Evolution of a Restriction Factor by Domestication of a Yeast Retrotransposon.

Transposable elements drive genome evolution in all branches of life. Transposable element insertions are often deleterious to their hosts and necessitate evolution of control mechanisms to limit their spread. The long terminal repeat retrotransposon Ty1 prime (Ty1'), a subfamily of the Ty1 family, is present in many Saccharomyces cerevisiae strains, but little is known about what controls its copy number. Here, we provide evidence that a novel gene from an exapted Ty1' sequence, domesticated restriction of Ty1' relic 2 (DRT2), encodes a restriction factor that inhibits Ty1' movement. DRT2 arose through domestication of a Ty1' GAG gene and contains the C-terminal domain of capsid, which in the related Ty1 canonical subfamily functions as a self-encoded restriction factor. Bioinformatic analysis reveals the widespread nature of DRT2, its evolutionary history, and pronounced structural variation at the Ty1' relic 2 locus. Ty1' retromobility analyses demonstrate DRT2 restriction factor functionality, and northern blot and RNA-seq analysis indicate that DRT2 is transcribed in multiple strains. Velocity cosedimentation profiles indicate an association between Drt2 and Ty1' virus-like particles or assembly complexes. Chimeric Ty1' elements containing DRT2 retain retromobility, suggesting an ancestral role of productive Gag C-terminal domain of capsid functionality is present in the sequence. Unlike Ty1 canonical, Ty1' retromobility increases with copy number, suggesting that C-terminal domain of capsid-based restriction is not limited to the Ty1 canonical subfamily self-encoded restriction factor and drove the endogenization of DRT2. The discovery of an exapted Ty1' restriction factor provides insight into the evolution of the Ty1 family, evolutionary hot-spots, and host-transposable element interactions.

Safety aspects of riding with children: Descriptive analysis of adult riders' self-report.

Active transport, including cycling, is promoted as an effective way of increasing children's physical activity and health. Parents can support children's riding by riding with them and it is important to address relevant safety issues. Little is known about parents' experience of safety-relevant aspects of riding with children. Participants in the Safer Cycling Study in New South Wales, Australia, who reported that they had ridden with children in the last 12 months were questioned about how they ride with children, and their experience of safety issues and crashes. Among the 187 respondents who had ridden with children on their bicycle, the most common form of carrier was a rear-mounted seat (48%) followed by a trailer (29%). Many respondents (79%) identified risks specific to riding carrying children, including those linked with specific carrier types and with use of footpaths. Most (92%) indicated that they change their behaviour when carrying a child on their bicycle; for example, riding more slowly, more carefully, and away from roads. Among crashes with a child on the bicycle, most were falls. Among the 345 participants who had ridden to accompany a child on a bicycle, approximately three quarters identified risks specific to accompanying children, such as managing the child's limited skill, awareness and predictability. Ninety-seven percent reported behavioural changes including positioning themselves as a barrier for their child and caution crossing roads. Findings suggest strategies to support parents in riding safely with children.

An evaluation of the effects of an innovative school-based cycling education program on safety and participation.

Cycling education programs for children could play a role in promoting both cycling participation and cycling safety, and they exist in many countries - often in school settings. Evaluations have generally shown improvements in skills and knowledge, but effects on less-researched outcomes such as safety-related behaviour, crashes or injuries, cycling participation, and cycling confidence, are unclear. The present research evaluated Safe Cycle, an innovative Australian school-based program that addresses hazard awareness and overconfidence in addition to more typical content (e.g. handling skills), in terms of a comprehensive range of outcomes. Students from Years 4 to 8 (n = 108) completed online surveys in class before, immediately after, and approximately 14 weeks after, the 8-week program was delivered. Significant increases in knowledge and confidence were observed, while results also suggested increases in cycling participation. The program appeared to address illusory invulnerability effectively, but there was no evidence that the program improved safety-relevant cycling behaviours or experience of crashes. The benefits of Safe Cycle might be enhanced by including elements to increase motivation to perform safety-relevant behaviours and durability of program effects.

Corn stover harvest N and energy budgets in central Iowa.

Harvesting corn stover removes N from the fields, but its effect on subsurface drainage and other N losses is uncertain. We used the Root Zone Water Quality Model (RZWQM) to examine N losses with 0 (NRR) or 50% (RR) corn residue removal within a corn and soybean rotation over a 10-yr period. In general, all simulations used the same pre-plant or post-emergence N fertilizer rate (200 kg ha-1 yr-1). Simulated annual corn yields averaged 10.7 Mg ha-1 for the post emergence applications (NRRpost and RRpost), and 9.5 and 9.4 Mg ha-1 yr-1 for NRRpre and RRpre. Average total N input during corn years was 19.3 kg N ha-1 greater for NRRpre compared to RRpre due to additional N in surface residues, but drainage N loss was only 1.1 kg N ha-1 yr-1 greater for NRRpre. Post-emergence N application with no residue removal (NRRpost) reduced average drainage N loss by 16.5 kg ha-1 yr-1 compared to pre-plant N fertilization (NRRpre). The farm-gate net energy ratio was greatest for RRpost and lowest for NRRpre (14.1 and 10.4 MJ output per MJ input) while greenhouse gas intensity was lowest for RRpost and highest for NRRpre (11.7 and 17.3 g CO2-eq. MJ-1 output). Similar to published studies, the simulations showed little difference in N2O emissions between scenarios, decreased microbial immobilization for RR compared to NRR, and small soil carbon changes over the 10-yr simulation. In contrast to several previous modeling studies, the crop yield and N lost to drain flow were nearly the same between NRR and RR without supplemental N applied to replace N removed with corn stover. These results are important to optimizing the energy and nitrogen budgets associated with corn stover harvest and for developing a sustainable bioenergy industry.

N loss to drain flow and N2O emissions from a corn-soybean rotation with winter rye.

Anthropogenic perturbation of the global nitrogen cycle and its effects on the environment such as hypoxia in coastal regions and increased N2O emissions is of increasing, multi-disciplinary, worldwide concern, and agricultural production is a major contributor. Only limited studies, however, have simultaneously investigated NO3- losses to subsurface drain flow and N2O emissions under corn-soybean production. We used the Root Zone Water Quality Model (RZWQM) to evaluate NO3- losses to drain flow and N2O emissions in a corn-soybean system with a winter rye cover crop (CC) in central Iowa over a nine year period. The observed and simulated average drain flow N concentration reductions from CC were 60% and 54% compared to the no cover crop system (NCC). Average annual April through October cumulative observed and simulated N2O emissions (2004-2010) were 6.7 and 6.0kgN2O-Nha-1yr-1 for NCC, and 6.2 and 7.2kgNha-1 for CC. In contrast to previous research, monthly N2O emissions were generally greatest when N loss to leaching were greatest, mostly because relatively high rainfall occurred during the months fertilizer was applied. N2O emission factors of 0.032 and 0.041 were estimated for NCC and CC using the tested model, which are similar to field results in the region. A local sensitivity analysis suggests that lower soil field capacity affects RZWQM simulations, which includes increased drain flow nitrate concentrations, increased N mineralization, and reduced soil water content. The results suggest that 1) RZWQM is a promising tool to estimate N2O emissions from subsurface drained corn-soybean rotations and to estimate the relative effects of a winter rye cover crop over a nine year period on nitrate loss to drain flow and 2) soil field capacity is an important parameter to model N mineralization and N loss to drain flow.

On the use of naturalistic methods to examine safety-relevant behaviours amongst children and evaluate a cycling education program.

School-based cycling education programs aim to improve cycling safety and participation amongst children. Available research suggests that typical programs, which focus on bicycle manoeuvring skills, have limited effects on behaviour observed on a track or planned route. The current study uses theoretically more valid, naturalistic cycling data, to evaluate Safe Cycle, a program that incorporates hazard and self-awareness training. Soon after Safe Cycle was delivered at treatment schools, research bicycles instrumented with a rearward- and a forward-facing camera were loaned to six children from treatment schools and six children from (waitlist) control schools. In each group half the children were in Year 6, and half were in Year 7/8. Each child was instructed to ride the research bicycle instead of their own bicycle for the 1-2 weeks that they had a research bicycle. Video data were reduced using a purpose-designed coding scheme that identified whether participants performed specific safety-relevant behaviours in appropriate circumstances. While the participants controlled their bicycles well, gave way appropriately to traffic at intersections, and stopped at red lights, participants frequently removed one or both hands from the handlebars, and seldom signalled turns, conducted over-shoulder-checks when changing lanes, or looked in multiple directions at intersections (except when crossing a road). While aspects of design and small sample sizes limited evaluation findings, this research demonstrated the feasibility and potential of naturalistic data to support cycling education program evaluation. Further, the study substantially extended available naturalistic study of children's cycling behaviour to highlight behaviours which might be targeted by cycling safety initiatives.

Near miss experiences of transport and recreational cyclists in New South Wales, Australia. Findings from a prospective cohort study.

This paper investigates events in which cyclists perceive a cycling crash is narrowly avoided (henceforth, a near miss). A cohort of 2038 adult transport and recreational cyclists from New South Wales (Australia) provided self-reported prospectively collected data from cycling diaries to allow the calculation of an exposure-based rate of near misses and investigation of near miss circumstances. During 25,971days of cycling, 3437 near misses were reported. For a given time cycling, cyclists who rode mainly for transport (compared with those who rode mainly for recreation), and cyclists with less experience (compared to those with more experience) were more likely to report a near miss; older cyclists (60+ years) were less likely to report a near miss than younger cyclists (25-59 years). Where type of near miss was recorded, 72.0% involved motor vehicles, 10.9% involved pedestrians and 6.9% involved other cyclists. Results indicate some similarities between near misses and crashes reported by this cohort during the same reporting period. A bias toward reporting near misses with motor vehicles was suggested, which likely reflects cyclists' perceptions that crashes involving motor vehicles are particularly serious, and highlights their impact on perceived safety. Given the relative rarity of crashes, and the limited breadth and depth of administrative data, collection of near miss data may contribute to our understanding of cycling safety by increasing the volume and detail of information available for analysis. Addressing the causes of near misses may offer an opportunity to improve both perceived and actual safety for cyclists.

Characteristics, cycling patterns, and crash and injury experiences at baseline of a cohort of transport and recreational cyclists in New South Wales, Australia.

This paper examines self-reported retrospective data for a 12 month period from 2038 adult cyclists from New South Wales (Australia), and compares cyclists according to whether they self-identify as riding mainly for transport or mainly for recreation. Statistically significant differences were found in the demographic characteristics, cycling patterns, and crash experiences between these two groups of cyclists. Transport cyclists tended to be younger, travel more days per week, and within morning and evening peak hours than recreational cyclists; recreational cyclists were more likely to identify fitness as a purpose for cycling. The proportion of cyclists experiencing a crash or crash-related injury in the previous 12 months was similar for transport and recreational cyclists, but there were differences in crash types and location which likely reflect different cycling environments. Heterogeneity within transport and recreational cyclists was also found, based on self-reported riding intensity. An understanding of the different cycling patterns and experiences of various types of cyclists is useful to inform road safety, transport and health promotion policy.

An exposure based study of crash and injury rates in a cohort of transport and recreational cyclists in New South Wales, Australia.

This paper examines self-reported prospectively collected data from 2038 adult transport and recreational cyclists from New South Wales (Australia) to determine exposure-based incident crash and injury rates. During 25,971 days of cycling, 198 crashes were reported, comprising approximately equal numbers of falls and collisions. The overall crash rate was 0.290 (95% CI, 0.264-0.319) per 1000km or 6.06 (95% CI, 5.52-6.65) per 1000h of travel. The rate of crashes causing any injury (self-treated, or medically attended without overnight hospital stay) was 0.148 (95% CI, 0.133-0.164) per 1000km or 3.09 (95% CI, 2.79-3.43) per 1000h of travel. The rate of crashes causing a medically attended injury (without overnight hospital stay) was 0.023 (95% CI, 0.020-0.027) per 1000km or 0.49 (95% CI, 0.43-0.56) per 1000h of travel. No injuries requiring an overnight stay in hospital were reported on days meeting the inclusion criteria. After adjustment for exposure in hours, or for the risks associated with different infrastructure utilisation, the rates of crashes and medically attended injuries were found to be greater for females than males, less experienced than more experienced cyclists, and for those who rode mainly for transport rather than mainly for recreation. Comparison of estimated crash and injury rates on different infrastructure types were limited by the small number of events, however findings suggest that the separation of cyclists from motorised traffic is by itself not sufficient to ensure safe cycling.

A scoping review of unintended harm associated with public health interventions: towards a typology and an understanding of underlying factors.

OBJECTIVES: Unintended harm theory as related to public health interventions (PHI) is under developed, with harm evaluation and reporting often absent or incomplete. This review presents a typology for, and underlying factors linked to, PHI-associated unintended harm. METHODS: This scoping review was conducted electronically and includes articles from 1992 to June of 2013. Out of 2,490 originally identified titles, 26 full-text articles were included that discussed unintended harm associated with PHI. An iterative data analysis process was utilized to identify both a typology and underlying factors associated with unintended harm. RESULTS: A typology of PHI-associated unintended harm was identified: (1) physical; (2) psychosocial; (3) economic; (4) cultural and (5) environmental. Five underlying factors associated with PHI unintended harm emerged: (1) limited and/or poor quality evidence; (2) prevention of one extreme leads to another (boomerang effects); (3) lack of community engagement; (4) ignoring root causes; and (5) higher-income country PHI implementation in a lower- or middle-income country. CONCLUSIONS: PHI planning and evaluation frameworks may benefit from the consideration and potential incorporation of the unintended harm typology and underlying factors.

A low frequency variant within the GWAS locus of MTNR1B affects fasting glucose concentrations: genetic risk is modulated by obesity.

Two common variants (rs1387153, rs10830963) in MTNR1B have been reported to have independent effects on fasting blood glucose (FBG) levels with increased risk to type 2 diabetes (T2D) in recent genome-wide association studies (GWAS). In this investigation, we report the association of these two variants, and an additional variant (rs1374645) within the GWAS locus of MTNR1B with FBG, 2h glucose, insulin resistance (HOMA IR), ß-cell function (HOMA B), and T2D in our sample of Asian Sikhs from India. Our cohort comprised 2222 subjects [1201 T2D, 1021 controls]. None of these SNPs was associated with T2D in this cohort. Our data also could not confirm association of rs1387153 and rs10830963 with FBG phenotype. However, upon stratifying data according to body mass index (BMI) (low ≤ 25 kg/m(2) and high > 25 kg/m(2)) in normoglycemic subjects (n = 1021), the rs1374645 revealed a strong association with low FBG levels in low BMI group (ß = -0.073, p = 0.002, Bonferroni p = 0.01) compared to the high BMI group (ß = 0.015, p = 0.50). We also detected a strong evidence of interaction between rs1374645 and BMI with respect to FBG levels (p = 0.002). Our data provide new information about the significant impact of another MTNR1B variant on FBG levels that appears to be modulated by BMI. Future confirmation on independent datasets and functional studies will be required to define the role of this variant in fasting glucose variation.

Comparing the treatment response of great saphenous and small saphenous vein incompetence following surgery and endovenous laser ablation: a retrospective cohort study.

OBJECTIVE: Many venous trials mix patients with great saphenous vein (GSV) and small saphenous vein (SSV) diseases. There is no evidence that both respond similarly to treatment and our aim was to test this assumption. METHOD: This cohort study compares patients with isolated GSV and SSV incompetence following treatment with open surgical ligation or endovenous laser ablation (EVLA). Outcomes included: quality of life (QoL; Aberdeen Varicose Vein Questionnaire [AVVQ]; Short Form 36 [SF36]; Euroqol [EQ5D]; and Venous Clinical Severity Score [VCSS]). RESULTS: A total of 370 patients with no differences in baseline QoL, underwent treatment. Despite equivalent morbidity, SSV sufferers had a lower VCSS (P < 0.001). Following surgery, SSV patients scored higher (worse) on AVVQ (P = 0.045) than GSV sufferers, but lower (better) following EVLA (P = 0.042). CONCLUSION: The morbidity associated with SSV incompetence is greater than suggested by its clinical severity and responds differently following treatment to that of the GSV. Trials should consider patients with GSV and SSV reflux separately. EVLA may offer additional benefits to SSV sufferers.

Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins.

BACKGROUND: This report describes the clinical effectiveness and recurrence rates from a randomized trial of endovenous laser ablation (EVLA) and surgery for varicose veins. METHODS: Some 280 patients were randomized equally using sealed opaque envelopes to two parallel groups: surgery and EVLA. Inclusion criteria included symptomatic disease secondary to primary, unilateral, isolated saphenofemoral junction incompetence, leading to reflux into the great saphenous vein (GSV). Outcomes were: technical success, recurrent varicose veins on clinical examination, patterns of reflux on duplex ultrasound examination, and the effect of recurrence on quality of life, assessed by the Aberdeen Varicose Vein Questionnaire (AVVQ). Assessments were at 1, 6, 12 and 52 weeks after the procedure. RESULTS: Initial technical success was greater following EVLA: 99.3 versus 92.4 per cent (P = 0.005). Surgical failures related mainly to an inability to strip the above-knee GSV. The clinical recurrence rate at 1 year was lower after EVLA: 4.0 versus 20.4 per cent (P < 0.001). The number of patients needed to treat with EVLA rather than surgery to avoid one recurrence at 1 year was 6.3 (95 per cent confidence interval 4.0 to 12.5). Twelve of 23 surgical recurrences were related to an incompetent below-knee GSV and ten to neovascularization. Of five recurrences after EVLA, two were related to neoreflux in the groin tributaries and one to recanalization. Clinical recurrence was associated with worse AVVQ scores (P < 0.001). CONCLUSION: EVLA treatment had lower rates of clinical recurrence than conventional surgery in the short term.

Modelling the effect of venous disease on quality of life.

BACKGROUND: A clear understanding of the relationship between venous reflux, clinical venous disease and the effects on quality of life (QoL) remains elusive. This study aimed to explore the impact of venous disease, and assess any incremental direct effect of progressive disease on health-related QoL, with the ultimate aim to model venous morbidity. METHODS: Consecutive patients with venous disease were assessed for inclusion in the study. Patients with isolated, unilateral, single superficial axial incompetence diagnosed on duplex imaging were included. Clinical grading was performed with the Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification and Venous Clinical Severity Score (VCSS). Patients completed generic (Short Form 36, SF-36(®); EuroQol 5D, EQ-5D(™)) and disease-specific (Aberdeen Varicose Vein Questionnaire, AVVQ) QoL instruments. Multivariable regression modelling was performed, taking account of demographic and anatomical factors, to explore the effect of clinical severity on QoL impairment. RESULTS: Some 456 patients with C2-6 venous disease were included, along with control data for 105 people with C0-1 disease. Increasing clinical grade corresponded strongly with deterioration in disease-specific QoL (P < 0.001). This could be stratified into three distinguishable groups: C0-1, C2-4 and C5-6 (P < 0.001 to P = 0.006). Increasing clinical grade also corresponded with deterioration in the physical domains of SF-36(®) (P < 0.001 to P = 0.016), along with EQ-5D(™) index utility (quality-adjusted life year) scores (P < 0.001). CONCLUSION: Demonstrable morbidity was seen, even with uncomplicated venous disease. The physical impairment seen with venous ulceration was comparable with that seen in congestive cardiac failure and chronic lung disease.

Promoting health, preserving culture: adapting RARE in the Maasai context of Northern Tanzania.

HIV/AIDS prevention strategies often neglect traditions and cultural practices relevant to the spread of HIV. The role of women in the HIV/AIDS context has typically been relegated to high-risk female groups such as sex workers, or those engaged in transactional sex for survival. Consequently, these perceptions are born out in the escalation of HIV/AIDS among communities, and female populations in particular where prevention frameworks remain culturally intolerant. We have attempted to address these issues by using an adapted Rapid Assessment Response and Evaluation (RARE) model to examine the impact of HIV/AIDS in the Maasai community of Ngorongoro. Our adapted RARE model used community engagement venues such as stockholder workshops, key informant interviews, and focus groups. Direct observations and geomapping were also done. Throughout our analysis, a gender and a pastoralist-centered approach provided methodological guidance, and served as value added contributions to out adaptation. Based in the unique context of a rural pastoralist community, we made recommendations appropriate to the cultural setting and the RARE considerations.

Randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins.

BACKGROUND: Endovenous laser ablation (EVLA) is a popular minimally invasive treatment for varicose veins. Surgical treatment, featuring junctional ligation and inversion stripping, has shown excellent clinical and cost effectiveness. The clinical effectiveness of both treatments was compared within a randomized trial. METHODS: Some 280 patients were randomized equally into groups receiving either surgery or EVLA. Participants had primary, symptomatic, unilateral venous insufficiency, with isolated saphenofemoral junction incompetence, leading to reflux into the great saphenous vein. Outcomes included: quality of life (QoL), Venous Clinical Severity Score (VCSS), pain scores and time taken to return to normal function. Owing to the nature of the procedures, blinding was not possible. RESULTS: Both groups had significant improvements in VCSS after treatment (P < 0.001), which resulted in improved disease-specific QoL (Aberdeen Varicose Vein Questionnaire, P < 0.001) and quality-adjusted life year (QALY) gain (P < 0.001). The pain and disability following surgery impaired normal function, with a significant decline in five of eight Short Form 36 (SF-36(®)) domains (P < 0.001 to P = 0.029). Periprocedural QoL was relatively preserved following EVLA, leading to a significant difference between the two treatments in pain scores (P < 0.001), six of eight SF-36(®) domains (P = 0.004 to P = 0.049) and QALYs (P = 0.003). As a result, surgical patients took longer to return to work and normal activity (14 versus 4 days; P < 0.001). Complications were rare. CONCLUSION: EVLA was as effective as surgery for varicose veins, but had a less negative impact on early postintervention QoL. REGISTRATION NUMBER: NCT00759434 (http://www.clinicaltrials.gov).

An adenylyl cyclase signaling pathway predicts direct dopaminergic input to vestibular hair cells.

Adenylyl cyclase (AC) signaling pathways have been identified in a model hair cell preparation from the trout saccule, for which the hair cell is the only intact cell type. The use of degenerate primers targeting cDNA sequence conserved across AC isoforms, and reverse transcription-polymerase chain reaction (RT-PCR), coupled with cloning of amplification products, indicated expression of AC9, AC7 and AC5/6, with cloning efficiencies of 11:5:2. AC9 and AC5/6 are inhibited by Ca(2+), the former in conjunction with calcineurin, and message for calcineurin has also been identified in the trout saccular hair cell layer. AC7 is independent of Ca(2+). Given the lack of detection of calcium/calmodulin-activated isoforms previously suggested to mediate AC activation in the absence of Gαs in mammalian cochlear hair cells, the issue of hair-cell Gαs mRNA expression was re-examined in the teleost vestibular hair cell model. Two full-length coding sequences were obtained for Gαs/olf in the vestibular type II-like hair cells of the trout saccule. Two messages for Gαi have also been detected in the hair cell layer, one with homology to Gαi1 and the second with homology to Gαi3 of higher vertebrates. Both Gαs/olf protein and Gαi1/Gαi3 protein were immunolocalized to stereocilia and to the base of the hair cell, the latter consistent with sites of efferent input. Although a signaling event coupling to Gαs/olf and Gαi1/Gαi3 in the stereocilia is currently unknown, signaling with Gαs/olf, Gαi3, and AC5/6 at the base of the hair cell would be consistent with transduction pathways activated by dopaminergic efferent input. mRNA for dopamine receptors D1A4 and five forms of dopamine D2 were found to be expressed in the teleost saccular hair cell layer, representing information on vestibular hair cell expression not directly available for higher vertebrates. Dopamine D1A receptor would couple to Gαolf and activation of AC5/6. Co-expression with dopamine D2 receptor, which itself couples to Gαi3 and AC5/6, will down-modulate levels of cAMP, thus fine-tuning and gradating the hair-cell response to dopamine D1A. As predicted by the trout saccular hair cell model, evidence has been obtained for the first time that hair cells of mammalian otolithic vestibular end organs (rat/mouse saccule/utricle) express dopamine D1A and D2L receptors, and each receptor co-localizes with AC5/6, with a marked presence of all three proteins in subcuticular regions of type I vestibular hair cells. A putative efferent, presynaptic source of dopamine was identified in tyrosine hydroxylase-positive nerve fibers which passed from underlying connective tissue to the sensory epithelia, ending on type I and type II vestibular hair cells and on afferent calyces.

Energy delivery during 810 nm endovenous laser ablation of varicose veins and post-procedural morbidity.

AIM: The durability of occlusion post endovenous laser therapy (EVLT) for varicose veins is linked to the magnitude of energy delivered to the vein and consequently increasing amounts of energy are employed. The aim of this study is to establish whether increasing the energy results in greater periprocedural morbidity or complications. METHODS: Linear and logistic regression models were built to study the effect of energy delivery on outcome. The models controlled for age, gender, BMI, pre-operative quality of life and vein dimension. The outcomes were pain and analgesia requirement in week 1, change in disease specific quality of life (Aberdeen varicose vein questionnaire (AVVQ), change in generic quality of life (Short Form-36 (SF-36) and Euroqol (EQ5D)at week 1 and 6 and complication rates. The sample size calculation established that 115 patients would be required to detect any significant relationship. RESULTS: 232 patients were included. The mean (range) age was 50 (18-83) years. 63% were women. The mean (range) energy delivery was 89.8 (44.5-158.4) J/cm. There was no significant effect on any outcome related to increasing energy delivery. CONCLUSION: Up to 160 J/cm, increasing energy delivery has no significant effect upon the morbidity or complications of EVLT for superficial venous insufficiency.

Randomized clinical trial of co-amoxiclav versus no antibiotic prophylaxis in varicose vein surgery.

BACKGROUND: Wound infection rates of up to 16 per cent are reported following varicose vein surgery and the value of antibiotic prophylaxis in clean surgery remains unclear. METHODS: Some 443 patients undergoing varicose vein surgery randomly received a single prophylactic dose of 1.2 g co-amoxiclav (219 patients) or no antibiotic (224). Patients completed a wound diary on postoperative days 3, 5, 7, 9 and 10 using an adapted ASEPSIS method of wound assessment, and were reviewed after 14 days. RESULTS: Patients who had prophylaxis had lower ASEPSIS wound scores on days 3, 5 and 7 (P = 0.043, P = 0.032 and P = 0.003 respectively), and lower total ASEPSIS scores (median (interquartile range) 3 (0-9) versus 6 (0-15); P = 0.013). They were less likely to consult their general practitioner (16.0 versus 24.3 per cent; P = 0.040) or to receive postoperative antibiotics (4.7 versus 13.5 per cent; P = 0.002) for wound-related problems. Wound outcomes were worse with higher body mass index (odds ratio (OR) 0.92 (95 per cent confidence interval (c.i.) 0.87 to 0.97); P = 0.005) and current smoking (OR 0.5 (0.3 to 0.9); P = 0.033). Prophylactic antibiotics conferred satisfactory wound healing (OR 2.2 (95 per cent c.i. 1.3 to 3.6); P = 0.003). CONCLUSION: Antibiotic prophylaxis reduced wound-related problems after varicose vein surgery. Registration number ISRCTN12467340 (http://www.controlled-trials.com).

Randomized clinical trial of concomitant or sequential phlebectomy after endovenous laser therapy for varicose veins.

BACKGROUND: The management of residual varicosities following endovenous laser therapy (EVLT) for varicose veins is contentious. Ambulatory phlebectomy may be performed concomitantly with the initial EVLT, or sequentially as a secondary procedure. This randomized trial compared these two approaches. METHODS: Fifty patients with great saphenous varicose veins were randomized to EVLT alone or EVLT with concomitant ambulatory phlebectomies (EVLTAP). Principal outcomes were procedure duration, pain scores, requirement for secondary procedures and quality of life after 3 months. RESULTS: EVLTAP took longer, but significantly decreased the requirement for subsequent interventions. There was no impairment in immediate postprocedural pain, Short Form 36 or EuroQol 5D scores with EVLTAP. Median (i.q.r.) Venous Clinical Severity Score (VCSS) at 3 months was lower for EVLTAP than for EVLT alone (0 (0-1) versus 2 (0-2); P < 0.001), with lower Aberdeen Varicose Vein Questionnaire (AVVQ) scores at 6 weeks (7.9 (4.1-10.7) versus 13.5 (10.9-18.1); P < 0.001) and 3 months (2.0 (0.4-7.7) versus 9.6 (2.2-13.8); P = 0.015). At 1 year, there were no differences in VCSS or AVVQ scores. CONCLUSION: Concomitant phlebectomy with EVLT prolonged the procedure, but reduced the need for secondary procedures and significantly improved quality of life and the severity of venous disease.