Anterior translation of the tibia in relation to femur in mucoid degeneration of ACL - An observational study.

BACKGROUND: Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) are a well-known pathological entity.We have encountered several patients with MD of the ACL, found to have a anterior translation of tibia a exceeding 5 mm with an intact ACL. We studied this cohort and investigated the likely cause of this. METHODS: A retrospective search of our department's radiology system to identify all patients referred from the knee orthopaedic clinic for MR imaging over a span of 10 years. All patients had MD within the substance of the ACL and an intact ACL. We evaluated the degree of anterior translation of the tibia (ATT) in relation to the femur in mucoid degeneration of ACL. RESULTS: We identified 464 consecutive cases. The mean age was 52 years. There was a male predominance of 261 to 203 female. The average PTF measurement was 2.4 mm with a range of 0-20mm. Of the 464 cases, 3 397 patients had an insignificant ATT of < 5 mm. (0mm. 67. 67 67 patients had a ATT >5 mm. Of them, 32.8% had a ATT of 6 mm, 53.7% had a ATT range between 7 and 9 mm, with the remaining 13.4% above 9 mm in length. CONCLUSION: It is essential to look for other secondary signs of ACL tears and not only focus on ATT as well as correlate this with clinical findings.

National Survey Of The Aetiological Assessment Service Of Permanent Childhood Hearing Loss In Ireland

Aim The Universal Neonatal Hearing Screening Programme (UNHS) was implemented nationally in 2014. All infants identified with permanent childhood hearing loss (PCHL) should have a paediatric assessment performed. This survey aimed to assess available paediatric services and to inform service development. Methods All paediatricians involved in assessment of infants with PCHL were identified. A questionnaire was developed using the BAAP standards. Results were collated on excel. Results Thirty-three paediatricians assess children with PCHL, only 18% (6/33) had received specific training. Waiting time for assessment was beyond the recommended timeframe in the majority of cases (mean 14.4 weeks, range 2-52). Timely access to services such as MRI, genetics and ophthalmology was limited. Conclusion The survey highlights significant deficits in the paediatric component of the UNHS. A model of regionalisation with recommendations to improve the paediatric skill set, resources and supporting services is suggested.

Goats singly heterozygous for PRNP S146 or K222 orally inoculated with classical scrapie at birth show no disease at ages well beyond 6 years.

Scrapie is a transmissible spongiform encephalopathy of sheep and goats, and scrapie eradication programs in many parts of the world rely on strong genetic resistance to classical scrapie in sheep. However, the utility of putative resistance alleles in goats has been a focus of research because goats can transmit scrapie to sheep and may serve as a scrapie reservoir. Prior work showed that disease-free survival time was significantly extended in orally inoculated goats singly heterozygous for prion amino acid substitutions S146 or K222, but average durations were only around 3 years post-inoculation. The aim of this study was to investigate whether extended survival would exceed 6 years, which represents the productive lifetimes of most commercial goats. While all control homozygotes were clinically affected by an average of <2 years, none of the NS146 or QK222 goats developed clinical scrapie or had PrPSc-positive rectal biopsies. Several NS146 and QK222 goats developed other conditions unrelated to scrapie, but tissue accumulation of PrPSc was not detected in any of these animals. The NS146 heterozygotes have remained disease-free for an average of 2734days (approximately 7.5 years), the longest duration of any classical scrapie challenge experiment with any genotype to date. The QK222 heterozygotes have remained disease-free for an average of 2450days (approximately 6.7 years), the longest reported average duration for QK222 goats challenged with classical scrapie. This research is ongoing, but the current results demonstrate S146 and K222 confer strong resistance to classical scrapie in goats.

The effect of purse-string approximation versus linear approximation of ileostomy reversal wounds on morbidity rates and patient satisfaction: the 'STOMA' trial.

BACKGROUND: Ileostomy reversal is associated with surgical site infection (SSI) rates as high as 37%. Recent literature suggests that employing a purse-string approximation (PSA) of the reversal wound reduces this rate of SSI. Thus we wished to perform a randomised controlled trial to compare SSI rates in purse-string versus linear closure (PLC) wounds following ileostomy reversal. METHODS: A randomised, controlled trial was conducted at University Hospital Limerick. Sixty-one patients undergoing ileostomy reversal were included. Thirty-four patients were randomised to PSA and 27 patients to linear closure. The primary endpoint was incidence of SSI and secondary endpoints measured were quality of life and satisfaction with cosmesis. Statistical analysis was performed on a per protocol basis using SPSS version 22.0. RESULTS: Three patients in the PSA group developed an SSI compared to 8 in the PLC group at 30 days (8 vs 30%, p = 0.03). The mean time to SSI diagnosis was faster in the PSA group (3 vs 12.3 days, p = 0.08). Patients who developed SSI experienced a longer mean length of stay (6.8 vs 11.4 days, p = 0.012). On multivariate analysis, PLC was the only predictive factor of SSI formation (p < 0.001). There was no difference in patient satisfaction between the two study groups (p = 0.14). CONCLUSIONS: PSA of wounds following ileostomy reversal significantly reduces SSI formation compared to linear approximation without any effect on patient satisfaction.

Neoadjuvant therapy does not affect lymph node ratio in rectal cancer.

AIMS: Recently, lymph-node ratio (LNR) has emerged as a prognostic tool in staging rectal cancer. Studies to date have demonstrated threshold values above and below which survival is differentially altered. Neoadjuvant therapy significantly reduces the number of lymph node retrieved. The aim of the present study was to determine the effect of neoadjuvant therapy on LNR and its prognostic properties. METHODS: Consecutive patients who underwent curative rectal cancer resections in a single institution from 2007 to 2010 were reviewed. LNR was stratified into five subgroups of 0, 0.01-0.17, 0.18-0.41, 0.42-0.69 and 0.7-1.0 based on a previous study. The effect of neoadjuvant therapy on lymph node retrieval, LNR, locoregional (LR) and systemic recurrence (SR), disease-free (DFS) and overall survival (OS) was compared between patients who did (Neoadjuvant) and did not (Surgery Alone) receive neoadjuvant therapy. RESULTS: Neoadjuvant and Surgery Alone groups were comparable in gender, age and tumour stage. The number of lymph nodes retrieved were significantly lower in the Neoadjuvant group (p < 0.01). However, LNR remained similar in both groups (p = 0.36). There was no statistical difference in the DFS and OS between the Neoadjuvant and Surgery Alone groups at the various LNR cut off values in patients with AJCC Stage 3 tumours. CONCLUSIONS: LNR ratio remains unaltered despite reduced lymph node retrieval after neoadjuvant therapy in rectal cancer. LNR may therefore be a more reliable prognostic indicator in this subgroup of patients.

Vertical rectus abdominis myocutaneous flap and quality of life following abdominoperineal excision for rectal cancer: a multi-institutional study.

BACKGROUND: To obtain a clear surgical margin, abdominoperineal excision (APE) for rectal cancer frequently leaves a large perineal defect surrounded by irradiated tissue. A vertical rectus abdominis myocutaneous (VRAM) flap may facilitate healing of this wound. The current study aims to determine the effect of VRAM flap perineal reconstruction following APE on patient quality of life (QOL). METHODS: This is a retrospective cohort study from a prospectively collected database. Data on QOL were assessed via telephone questionnaire using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30, EORTC QLQ-C29 and the Cleveland Clinic QOL questionnaires. RESULTS: Twenty-seven patients underwent primary perineal closure, and 12 patients underwent a VRAM flap perineal reconstruction. The mean duration of follow-up was 16.8 months. Overall, there was no significant difference in the Cleveland Clinic QOL score between groups (VRAM vs. no VRAM: 0.7 ± 0.2 vs. 0.7 ± 0.2, p 0.735). Patients in the VRAM group had lower levels of fatigue (5.5 ± 9.9 vs. 23.6 ± 19.2, p 0.004). Patients in the VRAM group had reduced sore skin scores around the stoma site (11.0 ± 16.2 vs. 31.8 ± 31.1, p 0.036). VRAM flap was associated with an increased incidence of abdominal wall hernia (VRAM vs. no VRAM: 25 % vs. 0 %, p 0.024). CONCLUSIONS: This study is limited by its non-randomized retrospective design and relatively small sample size. A significant difference in patient QOL was not demonstrated between VRAM flap and primary perineal closure after APE for rectal cancer. Further studies in this area are warranted.

Overall survival is improved in mucinous adenocarcinoma of the colon.

INTRODUCTION: Debate persists regarding the relationship between mucin expression and outcome in colon cancer. This arises due to discrepancy in the definition of mucinous adenocarcinoma and the combination of both colon and rectal cancers in analyses. This study examines the relationship between increased mucin production and outcomes in colon cancer. METHODS: Cases were classified according to the World Health Organization classification of mucinous adenocarcinoma of the colon. Accordingly, tumors were categorized as either (a) mucinous adenocarcinoma of the colon (greater than 50% of the extracellular matrix occupied by mucin) or (b) non-mucinous adenocarcinoma of the colon. Overall survival and disease-free survival were calculated. A stepwise Cox proportional hazards regression model was employed to determine the risk of death/disease recurrence. Kaplan-Meier estimates of overall survival and disease-free survival were plotted for each group and compared using a log-rank test. RESULTS: On univariate analysis, mucinous adenocarcinoma was associated with reduced risk of death (P = 0.01). On multivariate analysis, mucinous adenocarcinoma was also associated with reduced risk of death (hazard ratio (HR) 0.33, 95% confidence interval (CI) 0.14-0.79, P = 0.01). Kaplan-Meier estimates confirmed improved rate of survival in the mucinous vs. non-mucinous group (P = 0.01). Mucinous adenocarcinoma did not affect disease-free survival (HR 0.75, 95% CI 0.46-1.21, P = 0.22). A comparison of Kaplan-Meier estimates for systemic recurrence demonstrated significant increases in systemic recurrence in the group with no mucin production (P = 0.04) but not for locoregional recurrence (P = 0.24). CONCLUSIONS: Histopathological evidence of mucinous adenocarcinoma in colon cancer is associated with improved outcomes.

Early quality of life outcomes following Doppler guided transanal haemorrhoidal dearterialisation: a prospective observational study.

BACKGROUND AND AIMS: There are few studies examining the quality of life (QOL) of patients with haemorrhoidal disease. Transanal heamorrhoidal dearterialization (THD) is a treatment modality for heamorrhoidal disease in which a Doppler transducer is used to locate the supplying arteries that are subsequently ligated. The aim of this study was to assess symptoms and QOL changes following THD. PATIENTS AND METHODS: This was a prospective evaluation of QOL and symptom changes following THD. Patient symptoms, demographics and QOL were recorded preoperatively and 1-month post-operatively following THD using the medical outcomes study short-form-36 (SF-36). RESULTS: Thirteen patients undergoing THD were evaluated. One month following THD symptoms of haemorrhoid protrusion, bleeding, anal pain, painful defaecation, constipation and tenesmus, had all significantly reduced (P <0.05). Limitations in usual role activities because of physical health problems (53.8 +/- 10.5 Vs 90.4 +/-4.5, P = 0.004), vitality, energy and fatigue (45 +/- 6.9 Vs 73.5 +/- 5.0, P= 0.003), general mental health, psychologic distress and wellbeing (60.9 +/- 6.9 Vs 83.1 +/- 5.9, P= 0.023), limitations in social activities because of physical or emotional problems (58.7 +/- 8.8 Vs 84 +/- 5.9, P = 0.025), and physical pain (52.9 +/- 7.9 Vs 84.6 +/- 6.4, P= 0.005) scores had all improved 1-month following THD. CONCLUSIONS: THD significantly reduces symptoms of haemorrhoidal disease and improves specific aspects of QOL 1-month following surgery.

Performance of Boer-Spanish and Spanish goats in Texas I: Body weights, fertility, prolificacy, and number of kids weaned.

Production records from 291 Boer-Spanish and Spanish does, collected between 1994 and 2004 in the Edwards Plateau region of West Texas, were examined to compare Boer-Spanish and Spanish does for body weights, fertility, prolificacy, and number of kids weaned. Traits were analyzed using single-trait mixed models. Boer-Spanish does were heavier at birth than Spanish does (2.79 vs. 2.67 kg, P = 0.05) but similar weight at weaning (15.2 vs. 15.0 kg, P = 0.59). Boer-Spanish does had a heavier body weight at breeding than Spanish does (46.5 vs. 43.5 kg, P < 0.01). Boer-Spanish does had similar fertility over 8 annual breeding seasons (0.87 vs. 0.84, P = .22). Boer-Spanish does had an advantage over Spanish does for fertility to a 30-d breeding season (0.53 vs. 0.48; P = .09). Boer-Spanish does produced more kids than Spanish does (1.70 vs. 1.62, P = .09). Boer-Spanish does weaned a similar number of kids (1.30 vs. 1.31, P = .76). Age of doe significantly affected (P < 0.05) both number of kids born and number of kids weaned, with older does giving birth to, and weaning, more kids. Boer-Spanish does had greater birth weight, body weight at breeding, and number of kids born than Spanish does. Boer-Spanish does had a similar number of kids weaned as Spanish does.

Growth and feed conversion efficiency of Dorper and Rambouillet lambs.

Data from Dorper and Rambouillet ram lambs (n = 79) were used to estimate breed means for postweaning growth rate, feed intake, feed conversion efficiency (kilograms of gain divided by kilograms of feed consumed), and residual feed intake on a high concentrate diet during the typical age and weight range for U.S. lamb production. Lambs were progeny of 6 unrelated sires/breed and were born over a 2-yr period. Dams of the lambs were a representative sample of Dorper ewes in the United States and Rambouillet ewes in Texas. Data were analyzed using SAS PROC MIXED with a model that included year, breed, birth type, and feeder pen as fixed effects and sire as a random effect. The mean BW at the start of the feeding trial was 31.4 ± 3.7 kg at a mean age of 92.7 ± 9.2 d. Electronic feeders were used to record individual animal feed intake. Growth rate and feed intake were measured for 77 d during the postweaning growth period. Mean ADG was 340 ± 9.2 g for Dorper lambs and 346 ± 8.6 g for Rambouillet lambs. The mean final bodyweight was 58.1 ± 4.8 kg when the mean age was 170 d. Average daily feed intake was 2,223 ± 50 g for Dorper lambs and 2,215 ± 48 g for Rambouillet lambs. Feed conversion efficiency was 0.153 ± 0.003 for Dorper lambs and 0.158 ± 0.003 for Rambouillet lambs. No significant differences were observed between Dorper and Rambouillet lambs for weaning weight, postweaning gain, final weight, feed intake, feed conversion efficiency, or residual feed intake. Growth rate, feed intake, and feed conversion efficiency were similar for Dorper and Rambouillet ram lambs fed from a mean of 31 kg BW and 93 d of age to a mean BW of 58 kg and a mean age of 170 d.

Beware the contracted gallbladder - Ultrasonic predictors of conversion.

INTRODUCTION: Pre-operative ultrasound is the gold standard pre-operative investigation for patients undergoing a cholecystectomy. Ultrasound provides a sensitive approach for analysing characteristics of the gallbladder. Thus, we aimed to examine the importance of ultrasonic gallbladder characteristics on laparoscopic cholecystectomy conversion rates and then sought to devise a pre-operative predictive score for conversion based on our findings. METHODS: A retrospective analysis of patients undergoing a laparoscopic cholecystectomy was performed between January 2000 and December 2006. Patient demographic data and pre-operative imaging results from abdominal ultrasounds were analysed. We then devised a pre-operative predictive score for conversion based on independent variables derived from multivariate analysis. RESULTS: A total of 1061 patients underwent a laparoscopic cholecystectomy. Conversion to an open procedure was required in 58 cases. The overall conversion rate was 5.4%. Univariate analysis revealed male gender (p < 0.0001), gallbladder wall thickness >4 mm (p = 0.0024), a contracted gallbladder (p = 0.005) and a dilated CBD (p = 0.0416) as being significantly associated with conversion. These variables were then evaluated using multivariate analysis and three variables, namely, male gender, a contracted gallbladder and a thickened gallbladder wall were identified as independent predictors. A pre-operative predictive score for conversion was devised from a training cohort (n = 761) and tested on a sub-cohort (n = 300). Patients with a score of 2 or more had a 19.2% risk of conversion (p < 0.001). CONCLUSION: Conversion to an open cholecystectomy shows a strong associated with gallbladder ultrasonic characteristics which are available pre-operatively. The likelihood of conversion can be accurately predicted using a pre-operative scoring system.

Effect of fat content and homogenization under conventional or ultra-high-pressure conditions on interactions between proteins in rennet curds.

The objective of this study was to investigate the influence of conventional and ultra-high-pressure homogenization on interactions between proteins within drained rennet curds. The effect of fat content of milk (0.0, 1.8, or 3.6%) and homogenization treatment on dissociation of proteins by different chemical agents was thus studied. Increasing the fat content of raw milk increased levels of unbound whey proteins and calcium-bonded caseins in curds; in contrast, hydrophobic interactions and hydrogen bonds were inhibited. Both homogenization treatments triggered the incorporation of unbound whey proteins in the curd, and of caseins through ionic bonds involving calcium salts. Conventional homogenization-pasteurization enhanced interactions between caseins through hydrogen bonds and hydrophobic interactions. In contrast, ultra-high-pressure homogenization impaired hydrogen bonding, led to the incorporation of both whey proteins and caseins through hydrophobic interactions and increased the amount of unbound caseins. Thus, both homogenization treatments provoked changes in the protein interactions within rennet curds; however, the nature of the changes depended on the homogenization conditions.

Genetic structure and diversity among sheep breeds in the United States: identification of the major gene pools.

Understanding existing levels of genetic diversity of sheep breeds facilitates in situ and ex situ conservation activities. A comprehensive evaluation of US sheep breeds has not been previously performed; therefore, we evaluated the genetic diversity among and within 28 US sheep breeds. Both major and minor breeds were included in the analysis and consisted of 666 animals from 222 producers located in 38 states. The level of within-breed genetic diversity was variable and not dependent upon status of a breed as a major or minor breed. Bayesian cluster analysis indicated the breeds were grouped more by physiological differences (meat vs. wool production) rather than geographic origin. Results suggest several actionable items to improve in situ and ex situ conservation. The results clearly identify breeds in need of increased in situ and ex situ management (e.g., Hog Island and Karakul) and allow several suggestions for in situ management of flocks. Conversely, several of the breeds appear genetically similar and therefore require less emphasis on collecting germplasm samples for the gene bank. Commercially important breeds (e.g., Rambouillet and Suffolk) were found to have substantial variation, which should enable breeders to proceed, unencumbered by genetic diversity concerns, with selection strategies that maximize profit.

Rectum-conserving surgery in the era of chemoradiotherapy.

BACKGROUND: A complete pathological response occurs in 10-30 per cent of patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy (CRT). The standard of care has been radical surgery with high morbidity risks and the challenges of stomata despite the favourable prognosis. This review assessed minimalist approaches (transanal excision or observation alone) to tumours with a response to CRT. METHODS: A systematic review was performed using PubMed and Embase databases. Keywords included: 'rectal', 'cancer', 'transanal', 'conservative', 'complete pathological response', 'radiotherapy' and 'neoadjuvant'. Original articles from all relevant listings were sourced. These were hand searched for further articles of relevance. Main outcome measures assessed were rates of local recurrence and overall survival, and equivalence to radical surgery. RESULTS: Purely conservative 'watch and wait' strategies after CRT are still controversial. Originally used for elderly patients or those who refused surgery, the data support transanal excision of rectal tumours showing a good response to CRT. A complete pathological response in the T stage (ypT0) indicates < 5 per cent risk of nodal metastases. CONCLUSION: Rectal tumours showing an excellent response to CRT may be suitable for local excision, with equivalent outcomes to radical surgery. This approach should be the subject of prospective clinical trials in specialist centres.

Pharmacokinetic differences in exposure to camphor after intraruminal dosing in selectively bred lines of goats.

A pharmacokinetic dosing study with camphor was used to determine whether selection lines of high-juniper-consuming goats (HJC, n = 12) and low-juniper-consuming goats (LJC, n = 12) differed in their respective disposition kinetics. Postdosing plasma camphor concentrations were used to examine whether a timed single blood sample collected after intraruminal administration of camphor would be a useful screening test to aid in the identification of HJC. Yearling female Boer x Spanish goats (n = 24) received a single intraruminal dose of monoterpene cocktail (0.270 g/kg of BW) containing 4 different monoterpenes that represented their composition previously reported for Ashe juniper (Juniperus ashei). Camphor, the predominant monoterpene in Ashe juniper, was 49.6% of the mix and was the monoterpene analyzed for this study. Blood samples were taken at 15 time points from 0 to 8 h after dosing. Concentrations of camphor were measured in plasma using solid phase extraction and gas chromatography/flame-ionization detection analysis. Maximal plasma concentration of camphor was greater for LJC than HJC (P = 0.01), and area under the curve extrapolated to infinity was greater for LJC than HJC (P < 0.01). Total systemic exposure (area under the curve) to camphor was 5 times less in HJC goats. We conclude that 1) HJC goats possess internal mechanisms to reduce the bioavailability of camphor, and 2) a blood sample taken at 45 min or at 60 min after intraruminal administration of camphor may be useful for identifying HJC individual animals from within large populations of goats.

Heritability of juniper consumption in goats.

Data from goats (n = 505), collected over a 4-yr period, were used to estimate the heritability of juniper consumption. Juniper consumption was determined by near-infrared spectroscopy on fecal samples (n = 1,080) collected from female Boer-cross goats grazing pastures with a variety of plants, including juniper. The animals with records were progeny of 72 sires. Individual goats had from 1 to 4 observations over a 4-yr period. Predicted juniper consumption for individual observations ranged from -5 to +62% of the diet. Data were analyzed with a mixed model that included management group as a fixed effect, BW as a covariate, and permanent environment, animal, and residual as random effects. Management group was a significant source of variation. Least squares means of juniper consumption, as a percentage of the total intake, for management groups varied from 19 to 47%. Heritability of juniper consumption was 13%. Repeatability of juniper consumption was 31%. These results suggest that progress to selection for goats that will consume greater amounts of juniper is obtainable, but is expected to be slow.

Proxy assessment of quality of life in patients with prostate cancer: how accurate are partners and urologists?

OBJECTIVES: To assess the ability of partners and clinicians to make proxy judgements on behalf of patients with prostate cancer relating to selection of life priorities and quality of life (QoL). DESIGN: 47 consecutive patients with histologically proven adenocarcinoma, and their partners, were recruited. The partners were asked to assess, by proxy, the QoL of the patient by completion of a series of interview-led questionnaires assessing global QoL (SEIQoL-DW), health-related QoL (FACT-P) and overall QoL (visual analogue score [VAS]). The patients' clinicians were asked to complete the SEIQoL-DW and VAS by proxy as soon as possible after a consultation with the patient. SETTING: Patients with histologically proven adenocarcinoma, their partners and their clinicians. MAIN OUTCOME MEASURES: Proxy scores for SEIQoL-DW, FACT-P and VAS, as provided by partners and clinicians. RESULTS: 25 partners made a proxy assessment of the patients. The results showed that partners were able to select similar QoL cues to those of the patients (Spearman-Rank correlation 0.89). Comparison of the QoL scores obtained from patients and partners in proxy using the questionnaires showed no statistically significant difference (paired t-test). Urologists were poor predictors of areas of life (cues) that were important to their patients. The doctors overemphasized the importance of survival, postoperative complications, urinary symptoms, sexual ability, activities of daily living and finance, but underestimated the importance of wife, family, home and religion. Comparison of the QoL scores obtained from patients and urologists by proxy showed a significantly lower score when assessed by urologists using the SEIQoL-DW questionnaire. CONCLUSIONS: Partners are able to accurately assess, by proxy, the areas of life that are of importance to patients. Clinicians, however, who are charged with making decisions on behalf of patients, are very poor judges of their patients' life priorities and QoL. This illustrates that conventional views held by most doctors regarding the priorities patients set themselves when planning treatment should be called into question and consequently suggests that the way in which doctors and patients arrive at treatment decisions must be reviewed.