Changes in management and outcome of patients with rectal cancer in Northern Ireland: 1996-2006.

AIM: This study aimed to document developments in rectal cancer services in a UK population and evaluate changes in outcome over a 10-year period. METHOD: Patients diagnosed with primary rectal carcinoma in 1996, 2001 and 2006 were identified by the Northern Ireland Cancer Registry. Data were retrospectively collected on presentation, investigation, treatment and staging. Differences over the period were analysed using the chi-squared test; Kaplan-Meier and Cox regression tests were used for survival analysis. RESULTS: After exclusions there were 636 patients, including 187 presenting in 1996, 203 in 2001 and 246 in 2006. The use of preoperative MRI of the rectum, endorectal ultrasound and abdominal CT increased during the study period. For patients treated by surgery, total mesorectal excision (TME) increased from 19% in 1996 to 64% in 2006 (P < 0.001). The use of radiotherapy (27% in 1996, 47% in 2006) and chemotherapy (21% in 1996, 32% in 2006) increased. The overall 5-year survival improved significantly between 1996 and 2006 from 34% in 1996 to 45% in 2006 (P = 0.02). Among patients having surgery, 5-year survival increased from 43% in 1996 to 63% in 2006 (P < 0.001). Multivariate analysis showed that the improvement in survival was associated with TME and chemotherapy, while radiotherapy was not. CONCLUSION: Survival of patients with rectal cancer in Northern Ireland has improved significantly over the last decade, probably due to the increased use of TME and chemotherapy.

The role of surgery for pancreatic cancer: a 12-year review of patient outcome.

INTRODUCTION: Pancreatic cancer has a poor prognosis with <5% alive at 5 years, despite active surgical treatment. The study aim was to review patients undergoing pancreatic resection and assess the effect of clinical and pathological parameters on survival. PATIENTS AND METHODS: All patients who had undergone radical pancreatic surgery, January 1996 to December 2008, were identified from the unit database. Additional information was retrieved from the patient records. The demographic, clinical, and pathological records were recorded using Microsoft Excel. Survival was assessed using Kaplan-Meier and predictors of survival determined by multinominal logistic regression and log rank test. RESULTS: 126 patients were identified from the database. The majority (106) had a Whipple's procedure, 14 had a distal pancreatectomy and 6 had local periampullary excision. The average age of the Whipple's group of patients was 61.7 years (± 11.7) with most procedures performed for malignancy (n=100). Survival was worse with adenocarcinoma compared to all other pathologies (p=0.013), while periampullary tumours had a better prognosis compared to other locations (p=0.019). Survival decreased with poorer differentiation (p=0.001), increasing pT (p<0.001) and pN stage (p<0.001). Survival was worse with perineural (p=0.04) or lymphovascular invasion (p=0.05). A microscopic postive resection margin (R1) was associated with a worse survival (p=0.007). Tumour differentiation (p=0.001) and positive nodal status (p<0.001) were found to be independent predictors of mortality. CONCLUSION: Tumour differentiation and nodal status are important predictors of outcome. A positive resection margin is associated with a poorer survival.

The effect of growth stage and growth temperature on high hydrostatic pressure inactivation of some psychrotrophic bacteria in milk.

The effect of high hydrostatic pressure on the survival of the psychrotrophic organisms Listeria monocytogenes, Bacillus cereus, and Pseudomonas fluorescens was investigated in ultrahigh-temperature milk. Variation in pressure resistance between two strains of each organism were studied. The effect of growth stage (exponential and stationary phase), growth temperature (8 and 30 degrees C) on pressure resistance, and sublethal pressure injury were investigated. Exponential-phase cells were significantly less resistant to pressure than stationary-phase cells for all of the three species studied (P < 0.05). Growth temperature was found to have a significant effect at the two growth stages studied. Exponential cells grown at 8 degrees C were more resistant than those grown at 30 degrees C, but for stationary-phase cells the reverse was true. B. cereus stationary-phase cells grown at 30 degrees C were the most pressure resistant studied. L. monocytogenes showed the most sublethal damage compared to B. cereus and P. fluorescens. B. cereus spores were more resistant to pressure than vegetative cells. Pressure treatment at 400 MPa for 25 min at 30 degrees C gave a 0.45-log inactivation. Pressure treatment at 8 degrees C induced significantly less spore germination than at 30 degrees C. This study indicates the importance of the history of a bacterial culture prior to pressure treatment and that bacterial spores require more severe pressure treatments, probably in combination with other preservation techniques, to ensure inactivation.

Survival of Escherichia coli O157:H7 during storage in pressure-treated orange juice.

The effect of a high-pressure treatment on the survival of a pressure-resistant strain of Escherichia coli O157:H7 (NCTC 12079) in orange juice during storage at 3 degrees C was investigated over the pH range of 3.4 to 5.0. The pH of shelf-stable orange juice was adjusted to 3.4, 3.6, 3.9, 4.5, and 5.0 and inoculated with 10(8) CFU ml(-1) of E. coli O157:H7. The orange juice was then pressure treated at 400 MPa for 1 min at 10 degrees C or was held at ambient pressure (as a control). Surviving E. coli O157:H7 cells were enumerated at 1-day intervals during a storage period of 25 days at 3 degrees C. Survival of E. coli O157:H7 during storage was dependent on the pH of the orange juice. The application of high pressure prior to storage significantly increased the susceptibility of E. coli O157:H7 to high acidity. For example, after pressure treatment, the time required for a 5-log decrease in cell numbers was reduced from 13 to 3 days at pH 3.4, from 16 to 6 days at pH 3.6, and from >25 to 8 days at pH 3.9. It is evident that the use of high-pressure processing of orange juice in order to increase the juice's shelf-life and to inactivate pathogens has the added advantage that it sensitizes E. coli O157:H7 to the high acid conditions found in orange juice, which results in the survival of significantly fewer E. coli O157:H7 during subsequent refrigerated storage.

Inactivation of Escherichia coli O157:H7 in orange juice using a combination of high pressure and mild heat.

The effect of high pressure on the survival of a pressure-resistant strain of Escherichia coli O157:H7 (NCTC 12079) in orange juice was investigated over the pH range 3.4 to 5.0. The pH of commercial, sterile orange juice was adjusted to 3.4, 3.6, 3.9, 4.5, or 5.0. The juice was then inoculated with 10(8) CFU ml(-1) of E. coli O157:H7. The inoculated orange juice was subjected to pressure treatments of 400, 500, or 550 MPa at 20 degrees C or 30 degrees C to determine the conditions that would give a 6-log10 inactivation of E. coli O157:H7. A pressure treatment of 550 MPa for 5 min at 20 degrees C produced this level of kill at pH 3.4, 3.6, 3.9, and 4.5 but not at pH 5.0. Combining pressure treatment with mild heat (30 degrees C) did result in a 6-log10 inactivation at pH 5.0. Thus, the processing conditions (temperature and time) must be considered when pressure-treating orange juice to ensure microbiological safety.

Cuticular metals: quantification and mapping by complementary techniques.

Metal-replete cuticle was characterised by back-scattered electron imaging, secondary ion mass spectrometry, proton induced X-ray emission and SEM-X-ray microanalysis. Each technique was found to have singular advantages and limitations for localising and quantifying metal content. Manganese and zinc were found coincident at the mandibular cutting edge of the leaf-cutting ant Atta sexdens; these two metals were found in different zones within jaws of the ragworm, Nereis virens; while only manganese was found in the jaws of the termite C. cumulans. Copyright 1997 Academic Press

An inexpensive electronic counting system for step tests.

A simple electronic counter was designed to count step test cadence. Foot pads, a controller and a counter were used to record the number of times the subject placed both feet on the top step. The electronics insured accurate counting by preventing double counts on one ascent and requiring weight to be put on both feet on the top step.

Effects of a supervised home exercise program on patients with severe chronic obstructive pulmonary disease.

The purpose of this study was to analyze the effects of a home exercise program on physical work capacity and dyspnea during activities of daily living in patients with severe chronic obstructive pulmonary disease. Twenty patients with severe respiratory impairment were assigned in a stratified, random manner to an Exercise Group (n = 10) or a Control Group (n = 10). Patients in the Exercise Group performed the supervised home exercise program of daily mobility, strengthening, and endurance exercises. Patients in the Control Group were visited regularly by a physical therapist but did not follow the exercise program. Six patients were eliminated from the study, either because of death (n = 1) or noncompliance with experimental conditions (n = 5), leaving each group with seven patients. The results of a progressive bicycle ergometer test after 18 weeks showed a significant between-group difference in physical work capacity. The physical work capacity of patients in the Exercise Group had improved 3% and had deteriorated 28% for patients in the Control Group (p less than .05). The symptom-limited multistage step test and the Chronic Respiratory Disease Questionnaire showed no difference in the patients' physical work capacity or dyspnea during ADL. Although not conclusive, this study yielded some evidence for the beneficial effects of home exercise training on patients with severe chronic obstructive pulmonary disease.

Exercise, age and the development of the myocardial vasculature.

Previous studies in experimental animals have indicated that physical activity can increase the extent of the myocardial vasculature but the optimal age, intensity, and duration of exercise that cause such modifications is not yet clear. The purpose of this study was to determine the effects of varying exercise intensity and duration on the myocardial vasculature of both prepubescent and postpubescent rats. Prepubescent animals were trained for 3 or 6 weeks at either a high or low exercise intensity beginning at 3 weeks of age. Postpubescent animals were trained in a similar manner beginning at 14 weeks of age. The high intensity exercise program administered prepubertally resulted in a significant increase in both the capillary density (25%) and the capillary to fibre ratio. The low intensity exercise program did not cause any modifications of the myocardial capillary density in the pre-pubescent animals. Postpubertally the high intensity 3 week exercise program caused a significant increase in the capillary density but no change in the capillary to fibre ratio. The low intensity exercise program did result in a significant degree of myocardial hypertrophy with a concomitant increase in capillary proliferation sufficient to maintain a constant capillary density. The results indicate that there may be a critical age related range of exercise intensity that is conducive to proliferation of the myocardial capillaries.

A mathematical model of speedskating performance improvement for goal setting and program evaluation.

An analysis of world class performance improvement over chronological time was used to develop mathematical curves of performance for each speedskating event. The equations were calculated using an unconstrained non-linear least squares iterative curve-fitting technique. A non-linear model was selected to satisfy the principle of diminishing returns, that is, it is more difficult to achieve a unit of performance improvement as performance approaches the theoretical limits of man. Minimum criteria of acceptance for each curve were: 1) the coefficient of determination must be 0.90; 2) the year 2000 predicted value must be less than the current world record; and 3) the curve must be progressive, i.e. satisfy the principle of diminishing returns. Satisfactory curves were calculated for seven of the eight male and female events studied. A four year Olympic cycle was noted and a definite change in performance trend was identified as occurring in the mid 1960's. The calculated mathematical curves can be used in three applications: 1) setting objective individual goals and evaluating these goals; 2) evaluating and comparing training programs on successive years; and 3) evaluating total programs.