Using genomic prediction to detect microevolutionary change of a quantitative trait.

Detecting microevolutionary responses to natural selection by observing temporal changes in individual breeding values is challenging. The collection of suitable datasets can take many years and disentangling the contributions of the environment and genetics to phenotypic change is not trivial. Furthermore, pedigree-based methods of obtaining individual breeding values have known biases. Here, we apply a genomic prediction approach to estimate breeding values of adult weight in a 35-year dataset of Soay sheep (Ovis aries). Comparisons are made with a traditional pedigree-based approach. During the study period, adult body weight decreased, but the underlying genetic component of body weight increased, at a rate that is unlikely to be attributable to genetic drift. Thus cryptic microevolution of greater adult body weight has probably occurred. Genomic and pedigree-based approaches gave largely consistent results. Thus, using genomic prediction to study microevolution in wild populations can remove the requirement for pedigree data, potentially opening up new study systems for similar research.

Does liquid tissue adhesive increase satisfaction with wound and stoma management after surgery?

OBJECTIVE: This pilot study reviews the impact of tissue adhesive to seal skin wounds in elective large bowel resections where a stoma is fashioned. METHOD: Patients undergoing elective colorectal resection over six-month period were prospectively evaluated for wound infections rates, length of inpatient stay and patient satisfaction with their wound and stoma management. The wounds were observed for 30 days in both inpatient and outpatient settings. A patient satisfaction questionnaire was used with respect to the stoma and wound management. RESULTS: Fifty patients undergoing elective colorectal resection over a six-month period were prospectively evaluated. The median patient ages were 63.5 years (40-83) for males and 60 years (33-85) for females. Ninety-two per cent of the patients found their wound management satisfactory (overall satisfaction score >5, where 5 represents 'high satisfaction'). Eighty-six per cent reported a stoma management satisfaction score of >4 (where for 4 represents 'satisfaction'). Stoma site leakage was reported by 16%, but none of these developed a SSI. Two patients who had laboratory-confirmed SSI; they had an average length of inpatient stay of 18 days compared with 6.5 days for patients without SSI. . CONCLUSION: Liquid tissue adhesive provides a flexible, water-resistant and protective coating which increases the satisfaction and ease of surgical wound and stoma management. We recommend a randomised controlled trial be conducted to evaluate these results in larger cohorts.

Stability of antioxidants in an apple polyphenol-milk model system.

The stability of antioxidants in an apple polyphenol-milk model system was examined. The model system consisted of skim milk fortified with pH-neutralised apple polyphenols (AP, 0-200mg per 100ml milk), with or without ascorbic acid (100mg per 100ml milk). Physical and chemical changes were evaluated after thermal treatment (120°C, 5min) and oxidative storage (20°C and 38°C, up to 12 weeks). Antioxidant capacity was determined using both oxygen radical absorbance capacity (ORAC) assay and ferric reducing antioxidant power (FRAP) assay. Significant antioxidant capacity was detected in the presence of milk. Antioxidant capacity was retained during thermal treatment but decreased slowly during storage. The concentration of ascorbic acid decreased rapidly, and was close to zero after 2-week storage at 38°C or 10-week storage at 20°C. The brownness of the polyphenol-milk system increased over storage duration of 0-12 weeks; this effect was retarded by the addition of ascorbic acid. This high polyphenol-milk has demonstrated good physical stability.

Is laparoscopically assisted radical vaginal hysterectomy for cervical carcinoma safe? A case control study with follow up.

OBJECTIVE: To compare a new surgical approach, laparoscopically assisted radical vaginal hysterectomy (LARVH) with open radical hysterectomy in women with cervical cancer. Can selected women benefit from the minimally invasive approach without compromising safety (recurrence rate) and morbidity (complications)? DESIGN: Retrospective case control study. SETTING: A tertiary referral unit for gynaecological malignancies. POPULATION: Thirty women undergoing LARVH were included and compared with 30 women undergoing open radical surgery. The control group was matched for age, body mass index and disease stage. METHODS: Retrospective collection of data from patient files and follow up. MAIN OUTCOME MEASURES: Recurrence rate, complication rate, hospital stay, nodal counts, blood loss, operating time. RESULTS: Recurrence rates were equal (6.7%). There was one death, in the LARVH group. Follow up was mean 31 months in the LARVH group and 30.9 months in the open group. Blood loss as measured by mean drop in haemoglobin was greater in the open group (2.03 versus 3.01 g/dl, P = 0.02). Transfusions were given in 40% of women in the open group and 16.7% in the LARVH group. Hospital stay was significantly less in the LARVH group (5.9 versus 7.8 nights, P = 0.003). Mean operating time was longer in the LARVH group (131 versus 187 minutes P = 0.0001). Mean nodal counts did not differ significantly (17.4 in open vs 14.8 in LARVH, P > 0.05). There were seven perioperative complications in the open group and four in the LARVH group. There have been two recurrences in each group (6.67%) at mean follow up of 31 (LARVH) and 30.9 (open) months. CONCLUSIONS: The first 30 LARVH procedures performed in this unit are comparable in terms of safety (recurrence rate and complication rate) and economic factors (shorter hospital stay mitigating longer operating time). Further development of this technique is warranted.

Abnormal uterine bleeding: an evaluation endometrial biopsy, vaginal ultrasound and outpatient hysteroscopy.

Abnormal uterine bleeding is a common gynaecological symptom. Whilst most patients have benign disease, thorough investigation is necessary, particularly in the peri- and post-menopausal woman. Hysteroscopy with directed biopsy of suspicious lesions is the gold standard investigation but it is invasive and is not offered in all units as an outpatient procedure. Ultrasound and outpatient biopsy techniques may allow patients to be triaged to select those who require formal evaluation by hysteroscopy. We assessed the records of 100 consecutive referrals to the outpatient hysteroscopy clinic at the Royal Maternity Hospital, Belfast. In order to develop a nomogram for the investigation of women with abnormal bleeding patterns, we compared ultrasound/biopsy diagnoses with hysteroscopy/biopsy diagnosis. Pre- and peri-menopausal patients, and post-menopausal patients taking hormone replacement therapy should be investigated further if the endometrial thickness is more than 10 mm, if endometrial biopsy is abnormal, or if symptoms are recurrent. Similarly, post-menopausal patients not taking hormone replacement therapy with an endometrial thickness of 5 mm or more should be referred for hysteroscopy.

Going the distance: how far will women travel to undergo free mammography?

This study examined the effect of travel distance on mammography facility choice, with mammography cost held constant. Women who were eligible to undergo free mammography at a military treatment facility (MTF) responded to a mail survey by indicating whether their last mammograms were performed at an MTF (for free) or at a civilian medical facility (for a fee). The distance from each respondent's home to the MTF was also recorded. Analyses indicated that a majority of the women who traveled to the MTF for a mammogram lived within 20 miles of the facility. Results of this study suggest that, even if mammography screening is offered free of charge, women may not use the service if they must travel more than 20 miles to receive it. Furthermore, any MTF trying to increase its TRI-CARE market share may want to focus its marketing efforts on individuals who live within a 20-mile radius.

Teleoncology in the Department of Defense: a tale of two systems.

Two telemedicine networks were developed for the purpose of conducting multidisciplinary oncology ("teleoncology") conferences. The infrastructure of each system differed: one system was Internet-based; the other was delivered via Integrated Services Digital Network (ISDN) lines. The purpose of this study was to describe the infrastructure and cost, consultative process, technical aspects, and conference format of the two teleoncology programs. The two systems' technical aspects, participant satisfaction with the systems, and conference participation were compared qualitatively. Assessment of the technical aspects of the systems suggested that each had distinct advantages. Survey results indicated that provider satisfaction with the technical and logistical aspects of each type of teleoncology conference was high. The present study may prove helpful for individuals who are considering implementing their own teleoncology programs.

Trans-cervical resection of the endometrium: the first four years' experience at the Belfast City Hospital.

We have evaluated the quality of service provided in performing trans cervical resection of the endometrium (TCRE) in the treatment of women presenting with menstrual dysfunction. Of the 78 patients who underwent TCRE, ten had, at the time of writing, subsequently undergone hysterectomy. A chart review was carried out on those patients. Two others were on the waiting list for hysterectomy. Sixty-one of 68 (90%) patients responded to the postal questionnaires. Of these, 50 (82%) were satisfied with the result of the procedure. Twenty-three (38%) were rendered amenorrhoeic. Thirty-eight still had bleeding, but of these, 19 (31%) had very light regular periods and 13 (21%) had only an occasional stain. Overall, 90% of women felt that there had been an improvement in their bleeding. Six (10%) women claimed that there had been no improvement. TCRE is a safe and effective alternative to hysterectomy or medical treatment for the treatment of menstrual dysfunction.

Accuracy of five electronic pedometers for measuring distance walked.

This is a three-part study that examined the accuracy of five brands of electronic pedometers (Freestyle Pacer, Eddie Bauer, L.L. Bean, Yamax, and Accusplit) under a variety of different conditions. In Part I, 20 subjects walked a 4.88-km sidewalk course while wearing two devices of the same brand (on the left and right side of the body) for each of five different trials. There were significant differences among pedometers (P < 0.05), with the Yamax, Pacer, and Accusplit approximating the actual distance more closely than the other models. The Yamax pedometers showed close agreement, but the left and right Pacer pedometers differed significantly (P = 0.0003) and the Accusplit displayed a similar trend (P = 0.0657). In Part II, the effects of walking surface on pedometer accuracy were examined. Ten of the original subjects completed an additional five trials around a 400-m rubberized outdoor track. The devices showed similar values for sidewalk and track surfaces. In Part III, the effects of walking speed on pedometer accuracy were examined. Ten different subjects walked on a treadmill at various speeds (54, 67, 80, 94, and 107 m.min-1). Pedometers that displayed both distance and number of steps were examined. The Yamax was more accurate than the Pacer and Eddie Bauer at slow-to-moderate speeds (P < 0.05), though no significant differences were seen at the fastest speed. While there are variations among brands in terms of accuracy, electronic pedometers may prove useful in recording walking activities in free-living populations.

Abdominal ultrasound can be helpful in diagnosis of obscure small bowel haemorrhage.

A case of severe gastrointestinal bleeding occurring from a rare, pedunculated and ulcerated small bowel leiomyoma is reported. The possibilities of preoperative diagnosis in an intermittent gastrointestinal bleeding case, including abdominal ultrasound and small bowel meal are discussed.

Controversies in the management of malignant melanoma.

Early recognition and treatment of malignant melanoma may lead to a better prognosis. Lesions < 0.76 mm thick need only simple excision. There is little evidence that prophylactic lymphadenectomy is of benefit in advanced lesions. Multiple small recurrences can be effectively treated using the carbon dioxide laser.

Branched chain amino acids as the protein component of parenteral nutrition in cancer cachexia.

A prospective randomized trial was conducted to determine the effects of branched chain amino acids (BCAA) as the protein component of total parenteral nutrition (TPN) on protein kinetics in patients with intraabdominal adenocarcinoma. Nine malnourished patients were given both conventional TPN containing 19 per cent BCAA (AA) and isocaloric, isonitrogenous TPN containing 50 per cent BCAA (BCAA-TPN), in random order. Both [13C]leucine and [14C]tyrosine were employed as tracers to avoid the potential bias due to the different amino acid composition of the two TPN solutions. With BCAA-TPN, leucine and tyrosine flux increased significantly from (mean +/- s.d.) 158.0 +/- 37.2 to 243.5 +/- 75.8 mumol kg-1 h-1 (P less than 0.025) and from 35.0 +/- 8.4 to 42.6 +/- 11.0 mumol kg-1 h-1 (P less than 0.05) respectively. Leucine oxidation was significantly higher on BCAA-TPN (24.1 +/- 6.3 on AA versus 68.3 +/- 37.1 mumol kg-1 h-1, P less than 0.025) while tyrosine oxidation was significantly lower (3.7 +/- 1.8 mumol kg-1 h-1 on AA versus 2.5 +/- 2.0 mumol kg-1 h-1 on BCAA-TPN, P less than 0.05). Whole body protein synthesis and breakdown was significantly higher on BCAA-TPN by the tyrosine tracer (31.3 +/- 7.3 on AA versus 40.1 +/- 9.3 mumol kg-1 h-1, P less than 0.025 and 33.0 +/- 8.4 on AA versus 41.3 +/- 11.1 mumol kg-1 h-1, P less than 0.05) respectively. Using the leucine tracers both synthesis and breakdown were increased, but not significantly, from 133.8 +/- 40.0 to 175.3 +/- 65.1 mumol kg-1 h-1 and from 127.9 +/- 33.6 to 167.7 +/- 71.2 mumol kg-1 h-1 respectively. The fractional albumin synthetic rate increased significantly on BCAA-TPN from 4.3 +/- 2.9 on AA to 8.0 +/- 5.1 per cent per day (P less than 0.05). The reduction in tyrosine oxidation, suggesting improved protein utilization, coupled with an increase in protein and albumin synthesis, strongly support a positive benefit from BCAA-TPN in cancer cachexia.

Resting energy expenditure in the critically ill: estimations versus measurement.

A prospective trial was conducted in 20 surgical intensive care unit patients receiving mechanical ventilation to compare estimates of resting energy expenditure (REE) with the measured values. The 12 women and 8 men (mean age 61.7 +/- 2.8 (s.e.m.) years) underwent a full nutritional assessment before measurement of their REE by indirect calorimetry using the MGM II metabolic cart (Utah Medical). Their REE was estimated by the Harris-Benedict formula (mean 1324 +/- 53 (s.e.m.) kcal/day) as well as an empirical formula (where empirical formula = 22 x body weight in kg) (1370 +/- 68 (s.e.m.) kcal/day). Results by either estimate were not statistically different from the measured resting energy expenditure (MREE) (1382 +/- 130 (s.e.m.) kcal/day), by one-way analysis of variance. No multiplication factors were needed to relate the Harris-Benedict formula to MREE in this critically ill population and the estimate by the empirical formula was as good and simpler to perform. Although values by the Harris-Benedict formula and empirical formula correlated significantly with MREE (P less than 0.05) the correlation coefficients were low: 0.48 and 0.45 respectively. Thus, mean estimates were excellent for the group but less predictive for the individual. Multiple linear regressions did reveal that body composition and metabolic stress were of greater predictive value, since an equation relating weight (P less than 0.003), sex (P less than 0.003), white blood cell count (P less than 0.003) and 24-h urinary creatinine excretion (P less than 0.05) could predict 76 per cent of the variation (r = 0.87) in the MREE with an overall significance of P = 0.0002. Given the importance of matching energy intake to needs in many critically ill patients who are mechanically ventilated, accurate measurement of the REE is recommended now that instrumentation is equal to the task.

Immediate resection in emergency large bowel surgery: a 7 year audit.

In a consecutive series of 153 emergency admissions with large bowel disease during a 7 year period, 49 per cent were for colonic obstruction, 46 per cent for peritonitis and 5 per cent for miscellaneous conditions. Urgent operation was performed on 104 (68 per cent) patients. Of those operated upon, 82 (79 per cent) had a primary resection with a mortality rate of 12.2 per cent, intraperitoneal sepsis rate of 2.4 per cent and wound sepsis rate of 7.3 per cent. The median postoperative hospital stay was 21 days. An immediate anastomosis was performed in 46 (56 per cent) patients with a mortality rate of 8.7 per cent, anastomotic leak rate of 2.2 per cent, and wound sepsis rate of 8.7 per cent. The median postoperative hospital stay was 19 days. The mortality in patients presenting with large bowel emergencies is related to age and advanced malignant disease. Immediate resection is applicable in over 80 per cent of patients requiring urgent operation and morbidity can be low and treatment economical. Immediate anastomosis after proximal colonic resection is safe and the use of intra-operative colonic irrigation permits a primary anastomosis in selected patients after emergency resection of the distal colon.