Light microscopic observations of the ruminal papillae of cattle on diets with divergent forage to cereal ratios.

High levels of supplementation with cereal increases production rates in cattle but can increase incidence of disease, ranging from mild indigestion to acute ruminal acidosis and death. Therefore, there is motivation to determine biological markers which can be used to identify whether animals have been, or are being fed, sufficient or excessive cereals. This study aimed to describe light microscopic findings from animals being fed diverse dietary cereal proportions and to test the performance of a novel rumen epithelial scoring system. Rumen wall tissue samples were obtained from the abattoir from 195 cattle from 11 Scottish farms and processed for histological examination. Light microscopic examination was used to characterise ruminal epithelial response to dietary challenge. Secondary objectives included describing the distribution of immune-related cells in bovine ruminal epithelium and assessing the use of a modified Elastin Martius Scarlet Blue stain (EMSB) for histological examination of the rumen epithelium. Cells staining positive for cluster of differentiation 3 were distributed mainly in the lower layers of the stratum basale and were found in higher densities in animals offered lower cereal proportion diets. Cells staining positive for major histocompatibility complex class 2 (MHCII) were most common in perivascular locations and in the junction between the lower stratum basale and the propria-submucosa. The density of MHCII positive staining cells was higher in animals on lower cereal diets. The level of supplementation with cereal was also associated with the thickness of the stratum corneum (SCT) and stratum granulosum (SGT), the integrity of the stratum corneum and sloughing of cornified cells. There were no advantages in using EMSB stain over haematoxylin and eosin (H&E) in this scoring system. We concluded that a scoring system that included only SCT, SGT and a measure of the loss of appearance of intercellular space allowed differentiation of groups of animals according to the level of cereal supplementation.

A history of lameness and low body condition score is associated with reduced digital cushion volume, measured by magnetic resonance imaging, in dairy cattle.

Claw horn lesions (CHL) are the result of a failing of the functional anatomy of the hoof in dairy cows. The digital cushion is understood to be a vital structure in the prevention of CHL. Claw horn lesions have previously been shown to lead to pathological change to the pedal bone; however, their effects on the digital cushion are unknown. The primary aim of this study was to examine associations between the history of CHL through an animal's life and the structure of the digital cushion at slaughter using magnetic resonance imaging. The retrospective cohort study resulted in the scanning of 102 pairs of hindfeet, collected from adult Holstein dairy cows culled from a research herd, using a 3-Tesla research-grade magnetic resonance imaging scanner. Volume and fat measurements were calculated for each digital cushion within each claw from a modified Dixon Quant sequence. Animal-level variables were constructed around the animals' lactating lifetime, with lameness scores and body condition score collected at least every 2 wk. The combined volume of digital cushion in the lateral claws was used as the outcome variable in multivariable linear models. The volume of the digital cushion was negatively associated with the number of lameness events or CHL recorded. Furthermore, animals with body condition score >3, culled later in lactation, or of a greater body weight were more likely to have a higher volume of digital cushion in the lateral claws. We propose that the observations made in the current study are the effects of a range of factors broadly associated with genetic, developmental, and disease-related inputs. Our understanding of how we can select for genetically more robust animals and how we can precondition the hoof before first calving needs to be improved to reduce the risk of future CHL in adult dairy cattle. Furthermore, understanding optimal treatment regimens and their effect on hoof anatomy may reduce the recurrence of CHL in the current lactation and future lactations.

Postmortem observations on rumen wall histology and gene expression and ruminal and caecal content of beef cattle fattened on barley-based rations.

Sub-acute ruminal acidosis (SARA) can reduce the production efficiency and impair the welfare of cattle, potentially in all production systems. The aim of this study was to characterise measurable postmortem observations from divergently managed intensive beef finishing farms with high rates of concentrate feeding. At the time of slaughter, we obtained samples from 19 to 20 animals on each of 6 beef finishing units (119 animals in total) with diverse feeding practices, which had been subjectively classified as being high risk (three farms) or low risk (three farms) for SARA on the basis of the proportions of barley, silage and straw in the ration. We measured the concentrations of histamine, lipopolysaccharide (LPS), lactate and other short-chain fatty acids (SCFAs) in ruminal fluid, LPS and SCFA in caecal fluid. We also took samples of the ventral blind sac of the rumen for histopathology, immunohistopathology and gene expression. Subjective assessments were made of the presence of lesions on the ruminal wall, the colour of the lining of the ruminal wall and the shape of the ruminal papillae. Almost all variables differed significantly and substantially among farms. Very few pathological changes were detected in any of the rumens examined. The animals on the high-risk diets had lower concentrations of SCFA and higher concentrations of lactate and LPS in the ruminal fluid. Higher LPS concentrations were found in the caecum than the rumen but were not related to the risk status of the farm. The diameters of the stratum granulosum, stratum corneum and of the vasculature of the papillae, and the expression of the gene TLR4 in the ruminal epithelium were all increased on the high-risk farms. The expression of IFN-γ and IL-1ß and the counts of cluster of differentiation 3 positive and major histocompatibility complex class two positive cells were lower on the high-risk farms. High among-farm variation and the unbalanced design inherent in this type of study in the field prevented confident assignment of variation in the dependent variables to individual dietary components; however, the CP percentage of the total mixed ration DM was the factor that was most consistently associated with the variables of interest. Despite the strong effect of farm on the measured variables, there was wide inter-animal variation.

Undermining and bullying in surgical training: A review and recommendations by the Association of Surgeons in Training.

The 2012 General Medical Council National Trainees' Survey found that 13% of UK trainees had experienced undermining or bullying in the workplace. The Association of Surgeons in Training subsequently released a position statement raising concerns stemming from these findings, including potential compromise to patient safety. This article considers the impact of such behaviour on the NHS, and makes recommendations for creating a positive learning environment within the NHS at national, organisational, and local levels. The paper also discusses the nature of issues within the UK, and pathways through which trainees can seek help.

A cross sectional study of surgical training among United Kingdom general practitioners with specialist interests in surgery.

OBJECTIVES: Increasing numbers of minor surgical procedures are being performed in the community. In the UK, general practitioners (family medicine physicians) with a specialist interest (GPwSI) in surgery frequently undertake them. This shift has caused decreases in available cases for junior surgeons to gain and consolidate operative skills. This study evaluated GPwSI's case-load, procedural training and perceptions of offering formalised operative training experience to surgical trainees. DESIGN: Prospective, questionnaire-based cross-sectional study. SETTING/PARTICIPANTS: A novel, 13-item, self-administered questionnaire was distributed to members of the Association of Surgeons in Primary Care (ASPC). A total 113 of 120 ASPC members completed the questionnaire, representing a 94% response rate. Respondents were general practitioners practising or intending to practice surgery in the community. RESULTS: Respondents performed a mean of 38 (range 5-150) surgical procedures per month in primary care. 37% (42/113) of respondents had previously been awarded Membership or Fellowship of a Surgical Royal College; 22% (25/113) had completed a surgical certificate or diploma or undertaken a course of less than 1 year duration. 41% (46/113) had no formal British surgical qualifications. All respondents believed that surgical training in primary care could be valuable for surgical trainees, and the majority (71/113, 63%) felt that both general practice and surgical trainees could benefit equally from such training. CONCLUSIONS: There is a significant volume of surgical procedures being undertaken in the community by general practitioners, with the capacity and appetite for training of prospective surgeons in this setting, providing appropriate standards are achieved and maintained, commensurate with current standards in secondary care. Surgical experience and training of GPwSI's in surgery is highly varied, and does not yet benefit from the quality assurance secondary care surgical training in the UK undergoes. The Royal Colleges of Surgery and General Practice are well placed to invest in such infrastructure to provide long-term, high-quality service and training in the community.

Surgical training in primary care: consensus recommendations by the Association of Surgeons in Training.

Health service reconfigurations may result in increasing numbers of minor surgical procedures migrating from secondary care in hospitals to primary care in the community. Procedures may be performed by General Practitioners with a specialist interest in Surgery, or secondary care Surgeons who are sub-contracted to perform procedures in the community. Surgical training in such procedures, which are currently hospital based, may therefore be adversely affected unless surgical training also takes advantage of these opportunities. There is potential for surgical trainees to benefit from training in the community setting. ASiT supports the development of formal surgical training in the community setting for junior surgical trainees, providing high standards of patient care and training provision are ensured. Anticipated problems relating to the migration of surgical services to the community relate to the availability and quality assurance of training opportunities in primary care, its funding, including exposure to issues of indemnity cover for trainees, and also the release of surgical trainees from hospital duties in order to attend these training opportunities. These consensus recommendations set out a framework through which both patient care and training remain at the forefront of these continued service reconfigurations.

A pilot study of extralevator abdominoperineal excision for primary melanoma of the anorectum.

Melanoma of the anorectum represents <2 % of all anorectal cancers and 0.3 % of all primary melanomas. Prognosis is poor, and optimal surgical management is controversial. This series details the surgical management of patients with anorectal melanoma presenting between 2002 and 2013 to the Queen Elizabeth Hospital in Birmingham, UK, a tertiary referral centre for colorectal disease. A retrospective review of patient notes, histology reports, and clinical letters was used to assess perioperative course and long-term outcome of all surgical methods. Eight patients with a median age of 65.5 presented with primary anorectal melanoma during the study period. Six cases were staged as T4 pre-operatively, with two referred as incompletely excised polyps. All eight patients underwent abdominoperineal excision of the rectum (APER), with the most recent four cases undergoing extralevator APER. Clear resection margins were achieved in three out of the four patients in the extralevator APER group with no nodal spread detected at histological assessment. Extralevator APER appears to be feasible and safe in the treatment of melanoma of the anorectum, with 75 % medium-term survival (median 38 months) in selected patients. As it is known that clear margins at surgery are associated with disease-free survival, the wider excision margin at the level of the pelvic floor offered by extralevator APER could result in more favourable surgical outcomes in this prognostically poor malignancy.

Same-day assessment and management of urgent (2-week wait) colorectal referrals: an analysis of the outcome of 1606 patients attending an endoscopy unit-based colorectal clinic.

AIM: The Rapid Access Diagnosis and Remedy (RADAR) clinic combines 2-week wait (TWW) specialist consultation with 'straight-to-test' flexible sigmoidoscopy (FS) for left-sided 'red-flag' TWW criteria (excluding right-sided mass or iron-deficiency anaemia). The study aims were to determine the effectiveness of RADAR in differentiating colorectal cancer from benign disease and to evaluate the need for whole colonic investigation (WCI) following FS, in symptomatic patients. METHOD: Prospectively collated data of all RADAR patients from November 2005 to November 2009 were analysed, excluding patients referred internally for a FS. The local histology database was later interrogated to detect any missed cancers. RESULTS: Of 1690 patients (729 men; median (range) age: 68 (18-96) years) assessed in RADAR, 84 were excluded. Colorectal cancer (CRC) was diagnosed in 117 (7.3%). Eighty-seven cancers were diagnosed on the day of attendance and a further 13 within a week (88.9% overall). Two patients after a cancer-free FS were found to have a right-sided CRC on WCI (0.24%) and one synchronous cancer was found. No patient with a cancer-free FS having a WCI was subsequently found to have CRC at a median of 35 (12-58) months. CONCLUSION: Flexible sigmoidoscopy, in the context of an endoscopy unit TWW clinic, allows same-day diagnosis of most patients referred with left-sided symptoms, and immediate reassurance and treatment of most benign diagnoses. For these patients, the use of routine WCI following a cancer-free FS does not appear to be beneficial. Adopting this system would significantly reduce the number of barium enemas and colonoscopies currently performed.

Developing future surgical workforce structures: a review of post-training non-Consultant grade specialist roles and the results of a national trainee survey from the Association of Surgeons in Training.

The optimal workforce model for surgery has been much debated historically; in particular, whether there should be a recognised role for those successfully completing training employed as non-Consultant grade specialists. This role has been termed the 'sub-consultant' grade. This paper discusses historical and future career structures in surgery, draws international comparisons, and presents the results of a national trainee survey examining the post-Certificate of Completion of Training (CCT) non-consultant specialist grade. Junior doctors in surgical training (i.e. pre-CCT) were invited to participate in an electronic, 38-item, self-administered national training survey. Of 1710 questionnaires submitted, 1365 were appropriately completed and included in the analysis. Regarding the question 'Do you feel that there is a role in the surgical workforce for a post-CCT non-consultant specialist ("sub-consultant") grade in surgery?', 56.0% felt there was no role, 31.1% felt there was a role and 12.8% were uncertain. Only 12.6% of respondents would consider applying for such a post, while 72.4% would not and 15.0% were uncertain. Paediatric (23.3%), general (15.7%) and neurosurgery (11.6%) were the specialties with the highest proportions of trainees prepared to consider applying for such a role. For both questions, there was a significant gender difference in responses (p < 0.0001, Chi-square test) with female trainees more likely to consider applying. Overall 50.8% of respondents felt that the introduction of a post-CCT non-consultant specialist grade would impact positively upon service provision, however, only 21.6% felt it would have a positive impact on patient care, 13.9% a positive impact on surgical training, 11.1% a positive impact on the surgical profession and just 7.9% a positive impact on their surgical career. This survey indicates that the introduction of a 'sub-consultant' grade for surgeons who have completed training would be unpopular, with the majority believing it would be to the detriment of both patient care and surgical training. Changes to surgical career structures must be made in the interests of patient safety and quality, and on this basis ASiT supports the continued provision of primarily Consultant-delivered care.

The influence of socio-economic deprivation on rates of major lower limb amputation secondary to peripheral arterial disease.

OBJECTIVES: To investigate a hypothesised link between socio-economic deprivation and rates of major lower limb amputation within the catchment of a district general hospital in the United Kingdom. DESIGN: An analysis of a demographic database collated using patients identified by the OPCS codes for lower limb amputations. MATERIALS: All patients undergoing a lower limb amputation as a result of peripheral vascular disease, as identified by ICD-10 code, between January 2003 and January 2009 were included in the study. METHODS: A case-control study was undertaken, comparing the Index of Multiple Deprivation 2007 (IMD) scores of major lower limb amputees, to those of the catchment population. Multivariate analysis was not undertaken. RESULTS: A total of 327 patients underwent 445 lower limb amputations during the 6-year period. A comparative plot of cumulative frequency of IMD score in the catchment and amputation groups indicates greater numbers of major amputations in more deprived postcodes (P=0.004). The catchment population was further divided into population-matched deprivation quintiles. A significant increase in the number of amputations occurred in the two most deprived quintiles (OR (95%CI)=1.654 (1.121-2.440), P=0.011) CONCLUSIONS: This study indicates a positive association between increasing social deprivation and rates of lower limb amputation. If the most deprived quintiles are combined, this increase in amputation rates is approximately 65%. This inequity should be further investigated, and consideration given to targeted care within areas of greater social deprivation.

Correction of end colostomy prolapse using a curved surgical stapler, performed under sedation.

Acute stoma prolapse most commonly occurs following emergency surgery, frequently in patients with significant medical co-morbidities. Correction often requires re-laparotomy and resiting of the stoma, placing an already frail patient at risk of further morbidity. An elderly patient experienced an end colostomy prolapse 14 days following emergency laparotomy. A novel technique was employed using the CONTOUR curved stapling device to excise the prolapsed segment, under a brief period of intravenous sedation, thereby avoiding the sequelae of general anaesthetic. No complications were experienced, and the patient was deemed fit for discharge 5-days post re-intervention.

Sperm-mediated transformation of the honey bee, Apis mellifera.

Our primary objective was to identify techniques to transform the genome of the honey bee (Apis mellifera) with foreign DNA constructs. The strategy we adopted was to linearize foreign DNA and introduce it with sperm during the instrumental insemination of virgin queen honey bees. We analysed extracts from larvae within the same cohort and isolated the predicted fragment by means of PCR amplification of genomic DNA. Larvae that carried the construct also expressed the introduced DNA. We propagated several transgenic lines for up to three generations, which demonstrates its heritability. Once carried by a queen, the construct can be detected in that queen's larvae over several months. However, there was no evidence of integration of the construct, at least as determined by genomic Southern analysis. Nevertheless, this demonstrates the general viability of the technique for introduction of DNA, and it should be augmented by further use of transposable elements that enhance integration.

Sub-zero cooling synchronizes post-diapause development of codling moth, Cydia pomonella.

Sub-zero cooling treatments of -10 degree C and -15 degree C for 2-6 days were evaluated as a means of meeting the chilling requirement of diapause and to synchronize post-diapause development in larvae which were held in diapause for less than 6 months. Sub-zero cooling did not affect male longevity. After six months in diapause, diapause/cooled females were longer lived than diapause control females but not longer than non-diapause females. In general, diapause-cooled males passed more spermatophores than males from control diapause and non-diapause groups. In general, sub-zero cooling did not consistently affect fecundity and % egg hatch. Non-diapause females laid the most eggs after six months in diapause, and diapause-cooled females laid the most eggs after seven months in diapause. The duration of sub-zero cooling had a significant effect on post-diapause emergence in relation to the duration that the larvae were in diapause. Sub-zero cooling for 4 days at -10 degree C significantly reduced the number of days to adult emergence of larvae which had been in diapause for 0-4 months. Sub-zero cooling at -15 degree C for durations of 2, 4, and 6 days had more variable effects on emergence, but in most cases, sub-zero cooling reduced the amount of time to and span of adult emergence.

Correlation between limb length discrepancy and asymmetrical rearfoot position.

Ten subjects with a known limb length discrepancy were filmed with the two-dimensional Motion Analysis Foot Trak System; eight were filmed running and walking and two were filmed walking only. A control group of ten subjects with no measured limb length discrepancy was filmed in the same manner (eight walking and running and two walking only). The calcaneus-to-vertical angle was recorded for the entire stance gait cycle (heel contact to toe-off). Analysis of the data between the short and long side showed a significant difference in calcaneal position between the two sides at midstance, with the longer side being more everted by 3 degrees or greater than the short side in most cases. There was no significant difference in the calcaneus-to-vertical angle at heel contact between the long and short side. There was no significant difference between the calcaneus-to-vertical angles of the right and left sides of the ten control subjects, either walking or running.

Walking and hiking injuries. A one year follow-up study.

Injury patterns associated with walking and hiking activities were examined for all patients presenting to the clinic over a 1-year period. Among the patient group, the authors found that most injuries were unilateral, resulting from overuse, and occurred in the lower extremity, particularly in the foot, ankle, and knee. There are limited studies investigating walking and hiking injury rates in the general population. The results can be applied only to a small specific sample of the population.

Effect of extrinsic rearfoot posts on rearfoot position.

Twenty runners displaying abnormal subtalar joint pronation were selected for this study, the purpose of which was to investigate the effects of extrinsic rearfoot posted orthoses on frontal plane rearfoot and tibial position. Numerous temporal events were measured and compared for three different conditions: acrylic post, Birko post, and no post. The results suggested that rearfoot posts have a somewhat limited function in foot orthotic therapy and that the choice of posting material is of limited functional value.

The motion analysis system for dynamic gait analysis.

The research value of the Motion Analysis System, within its scope of limitations, is large and may allow the podiatrist to lend scientific data to support many areas that have been previously held to be of a theoretic or anecdotal basis. The whole concept of rearfoot control with orthoses is perhaps the most important of these. Podiatrists have been aware of the role of orthoses for years, but now there is the means to demonstrate these findings to other medical professions. The ability to compare a number of clinical variables is another truly useful feature. The Motion Analysis System and other similar equipment are not designed to replace or make obsolete the biomechanical examination and "trained human eye;" rather, they act to compliment these skills and to help bring the realm of podiatric biomechanics and orthotic therapy into the scientific arena.

Achilles tendon rupture. A protocol for conservative management.

The authors discuss surgical versus conservative management of closed Achilles tendon ruptures. They favor a conservative approach in most cases and present arguments to support this preference. They present a protocol for conservative management of closed Achilles tendon ruptures, which has been developed at the Center for Sports Medicine, Saint Francis Memorial Hospital, San Francisco.