chemically. All the water was found to be freely exchangeable in both normal and degenerate specimens. The diffusiviity of the water was equal to about 40% of the value in free solution, with an activation energy equal to that in free solution.

Chemical composition and swelling of normal and osteoarthrotic femoral head cartilage. I. Chemical composition.

Radiochemical and biochemical methods were used to characterize post-mortem and osteoarthrotic femoral head cartilage. Fixed charge density measurements were correlated with glycosaminoglycan content as estimated by uronic acid and hexosamine analyses. In post-mortem cartilage water content decreased from a maximum at the surface to a minimum in the deep zones.