Contamination by microplastics in oysters shows a widespread but patchy occurrence in a subtropical estuarine system.

Microplastics (MPs) have been widely documented in marine biota, with a notable presence in bivalve species. This study examines microplastic (MP) contamination in oysters across a subtropical estuarine system, revealing widespread and highly variable levels of contamination. Our results indicate a general trend of higher contamination in areas with greater anthropogenic impact, and unexpectedly high values in remote Marine Protected Areas, suggesting alternative sources of MPs. We observed a 94.31 % frequency of occurrence and an average contamination level of 8.16 ± 6.39 MP.ind-1, 1.06 ± 1.28 MP.g-1ww, and 7.54 ± 6.55 MP.g-1dw. Transparent fibers, predominantly composed of polyester and polyethylene from likely textile origins, were the most common. The findings underscore the significance of MP pollution in marine environments, even in protected zones. For enhanced spatial assessment and consistent data comparison, we recommend that future studies include MP quantities in terms of dry weight (MP.g-1dw) and biometric data such as size and weight.

Actions are characterized by 'canonical moments' in a sequence of movements.

Understanding what others are doing is an essential aspect of social cognition that depends on our ability to quickly recognize and categorize their actions. To effectively study action recognition we need to understand how actions are bounded, where they start and where they end. Here we borrow a conceptual approach - the notion of 'canonicality' - introduced by Palmer and colleagues in their study of object recognition and apply it to the study of action recognition. Using a set of 50 video clips sourced from stock photography sites, we show that many everyday actions - transitive and intransitive, social and non-social, communicative - are characterized by 'canonical moments' in a sequence of movements that are agreed by participants to 'best represent' a named action, as indicated in a forced choice (Exp 1, n = 142) and a free choice (Exp 2, n = 125) paradigm. In Exp 3 (n = 102) we confirm that canonical moments from action sequences are more readily named as depicting specific actions and, mirroring research in object recognition, that such canonical moments are privileged in memory (Exp 4, n = 95). We suggest that 'canonical moments', being those that convey maximal information about human actions, are integral to the representation of human action.1.

Production and meat quality traits of genetically lean immunocastrated pigs naturally divergent for loin tenderness.

Warner-Bratzler Shear Force (WBSF) is a quantitative measurement of meat toughness that has great impact on the consumer acceptability of meat. This study was conducted to evaluate growth performance, carcass and meat quality characteristics, and fatty acids profile of longissimus lumborum (LL) intramuscular fat (IMF) of pigs that are genetically divergent for WBSF. Based on WBSF values of the LL from a previous study, 12 immunocastrated male pigs selected from 96 pigs were divided into two groups with high WBSF (53.28 to 42.50 N) and low WBSF (37.27 to 27.79 N). Although high-WBSF pigs tended to have improved (P = 0.08) gain-to-feed ratio, overall performance was similar between WBSF groups. High-WBSF pigs also tended to have higher (P = 0.09) cooling loss and lean percentage as well as decreased (P = 0.08) 10th-rib backfat depth than low-WBSF pigs. Loins from high-WBSF pigs tended to have lower (P = 0.07) IMF content and higher (P = 0.09) cooking loss than low-WBSF pigs. Compared to low-WBSF pigs, IMF of the LL from high-WBSF pigs had lower (P = 0.05) percentage of oleic acid and tended to have a decreased (P = 0.07) percentage of total monounsaturated fatty acids. Loins from pigs with high WBSF tended to have increased (P = 0.09) total polyunsaturated fatty acids (PUFA) content and had higher (P = 0.03) PUFA: saturated fatty acid ratio than low-WBSF pigs. Selecting pigs for pork tenderness could potentially conflict with lean growth efficiency and a healthier fatty acids profile for human consumption.

Investigating variability among fisheries litter accumulation on beaches in Paraná, Brazil.

Fishing activities strongly influence coastal and marine environments and are responsible for generating marine litter. In southern Brazil, there are several artisanal (small-scale) fisher settlements that potentially contribute towards regional marine litter. The present study sought to address the deficit in available information by investigating the in situ contribution of artisanal fishing communities to marine litter on adjacent beaches. During one month in the 2019 austral winter, 200-m stretches of beach were investigated at four locations (three artisanal fishing and one control community) in Paraná state. In total, 2196 items were collected; among which only 104 (<5 %) were fisheries related and these remained partially independent of the presence of the three fishing communities across both small and large spatial scales (i.e., from m to km). Rather than the presence of fishing communities, fisheries-related litter appears to primarily originate from external sources and may regionally accumulate via natural vectors such as oceanic currents.

Development of a Swine Production Cost Calculation Model.

This paper aims to present a tool that offers pig producers a standard method to calculate and control their production costs and, consequently, provides the necessary information to guide strategic decision-making. Following these premises, a mathematical model to estimate swine production costs were developed using Microsoft Excel® software (version 2207). Case studies were used to assist in the characterization and construction of the model. Through the panel method, the tool was validated by professionals in the sector. Costs were considered according to the Neoclassical Economic Theory of Costs and allocated in the order of variable costs, fixed operating costs, and opportunity costs of capital and land. These costs together create the total cost. The model provides the total cost per batch, per market pig, per arroba, and per kilogram, which facilitates the interpretation of the results and economic evaluations of the system. The model is adaptable to different types of swine farming, as well as the consideration of all costs involved in the production system, whether explicit or implicit. The model developed has the potential to be used as a management tool in commercial swine production systems, assisting the producer in the decision-making process through the management and control of production costs.

Perceptions on the effectiveness of environmental education programs as environmental licensing tools for port-related enterprise in Brazil.

Environmental Education Programs (EEPs) are considered environmental management tools in Brazilian environmental licensing processes, within the scope of mitigatory and compensatory measures to the social, environmental, and economic impacts caused by development projects or new enterprises. Here, we assess the perceptions and expectations regarding environmental education programs of three groups of actors (communities, environmental managers, and environmental agency technicians) involved in the licensing processes of port activities in the region of Paranaguá, in the State of Paraná, Brazil. Paranaguá is the largest coastal municipality of the state of Paraná, in the southern region of Brazil, and is home to Brazil`s second largest port. Since this is environmental conservation area, the conflicts between the port activities, environmental protection and needs of the local communities require efficient environmental management practices, with EEPs as one of their main implementation tools. The evaluation was based on semi-structured interviews which were analyzed using the methods of content analysis and discourse of the collective subject. The actors understand that environmental education is a potentially effective tool to promote the mitigation or compensation of environmental impacts generated by port developments undergoing licensing processes. The groups considered that the continuity, promotion of social organization, and correlation with the actual environmental impacts related to each enterprise are essential qualities for good EEPs. The evaluated perceptions were complementary and indicate a complex but effective ideal scenario for EEPs in the region.

Daily environmental variation influences temporal patterns of marine debris deposition along an estuarine outlet in southern Brazil.

The influence of short-term (daily) variation in environmental conditions (rainfall, wind, tide, river flow) on debris accumulation was examined on two beaches at an estuarine outlet. Sampling occurred over 60 consecutive days along two sections (Internal Area, IA; and External Area, EA) of the Paranaguá Estuary Complex's southern outlet, in Paraná, southern Brazil. The IA is sheltered from direct wave action, whereas the EA is more exposed to wave and wind action from the open ocean. The IA accounted for 71% of the total debris, while the EA accounted for 29%. Debris abundance was highest after intermediate bouts of rainfall, although river flow only affected debris accumulation in the IA. Wind and tide influenced accumulation differently across sites. These results highlight the importance of short-term variation in the accumulation of marine debris on sandy beaches, which should be considered when designing and monitoring assessment programs and removal strategies.

Spray-dried porcine plasma improves feed intake of weaned piglets subjected to heat stress.

The objective of this study was to evaluate the effects of spray-dried porcine plasma (SDPP) on performance, measurement of thyroid hormones triiodothyronine (T3) and thyroxine (T4), body temperature and relative organ weights of weaned piglets exposed to a heat stress or a thermoneutral environment. One hundred and forty-four piglets with initial BW of 5.82 ± 0.33 kg (28 d old) were used. The experimental design was a 4 x 2 factorial arrangement, four plasma levels (0.0, 2.5, 5.0 and 7.5%) and two environments (34º [heat stress (HS)] and 24°C [thermoneutral (TN)]). SDPP was fed from weaning (28 d of age) to the end of the trial (piglets were weighed at the beginning, 7, 21 and 35 days of trial). Rectal, neck, shoulder and leg temperatures were measured every seven days. At 21 days of trial, one piglet per pen was slaughtered to determine the weight of the carcass and organs. Blood samples were collected at 18 and 35 days of trial to determine levels T3 and T4. The rectal, neck, shoulder and leg temperatures were increased (p < 0.05) 0.4, 1.5, 1.0 and 1.3ºC, respectively, and relative weight of the lungs (p < 0.05) and total T3 (p < 0.05) were decreased 0.001 kg/kg and 0.19 ng/dl, respectively, for pigs in the HS environment. The estimated inclusion of 5.1% of SDPP had the greatest (p < 0.05) weight gain during the first week, and throughout the nursery phase, the 5% of inclusion had a tendency of improvement (p = 0.075), regardless of ambient temperature. For the entire period, pigs reared in the HS environment had the greatest (p < 0.05) estimated feed intake by the quadratic regression with the inclusion of 4.3% of SDPP.

Influence of oceanographic and meteorological events on the quantity and quality of marine debris along an estuarine gradient.

The influence of three meteorological/oceanographic conditions - frontal systems (FS), high riverine discharges (HRD) and regular weather conditions (RWC) - over the quantity (Overall Abundance and Richness of types) and quality (composition and most probable source) of marine debris was assessed in sand beaches along three sectors (internal, I; median, M; and external, E) of an estuarine gradient. The highest overall abundance and richness of types were observed in HRD (I and E), while the lowest were observed in RWC (I and M). The external sector showed lowest abundance in FS. Greatest numbers of "domestic" and "sewage related debris" were observed under HRD (I > E > M). Greatest numbers of "fisheries" items were observed in HRD (I and E). For "unknown" sourced items, there was no indication of a single condition with smaller quantities (E > I = M). Results suggest that adopting oceanographical and meteorological conditions for analysis have the potential to detect temporal variations.

Developmental tasks, family structures and functions of selected Filipino families with young children: A cross-sectional study

Background@#The family life cycle describes the stages of family development starting from the formation of the emerging adults to marriage, birth of children, growth into adolescents, adulthood and families in later life. The cycle includes individual developmental changes of family members, evolution of marital relationship and cyclic development of the evolving family unit. Presently, there is no study that describes the developmental tasks, structures and functions of Filipino families with young children.@*Objective@#The objective of the study was to describe the developmental tasks, family structure and functions among selected Filipino families with young children.@*Methods@#A cross-sectional study was conducted from January to March 2016 on a total of 353 Filipino parents of families with young children ages 0-12 years old.@*Results@#The extended type of family (65%) is more predominant than the nuclear type (35%) among the participants. A high Family APGAR score of 9.2 (SD ± 1.1) translated to highly functioning families with young children. Overall, the first order changes on financing, marital adjustments and extended family relationships were highly met except that on the unexpected costs of family life. For second order changes, there was a significant association of decline in intimacy over time among couples progress thru the life stages (X2 12.75, p-value 0.013). Partners were able to adjust the marital relationship mainly through communication and acceptance. The parenting roles were done most of the time except for the roles on inspiring children for nationalism and providing wholesome educational materials. Finally, almost all families with young children (99%) were able to align relationship with extended family members.@*Conclusion@#The selected Filipino families with young children mostly have an extended family structure and are highly functional. Overall, the first and second developmental tasks were accomplished in varying degrees.

Transboundary movement of marine litter in an estuarine gradient: Evaluating sources and sinks using hydrodynamic modelling and ground truthing estimates.

Marine debris' transboundary nature and new strategies to identify sources and sinks in coastal areas were investigated along the Paranaguá estuarine gradient (southern Brazil), through integration of hydrodynamic modelling, ground truthing estimates and regressive vector analysis. The simulated release of virtual particles in different parts of the inner estuary suggests a residence time shorter than 5days before being exported through the estuary mouth (intermediate compartment) to the open ocean. Stranded litter supported this pathway, with beaches in the internal compartment presenting proportionally more items from domestic sources, while fragmented items with unknown sources were proportionally more abundant in the oceanic beaches. Regressive vector analysis reinforced the inner estuarine origin of the stranded litter in both estuarine and oceanic beaches. These results support the applicability of simple hydrodynamic models to address marine debris' transboundary issues in the land-sea transition zone, thus supporting an ecosystem transboundary (and not territorial) management approach.

Progression of varicose veins and chronic venous insufficiency in the general population in the Edinburgh Vein Study.

OBJECTIVE: The natural history in the general population of chronic venous disease in the legs is not well understood. This has limited our ability to predict which patients will deteriorate and to assign clinical priorities. The aims of this study were to describe the progression of trunk varicose veins and chronic venous insufficiency (CVI) in the general population, to identify important lifestyle and clinical prognostic factors, and to determine the relationship between venous reflux and progression. METHODS: The Edinburgh Vein Study is a population-based cohort study in which randomly selected adults aged 18 to 64 years had an examination at baseline. This included a questionnaire on lifestyle and clinical factors, standardized assessment and classification of venous disease in the legs, and duplex scan to detect venous reflux in eight segments of each leg. A follow-up examination 13 years later included a reclassification of venous disease to ascertain progression in the development or increase in severity of varicose veins and CVI. RESULTS: Among 1566 adults seen at baseline, 880 had a follow-up examination, of whom 334 had trunk varicose veins or CVI at baseline and composed the study sample. The mean (standard deviation) duration of follow-up was 13.4 (0.4) years. Progression was found in 193 (57.8%), equivalent to 4.3% (95% confidence interval [CI], 3.7-4.9) annually. In 270 subjects with only varicose veins at baseline, 86 (31.9%) developed CVI, with the rate increasing consistently with age (P = .04). Almost all subjects (98%) with both varicose veins and CVI at baseline deteriorated. Progression of chronic venous disease did not differ by gender or leg, but a family history of varicose veins and history of deep venous thrombosis increased risk (odds ratio [OR], 1.85 [95% CI, 1.14-1.30] and 4.10 [95% CI, 1.07-15.71], respectively). Overweight was associated with increased risk of CVI in those with varicose veins (OR, 1.85; 95% CI, 1.10-3.12). Reflux in the superficial system increased the likelihood of progression, especially in combination with deep reflux (OR, 2.57; 95% CI, 1.55-4.25) and when located in the small saphenous vein (OR, 4.73; 95% CI, 1.37-16.39). CONCLUSIONS: Nearly half of the general population with chronic venous disease deteriorated during 13 years, and almost one third with varicose veins developed skin changes of CVI, increasing their risk of ulceration. Age, family history of varicose veins, history of deep venous thrombosis, overweight, and superficial reflux, especially in the small saphenous vein and with deep reflux, might influence the risk of progression.

Incidence of chronic venous disease in the Edinburgh Vein Study.

BACKGROUND: Epidemiologic research in chronic venous disease has focused on prevalence and associated risk factors. Evidence on the risks and incidence that this condition will develop is limited. The aim of this study was to measure the incidence of new varicose veins and chronic venous insufficiency (CVI) in an adult population and to investigate risk factors associated with the development of these conditions. METHODS: The Edinburgh Vein Study is a cohort study of a random sample of the general population. Invitations were sent to 1456 men and women at baseline to participate in a 13-year follow-up examination. Each participant completed a questionnaire on lifestyle and medical history and underwent an examination that included clinical classification of venous disease. RESULTS: After a mean follow-up of 13.4 (standard deviation, 0.4) years, 880 of 1456 individuals participated (60.4% response). The overall incidence (95% confidence interval [CI]) of C2 varicose veins was 18.2% (15.2%-21.6%), giving an annual incidence rate of 1.4% (1.1%-1.7%), with incidence rates similar in men and women: the 13-year age-adjusted incidence of varicose veins was 15.2% (10.4%-20.0%) in men and 17.4% (13.1%-21.7%) in women (P = .97). The 13-year incidence of varicose veins increased consistently with age from 9.8% in those aged 18 to 34 years to 25.7% in those aged 55 to 64 years (P < .001). The 13-year incidence (95% CI) of CVI was 9.2% (7.0%-11.9%), and the annual incidence rate was 0.7% (0.5%-0.9%). The incidence of CVI was similar in men and women and increased consistently with age (P < .001). Participants with a family history of venous disease were more likely to develop C2 varicose veins (odds ratio, 1.75; 95% CI, 1.12-2.71). Obesity was associated with the development of CVI: the 13-year incidence (95% CI) was 6.1% (3.7%-9.6%) in those who were of normal weight and 23.6% (14.2%-37.0%) in obese participants, with an age-adjusted odds ratio of 3.58 (1.70-7.56). CONCLUSIONS: The Edinburgh Vein Study is one of a few cohort studies to report the incidence of varicose veins and CVI in the general population. The incidence of varicose veins and CVI did not differ significantly by sex and was strongly associated with increasing age. The risk of developing varicose veins was increased in those with a family history, and the risk of CVI was increased in those with higher body mass index.

Effects of playing a wind instrument on the occlusion.

INTRODUCTION: There is a popular belief among some musicians that playing a wind instrument regularly can affect the position of the teeth. The aim of this study was to investigate this hypothesis. METHODS: A cross-sectional observational study was carried out, comparing the occlusions of 170 professional musicians selected from 21 orchestras and organizations in the United Kingdom. The subjects were subdivided according to type of instrument mouthpiece and included 32 brass players with large cup-shaped mouthpieces, 42 brass players with small cup-shaped mouthpieces, and 37 woodwind players with single-reed mouthpieces. Fifty-nine string and percussion players formed the control group. Impressions were taken of the teeth of each subject, and occlusal parameters were assessed from the study casts. The results were analyzed by using analysis of variance (ANOVA) and chi-square tests. RESULTS: No statistically significant differences were found in overjet (P = 0.75), overbite (P = 0.55), crowding (maxillary arch, P = 0.31; mandibular arch, P = 0.10), irregularity index (maxillary arch, P = 0.99; mandibular arch, P = 0.16), and the prevalence of incisor classification (P = 0.15) between the wind instrument players and the control group. However, the large-mouthpiece brass group had a significantly higher prevalence of lingual crossbites in comparison with all other groups. CONCLUSIONS: Playing a wind instrument does not significantly influence the position of the anterior teeth and is not a major etiologic factor in the development of a malocclusion. However, playing a brass instrument with a large cup-shaped mouthpiece might predispose a musician to develop lingual crossbites or lingual crossbite tendencies.

Acquisition of 3-D arterial geometries and integration with computational fluid dynamics.

A system for acquisition of 3-D arterial ultrasound geometries and integration with computational fluid dynamics (CFD) is described. The 3-D ultrasound is based on freehand B-mode imaging with positional information obtained using an optical tracking system. A processing chain was established, allowing acquisition of cardiac-gated 3-D data and segmentation of arterial geometries using a manual method and a semi-automated method, 3D meshing and CFD. The use of CFD allowed visualization of flow streamlines, 2-D velocity contours and 3-D wall shear stress. Three-dimensional positional accuracy was 0.17-1.8mm, precision was 0.06-0.47mm and volume accuracy was 4.4-15%. Patients with disease and volunteers were scanned, with data collection from one or more of the carotid bifurcation, femoral bifurcation and abdominal aorta. An initial comparison between a manual segmentation method and a semi-automated method suggested some advantages to the semi-automated method, including reduced operator time and the production of smooth surfaces suitable for CFD, but at the expense of over-smoothing in the diseased region. There were considerable difficulties with artefacts and poor image quality, resulting in 3-D geometry data that was unsuitable for CFD. These artefacts were exacerbated in disease, which may mean that future effort, in the integration of 3-D arterial geometry and CFD for clinical use, may best be served using alternative 3-D imaging modalities such as magnetic resonance imaging and computed tomography.

Risk factors for chronic ulceration in patients with varicose veins: a case control study.

BACKGROUND/OBJECTIVE: Identifying which patients with varicose veins are at risk of progressing to more severe forms of chronic venous disease could help in assigning clinical priorities and targeting appropriate treatments. The aim of this study was to determine, in subjects with varicose veins, the characteristics of venous disease and other factors associated with an increased risk of ulceration. METHODS: One hundred twenty subjects with varicose veins and an open or healed venous leg ulcer were compared with 120 controls with varicose veins and no history of venous ulcer on this case control study. Subjects were recruited from hospital settings and primary care. Each subject completed a questionnaire on lifestyle and medical history and underwent an examination comprising of clinical classification of venous disease (CEAP), duplex scanning, quantitative digital photoplethysmography, and measurement of dorsiflexion. Multiple logistic regression analyses and calculation of receiver operating characteristic (ROC) curves were performed to identify the combination of factors which most accurately predicted which patients with varicose veins will develop leg ulcers. RESULTS: An increased risk of ulceration was associated with the severity of clinical venous disease, especially with the presence of skin changes (P < .0001). Other significant risk factors included history of deep vein thrombosis (DVT) (P = .001), higher body mass index (BMI) (P = .006), smoking (P = .009), and reflux in the deep veins (P = .0001). Ulceration was associated with reduced volume of blood displaced as reflected by photoplethysmography and a limited range of ankle movement (not wholly due to the effects of an active ulcer) (both P < .05). Multivariate analyses showed that skin changes including lipodermatosclerosis (odds ratio [OR] 8.90, 95% confidence interval [CI] 1.44-54.8), corona phlebectatica (OR 4.52, 95% CI 1.81-11.3) and eczema (OR 2.87, 95% CI 1.12-7.07), higher BMI (OR 1.08, 95% CI 1.01-1.15), and popliteal vein reflux (OR 2.82, 95% CI 1.03-7.75) remained independently associated with increased risk of ulceration while good dorsiflexion of the ankle (OR 0.88, 95% CI 0.81-0.97) and an effective calf muscle pump (OR 0.96, 95% CI 0.92-0.99) remained protective factors. ROC curve analyses indicated that a model based on clinical observation of skin changes, duplex scanning for popliteal reflux, and calf muscle pump tests would be the most accurate in determining which patients with varicose veins develop leg ulcers. CONCLUSIONS: The results of this study confirm that, in patients with varicose veins, those with skin changes of chronic venous insufficiency and deep vein incompetence are at greatly increased risk of ulceration. However, the risks may also be increased in those who smoke, are obese, and have restricted ankle movement and reduced calf muscle pump power.

Accelerating the transit time of barium sulphate suspensions in small bowel examinations.

PURPOSE: To determine whether hyperosmolar and effervescent agents proven individually to accelerate transit time in the barium small bowel examination have an additive effect when combined, surpassing that of either agent alone. MATERIALS AND METHODS: One hundred and forty-nine patients were randomised to four groups. Three hundred milliliters of barium sulphate alone was given to the first group. Fifteen milliliters of iodinated hyperosmolar contrast agent (Gastrografin, meglumine/sodium diatrizoate, Schering) was given in addition to barium sulphate to the second group while six packets of effervescent granules (Carbex, Ferring) were added for the third group. The final group was given a combination of both additives and barium sulphate. The time taken following ingestion for the contrast column to reach the caecum, as assessed by frequent interval fluoroscopy, was recorded. A subgroup of 32 patients were selected randomly from the four groups, 8 from each and assessed for quality of examination. Statistical assessments were made using Kruskal-Wallis and Mann-Whitney tests. RESULTS: One hundred and nineteen patients were analysed after exclusions. The addition of accelerant to barium sulphate, both individually and in combination significantly reduced the small bowel transit time (p<0.001). No significant difference existed between the additives when used with barium alone. The combined group had significantly faster transit times compared to the hyperosmolar group (p=0.02). Differences between combined and effervescent groups tended towards significance (p=0.09). No significant difference existed between groups when examination quality was assessed. CONCLUSION: These results suggest that the addition of combined effervescent and hyperosmolar agents to the barium suspension may significantly shorten the small bowel transit time without adversely affecting examination quality. This has implications for patient acceptability of the examination as well as potentially reducing screening time and therefore radiation dose.

Complementary role of helical CT cholangiography to MR cholangiography in the evaluation of biliary function and kinetics.

To explore the potential role of computed tomographic cholangiography (CTC) in relation to magnetic resonance cholangiography (MRC) in cases in which knowledge of biliary kinetics and functional information are important for therapeutic decisions, 31 patients (14 men and 17 women) underwent MRC followed by CTC. We examined nine post-cholecystectomy cases with right upper quadrant abdominal pain, six cases with a previous biliary-enteric anastomosis and clinical evidence of cholangitis, eight biliary strictures with pain or symptoms of cholangitis, four cases with strong clinical evidence of sclerosing cholangitis, three cases with suspected post-laparoscopic cholecystectomy bile leakage, and one case with chronic pancreatitis and a common bile duct stent associated with cholangitis. In relation to MRC, CTC provided additional biliary functional information as follows: abnormal biliary drainage through the ampulla in 7/9 cholecystectomy cases, impaired drainage in 3/6 biliary-enteric anastomoses, and complete obstruction in 2/8 biliary strictures. CTC diagnosed early sclerosing cholangitis in 4/4 cases and confirmed suspected bile leakage in 1/3 post-laparoscopic cholecystectomy patients, and the patency of the biliary stent in the patient with chronic pancreatitis. Thus, CTC provides clinically important information about the function and kinetics of bile and complements findings obtained by MRC.

Lifestyle factors and the risk of varicose veins: Edinburgh Vein Study.

The objective of this study was to determine the inter-relationships between a range of lifestyle factors and risk of varicose veins to identify which factors may be implicated in the etiology. An age-stratified random sample of 1566 subjects (699 men and 867 women) aged 18 to 64 years was selected from 12 general practices throughout Edinburgh. A detailed self-administered questionnaire was completed, and a comprehensive physical examination determined the presence and severity of varicose veins. The slightly higher age-adjusted prevalence of varicose veins in men than in women (39.7% versus 32.2%) was not explained by adjustment for an extensive range of lifestyle risk factors (male odds ratio [OR] 2.11, 95% confidence interval [CI] 1.51-2.96). In both sexes, increasing height showed a significant relationship with varicose veins (male OR 1.50, 95% CI 1.18-1.93 and female OR 1.26, 95% CI 1.01-1.58). Among women, body mass index was associated with an increased risk of varicose veins (OR 1.26, 95% CI 1.02-1.54). The current study casts doubt as to whether varicose veins occur predominantly in women. In addition, no consistent relationship with any lifestyle factor was shown. Self-reported evidence suggested a familial susceptibility, thereby warranting future genetic studies.

Patient, operative, and surgeon factors that influence the effect of superficial venous surgery on disease-specific quality of life.

BACKGROUND AND OBJECTIVE: Superficial venous surgery for CEAP 2 disease leads to an improvement in disease-specific quality of life (QoL) in the short term. However, which factors influence the magnitude of this improvement, how surgery affects QoL in patients with CEAP 4 to 6 disease, and whether this improvement is durable are not known. The objective of this study was to identify patient, operative, and surgeon factors that might influence the change in disease-specific QoL in the 2 years after superficial venous surgery. METHODS: This prospective study was comprised of 203 unselected, consecutive patients with CEAP 2 to 6 disease who underwent saphenous with or without subfascial endoscopic perforator surgery and who completed the Aberdeen Varicose Vein Symptoms Severity Score (AVVSSS) before surgery and at 4 weeks, 6 months, and 2 years after surgery. Univariate and multivariate analyses were performed. RESULTS: At baseline, recurrent and ulcer (CEAP 5 and 6) diseases were associated with a higher (worse) AVVSSS. Surgery was associated with a significant improvement in median (interquartile range [IQR]) AVVSSS: baseline, 17.8 (11.8 to 27.2); 4 weeks, 13.8 (7.9 to 21.3); 6 months, 9.6 (4.2 to 15.8); and 2 years, 8.1 (4.0 to 14.7). One hundred seventy-five patients (86%) at 6 months and 177 patients (87%) at 2 years reported an improvement in AVVSSS. Postoperative AVVSSS at both 6 months and 2 years was most significantly influenced by preoperative score (P <.0001). After adjustment for baseline AVVSSS, the following factors were identified in multivariate analysis as having a significant and independent positive (+) or negative (-) impact on AVVSSS: at 6 months, (-) recurrent disease (P =.009), (-) CEAP 4 disease (P =.026); and at 2 years, (+) long saphenous surgery (P =.02), (-) CEAP 5 disease (P =.030). CONCLUSION: In this unselected series, saphenous surgery with or without subfascial endoscopic perforator surgery led to an improvement in disease-specific QoL in 87% of patients out to 2 years. Although univariate analysis results suggested that many baseline factors might be associated with outcome, multivariate analysis results suggested that only surgery for recurrent disease and for CEAP 4/5 disease remained as significant negative, and only long saphenous surgery as significant positive, independent prognostic factors. These data provide evidence of the medium-term clinical effectiveness of venous surgery across the full spectrum of CEAP clinical grades, show the importance of multivariate analysis, and reemphasize the importance of minimization of recurrence.