Clinical outcomes and inflammatory response to single-incision laparoscopic (SIL) colorectal surgery: a single-blinded randomized controlled pilot study.

AIM: Single-incision laparoscopic (SIL) surgery is expanding, but its benefits, efficacy and safety compared with conventional laparoscopic (CL) surgery remain unclear. This pilot study examined clinical outcomes and biochemical markers of inflammation for colorectal resections by SIL and CL in a randomized controlled pilot trial. METHOD: Fifty patients undergoing elective colorectal resection were randomized to either SIL or CL. Primary outcomes were operating time and length of stay (LoS); secondary outcomes included combined length of scars, pain scores, complications, Quality of Life EQ5D-VAS and the inflammatory markers interleukin-6 (IL-6), IL-8 and C-reactive protein (CRP) at baseline, 2, 6, 24 and 72 h. RESULTS: There was no difference in age, gender, body mass index, indications and site of surgery, American Society of Anesthesiologists grade or incidence of previous surgery between the groups. Except for one conversion from SIL to open surgery, surgery was completed as intended. No difference between SIL and CL was found for operating time [median 130 (72-220) vs 130 (90-317) min, respectively, P = 0.528], LoS [median 4 (3-8) vs 4 (2-19)days, P = 0.888] and time to first flatus [2 (1-4) vs 2 (1-5) days, P = 0.374]. The combined length of scars was significantly shorter for SIL [4 (2-18) vs 7 (5-8) cm, P < 0.001]; in each group, four postoperative complications occurred (16%). Postoperative pain scores were similar [mean 7.67 (interquartile range 4) vs 7.25 (interquartile range 3.75), P = 0.835] to day 3. EQ5D-VAS was no different for both groups at discharge [72.5 (40-90) vs 70 (30-100), P = 0.673] but slightly higher for CL at 3 months [79 (45-100) vs 90 (50-100), P = 0.033].The IL-6, IL-8 and CRP levels between both groups showed similar peaks and no significant differences. CONCLUSION: SIL colorectal surgery by experienced laparoscopic surgeons appears to be safe and equivalent to CL, with no discernible difference in its effect on the physiological response to surgical trauma.

The effect of education plus access on perceived fruit and vegetable consumption in a rural African American community intervention.

African Americans have an increased risk of cardiovascular disease partly due to low fruit and vegetable consumption. This article reports the results of an intervention to provide nutrition education and access to fruits and vegetables through community gardens to change dietary behaviors among African Americans in rural Missouri. Cross-sectional surveys evaluated the intervention effect on blood pressure, body mass index (BMI), and perceived fruit and vegetable consumption in this quasi-experimental study with a comparison group. Hypertension (OR = 0.52, 95% CI: 0.38-0.71) and BMI (OR = 0.73, 95% CI: 0.52-1.02) were lower in the intervention county at mid-intervention. Participation in nutrition education (OR = 2.67, 95% CI: 1.63-4.40) and access to fruits and vegetables from a community garden (OR = 1.95, 95% CI: 1.20-3.15) were independently associated with perceived fruit and vegetable consumption. The strongest effect on perceived fruit and vegetable consumption occurred with high participation in nutrition education and access to community gardens (OR = 2.18, 95% CI: 1.24-3.81). Those with access but without education had a reduced likelihood of consuming recommended servings of fruits and vegetables (OR = 0.57, 95% CI: 0.34-0.95). Education plus access interventions may be best at increasing consumption of fruits and vegetables in a rural African American population.

Environmental and lunar cues are predictive of the timing of river entry and spawning-site arrival in lake sturgeon Acipenser fulvescens.

The associations were quantified between daily and interannual variation in the timing of a closed population of lake sturgeon Acipenser fulvescens migration and arrival at spawning sites with stream environmental and lunar covariates. Spawning data were gathered from 1262 fish in Black Lake, Michigan 2001 to 2008 and by video monitoring 2000 to 2002. Sex-specific variation in responses to external cues was also tested. Results showed that a greater number of individuals initiated migration from lake to riverine habitats at dawn and dusk relative to other times of the day. Current and lagged effects of water temperature and river discharge, and periods in the lunar cycle were important variables in models quantifying movements into the river and timing of adult arrival at spawning sites. Different suites of covariates were predictive of A. fulverscens responses during different periods of the spawning season. The timing of initiation of migration and spawning, and the importance of covariates to the timing of these events, did not differ between sexes. Stream flow and temperature covaried with other variables including day length and the lunar cycle. Anthropogenic disruption of relationships among variables may mean that environmental cues may no longer reliably convey information for Acipenseriformes and other migratory fishes.

Extensive non-redundancy in a recently duplicated developmental gene family.

BACKGROUND: It has been proposed that recently duplicated genes are more likely to be redundant with one another compared to ancient paralogues. The evolutionary logic underpinning this idea is simple, as the assumption is that recently derived paralogous genes are more similar in sequence compared to members of ancient gene families. We set out to test this idea by using molecular phylogenetics and exploiting the genetic tractability of the model nematode, Caenorhabditis elegans, in studying the nematode-specific family of Hedgehog-related genes, the Warthogs. Hedgehog is one of a handful of signal transduction pathways that underpins the development of bilaterian animals. While having lost a bona fide Hedgehog gene, most nematodes have evolved an expanded repertoire of Hedgehog-related genes, ten of which reside within the Warthog family. RESULTS: We have characterised their evolutionary origin and their roles in C. elegans and found that these genes have adopted new functions in aspects of post-embryonic development, including left-right asymmetry and cell fate determination, akin to the functions of their vertebrate counterparts. Analysis of various double and triple mutants of the Warthog family reveals that more recently derived paralogues are not redundant with one another, while a pair of divergent Warthogs do display redundancy with respect to their function in cuticle biosynthesis. CONCLUSIONS: We have shown that newer members of taxon-restricted gene families are not always functionally redundant despite their recent inception, whereas much older paralogues can be, which is considered paradoxical according to the current framework in gene evolution.

Relative information from thermal infrared imagery via unoccupied aerial vehicle informs simulations and spatially-distributed assessments of stream temperature.

Stream temperature is a measure of water quality that reflects the balance of atmospheric heat exchange at the air-water interface and gains or losses of water along a stream reach. In urban areas, stormwater sewers deliver water with varying magnitude and temperature to streams at variable timescales. Understanding the impacts of stormwater through space and time is therefore difficult to do with conventional approaches like in situ sensors. To study the impacts of stormwater on creek water temperatures, we combined in situ water temperature observations with thermal infrared (TIR) imagery collected via unoccupied aerial vehicle (UAV). Imagery was collected in May, June, and July of 2017. As ongoing work with UAV-based TIR suggests that this imagery is prone to poor accuracy, we focused on creating several data products beyond absolute water temperatures that can be used to assess temporal and spatial water temperature variations. In particular, TIR data products were used to extract the length of the observed stormwater plume as well as the width of the creek cross-section impacted by stormwater. From these values, we conclude that relatively narrow stormwater plumes affecting a small fraction of creek width can alter creek water temperatures for considerable distances downstream. We also applied TIR data to constrain results of a deterministic stream temperature model (HFLUX 3.0) that simulates the physical processes affecting stream heat exchanges. Stormwater plume lengths obtained from TIR imagery were used to refine spatially-distributed simulations, demonstrating that relative temperature information obtained from UAV imagery can provide useful calibration targets for stream temperature models. Overall, our work demonstrates the added value of UAV datasets for understanding urban stream temperatures, calibrating water quality models, and for modeling and monitoring of the impact of spatially explicit hydrologic processes on stream temperature.

Role of renal aquaporins in escape from vasopressin-induced antidiuresis in rat.

The purpose of this study was to investigate whether escape from vasopressin-induced antidiuresis is associated with altered regulation of any of the known aquaporin water channels. After 4-d pretreatment with 1-deamino-[8-D-arginine]-vasopressin (dDAVP) by osmotic mini-pump, rats were divided into two groups: control (continued dDAVP) and water-loaded (continued dDAVP plus a daily oral water load). A significant increase in urine volume in the water-loaded rats was observed by the second day of water loading, indicating onset of vasopressin escape. The onset of escape coincided temporally with a marked decrease in renal aquaporin-2 protein (measured by semiquantitative immunoblotting), which began at day 2 and fell to 17% of control levels by day 3. In contrast, there was no decrease in the renal expression of aquaporins 1, 3, or 4. The marked suppression of whole kidney aquaporin-2 protein was accompanied by a concomitant suppression of whole kidney aquaporin-2 mRNA levels. Immunocytochemical localization and differential centrifugation studies demonstrated that trafficking of aquaporin-2 to the plasma membrane remained intact during vasopressin escape. The results suggest that escape from vasopressin-induced antidiuresis is attributable, at least in part, to a vasopressin-independent decrease in aquaporin-2 water channel expression in the renal collecting duct.

Plasminogen activator system in oral squamous cell carcinoma.

BACKGROUND: The plasminogen activator system consists of two plasminogen activators, urokinase (uPA) and tissue (tPA); PA inhibitors (PAI-1, and -2), and a cell surface receptor for uPA (uPAR). The plasminogen activator system is involved at many stages of the metastatic cascade, including matrix remodelling, cell proliferation, and migration. AIMS: To compare tissue concentrations of the components of the plasminogen activator system in paired tumour tissue and normal tissue in patients with oral squamous cell carcinoma, and to correlate these with the histopathological grading of the tumour. METHODS: Thirty-eight paired tissue samples were analysed by enzyme-linked immunosorbent assays (ELISA; ng/mg protein) for uPA, tPA, uPAR, PAI-1, and PAI-2. RESULTS: Concentrations of uPA, uPAR, PAI-1, and PAI-2 were significantly higher in tumour than in normal oral tissue (median in uPAR tumour 1.6 (range; 0.1-7.5) ng/mg protein; normal=0.2 (0-2.3), p<0.05). There were strong correlations between the concentrations of certain components of the plasminogen activator system in particular between uPA, uPAR, and PAI-1 (p<0.05). Tissue concentrations of some components of the plasminogen activator system correlated with clinical and pathological indexes of aggression of tumours, including differentiation and T-stage. CONCLUSION: The relation between components of the plasminogen activator system, in particular uPA, uPAR, and PAI-1 in invasion, metastasis, prognosis, and survival, requires further investigation in oral squamous cell carcinomas.

The matrix metalloproteinase system in oral squamous cell carcinoma.

BACKGROUND: The matrix metalloproteinase (MMP) system is responsible for degradation of tissue in both normal and pathological processes, including tumour invasion and metastasis. AIM: To compare tissue concentrations of components of the MMP system between tumour tissue and normal tissue in patients with oral squamous cell carcinoma, and to correlate concentrations with pathological grade of tumour. METHODS: Thirty-eight paired tissue samples from tumours and normal tissue were analysed by three laboratory techniques: firstly, enzyme linked immunosorbent assays (ELISA) in ng/mg protein for MMP-1, MMP-3, and tissue inhibitors of metalloproteinases (TIMPs) -1 and -2. Secondly, gelatinase activity assays to measure concentrations of total and endogenous active gelatinases, MMP-2 and MMP-9 (ng/mg protein). And thirdly to use quenched fluorescent substrate hydrolysis to measure total MMP activity (pM/min). RESULTS: The concentration of all MMPs was significantly higher in tumour than in normal oral tissue (p < 0.05, Mann-Whitney U-test). Tissue concentrations of some of these factors correlated with clinical and pathological indices of aggressiveness of tumours, including T-stage, N-stage, tumour differentiation, and anatomical level of involved nodes. However, the study was not powered to show statistical significance. CONCLUSION: It is the balance between proteinases and their inhibitors that controls tissue degradation at each stage of tumour invasion and metastasis. Measurement of MMPs in oral mucosal biopsy samples may establish the invasive potential of tumours at their initial presentation.

Vasopressin V2 receptor binding is down-regulated during renal escape from vasopressin-induced antidiuresis.

This study evaluated whether renal escape from vasopressin-induced antidiuresis is associated with alterations of vasopressin V2 receptor binding in the kidney inner medulla. A radioligand binding assay was developed using a novel iodinated vasopressin V2 receptor antagonist to analyze vasopressin V2 receptor binding in kidney inner medullary tissue from three groups of rats: normal rats maintained on ad libitum water intake, rats treated with 1-deamino-[8-D-arginine]vasopressin (DDAVP), and rats treated with DDAVP that were also water loaded to induce renal escape from antidiuresis. Analysis of the binding data showed that DDAVP treatment reduced vasopressin V2 receptor binding to 72% of normal levels. Water loading induced a marked further down-regulation of vasopressin V2 receptor binding. This receptor down-regulation began by day 2 of water loading, which correlated with the initiation of renal vasopressin escape; by day 3 of water loading, vasopressin V2 receptor expression fell to 43% of DDAVP-treated levels. No differences in vasopressin V2 receptor binding affinities were found among the three groups. This study demonstrates that vasopressin V2 receptor binding capacity is down-regulated during renal escape from vasopressin-induced antidiuresis and suggests that both vasopressin-dependent mechanisms as well as vasopressin-independent mechanisms associated with water loading are involved in this receptor down-regulation.

The plasminogen activator and matrix metalloproteinase systems in colorectal cancer: relationship to tumour pathology.

The aim of this study was to determine the expression of proteinases and inhibitors from the matrix metalloproteinase (MMP) (MMPs 1, 2, 3, 9, tissue inhibitors of metalloproteinases (TIMPs) 1, 2) and plasminogen activator ((PA) urokinase (uPA), tissue type (tPA), uPAR, plasminogen activator inhibitors (PAIs) 1, 2) systems in colorectal cancer pathology by gelatin zymography, enzyme-linked immunosorbent assays (ELISAs) and quenched fluorescent substrate hydrolysis. The levels of all studied MMPs, uPA, uPAR, TIMP-1 and PAIs were significantly greater in tumour tissues than normal tissues. However, tPA and TIMP-2 were greater in normal colon (P<0.05, Mann-Whitney) e.g. PAI-1: tumour, median 14.9 (range 0.2-80.2) ng/mg total protein; normal, 2.1 (0.1-65.0). Tumour levels of several factors, in particular MMP-1 and PAI-1, correlated with pathology, i.e. Dukes' stage, differentiation, lymphatic or vascular invasion and tumour depth. The interactions between proteinase systems in colorectal cancer are complex and the balance between active proteinases and their inhibitors is important for extracellular matrix (ECM) degradation/remodelling at each stage of the metastatic cascade.

Effects of simulated acid rain on leaf wettability, rain retention and uptake of some inorganic ions.

Leaves of Phaseolus vulgaris L., Vicia faba L., Pisum sativum L. and Brassica napus L. were exposed from emergence to full expansion to seven treatments of simulated acid rain at pH values between 5.6 and 2.6. Droplet leaf contact angles in all species decreased on leaves exposed to simulated acid rain at pH <4.6 relative to those exposed at pH 5.6. Retention of rain containing fluorescein increased on P. vulgaris leaves exposed to simulated acid rain at pH 4.6 and at pH < 3.8. Retention by B. napus leaves was increased at pH < 4.6. Uptake of the three ions studied was in the order 86 Rb+ ≤35 SO4 2- ≤63 Ni2+ . Uptake of 86 Rb+ increased into B. napus leaves and decreased into P. vulgaris leaves exposed at pH ≤ 3.4. Uptake of 35 SO4 2- and 63 Ni2+ by B. napus leaves increased after exposure to simulated acid ruin at pH 2.6 but it was unaffected in P. vulgaris. Up to 7%, of applied 35 SO4 2- , was found in the epicuticular wax layer on B. napus leaves 48 h after application, most being found after exposure at pH 2.6. The order of lateral movement of ions within leaves paralleled the order of uptake. Movement of all three ions was increased in B. napus leaves exposed previously to simulated acid rain at pH 2.6. The increased retention of fluorescein on leaves exposed to simulated acid rain and the reduced contact angles for water are attributed to decreases in surface roughness. The altered ion uptake pattern could also be related to changes in surface wax structure or could be associated with observed changes in properties of cuticular membranes. These results demonstrate that the interaction of plants with their atmospheric environment could possibly be affected by pre-exposure to acid rain in amounts and at pH values that occur in ambient rainfall.

EROSION OF WAXES FROM LEAF SURFACES BY SIMULATED RAIN.

Effects of simulated rain on the epicuticular wax of glaucous leaves have been studied. Droplets (250 to 400 µm) travelling at low or medium velocity (0.25 to 5 m s-1 ) fractured the dendrites and tubes on leaves of Brassica spp., the tubes on Eucalyptus globulus Labillardere and the ribbons on the adaxial surfaces of Pisum sativum L. and Fragaria ananassa Duchesne. Rates of erosion for Brassica and E. globulus leaves were high during an initial application equivalent to 1 mm rainfall but declined markedly with extended exposure. In contrast, erosion from P. sativum and F. ananassa proceeded at a fairly uniform rate throughout the exposure period. The composition of the detached wax deposits was identical with that of the intact leaf wax for Brassica species but differed for the other species. The practical consequences of wax erosion of field crops are considered.

Principles of practice for academic/practice/community research partnerships.

CONTEXT: Researchers and practitioners are increasingly realizing that improvements in public health require changes in individual, social, and economic factors. Concurrent with this renewed awareness there has been a growing interest in working with communities to create healthful changes through academic/practice/community research partnerships. However, this type of research presents different challenges and requires different skills than traditional research projects. The development of a set of principles of practice for these types of research projects can assist researchers in developing, implementing, and evaluating their partnerships and their project activities. OBJECTIVE: This paper describes the different ways in which academics and community groups may work together, including academic/practice/community partnerships. Several principles of practice for engaging in these research partnerships are presented followed by a description of how these principles have been put into operation in a family violence prevention program. CONCLUSIONS: The principles presented are: (1) identify the best processes/model to be used based on the nature of the issue and the intended outcome; (2) acknowledge the difference between community input and active community involvement; (3) develop relationships based on mutual trust and respect; (4) acknowledge and honor different partner's "agendas"; (5) consider multi-disciplinary approaches; (6) use evaluation strategies that are consistent with the overall approach taken in the academic/practice/community partnership; and (7) be aware of partnership maturation and associated transition periods. The limitations of these principles and their application in various settings are discussed.

Measuring gelatinase activity in colorectal cancer.

AIMS: Gelatinases (MMP-2, -9) are the most extensively studied MMPs in cancer. The aim of the study was to determine the levels of active and latent forms of the gelatinases in paired colorectal tumour and normal tissue ( n=77) and correlate these with pathological stage. METHODS: Gelatinase levels were compared following the techniques of gelatin zymography (active and latent) and the novel gelatinase activity assays (total and endogenous/active). RESULTS: Both latent and active MMP-2 and MMP-9 lysis bands (zymography) and both total (active and latent) MMP-9 and endogenous (active) MMP-9 and MMP-2 levels (activity assays) were greater in tumour than normal colorectal tissue. Total MMP-2 and MMP-9 levels as determined by activity assays correlated with both the Dukes staging (e.g. total MMP-9 in tumours: adenoma, 1.0 (0.3--3.6); Dukes A, 9.6 (2.4--35.4); Dukes B, 14.7 (1.5--103.9); Dukes C, 22.3 (2.2--57.9) and Dukes D, 37.4 (2.1--47.0) ng/mg protein) and with lymphatic invasion (e.g. total MMP-9; in tumours which had undergone lymphatic invasion, 22.7 (2.1--57.9) and those with no lymphatic invasion, 14.0 (1.5--103.9) ng/mg protein). CONCLUSIONS: Both gelatinases were upregulated in tumour tissue, however total and not endogenous active levels correlated with the pathological stage of the tumour. Therefore gelatinases may only be activated when required for tumour invasion and metastasis.

Measuring community capacity: where do we go from here?

Goodman et al. have set us off on our journey to articulate and measure the dimensions of community capacity. While we have tried to identify some of the areas for future exploration, it is clear that this should be an ongoing process. Moreover, it is important that the process used to develop measures, assess capacity, and use the information to intervene be consistent with the intended outcome--building community capacity. In other words, at a minimum, the process should be cognizant of the history of the community, be participatory (i.e., incorporate the multitude of voices involved, particularly those of the community members themselves) and use the skills and resources available in professional, academic, and community settings. Perhaps most important, this dialogue must begin from a place of respect for the multitude of perspectives that need to be brought to bear to enhance community capacity to create healthful changes.

The Latino Health Advocacy Program: a collaborative lay health advisor approach.

There have been numerous calls in the literature for health educators to develop programs to improve access to and utilization of health and human services by traditionally underserved communities, including Latinos. While the literature suggests several principles that can guide the development of these programs, it is important to address the needs, and build on the strengths, of the specific community of interest. It is, therefore, important to use collaborative approaches in which community members take an active role in the initiation, design, implementation, and evaluation of program activities. Lay health advisor programs are particularly well suited to this approach as they are designed to build on the strength of already existing community relationships to improve community health. This article describes a collaborative, culturally appropriate, holistic, and ecological lay health advisor program--the Latino Health Advocacy Program. Lessons learned and implications for future program development are discussed.

A participatory approach to worksite health promotion.

A review of literature suggests that individual, social, and organizational factors are important to consider in the development of worksite health promotion programs. This article describes a conceptual framework that integrates these factors. The implications of this framework for the development, implementation, and evaluation of worksite health promotion programs and the results of an intervention based on this approach are presented. The results from this study highlight the importance of active employee involvement in all stages of worksite health promotion programs. The findings also indicate that programs need to address the causes, not just the symptoms, of stressful working conditions.

Occupational stress, safety, and health: conceptual framework and principles for effective prevention interventions.

The authors present an overarching conceptual model of occupational stress, safety, and health, incorporating multiple factors from diverse disciplines. They examine specific implications of the model for the development of prevention interventions (e.g., context-specific interventions and primary, secondary, and tertiary prevention). They review prevention interventions and describe and analyze 4 case studies that address exposure to environmental, ergonomic, and psychosocial stressors and a combination of physical-environmental and psychosocial stressors. The authors examine lessons learned from these interventions in light of the conceptual model (e.g., role of top management and integrating research and intervention).

Pressure-relieving properties of a intra-operative warming device.

OBJECTIVES: The primary objective of this study was to determine differences in interface pressure between four mattress combinations: a standard operating table mattress, a pressure-relieving gel pad and an under-patient warming device set at 38 degrees C (Pegasus Inditherm System) and at ambient temperature. The secondary objective was to determine whether the warming device remains stable in extreme surgical positions. METHOD: Interface pressures obtained with all four combinations were measured in 10 healthy volunteers using force sensing array technology. RESULTS: The warming device demonstrated better or equivalent pressure relief when compared with the standard gel pad. There was no significant difference in subject position 'shift' between the mattress, the gel pad and the warming device for either the Trendelenberg or reverse Trendelenberg positions. CONCLUSION: Both pressure-relieving mattresses and warming reduce intra-operative pressure damage. A mattress with both properties may further reduce pressure damage postoperatively. The warming device used in this study appears stable--subject 'slippage' was minimal in extreme positions. Research needs to be conducted among real anaesthetised patients to support these conclusions.