Prospective randomised multi-centre trial comparing the clinical efficacy, safety and patient acceptability of circular stapled anopexy with closed diathermy haemorrhoidectomy.

OBJECTIVE: Unlike excisional haemorrhoidectomy, stapled anopexy (SA), which does not involve radical excision, has theoretical advantages, thus offering potential patient benefits. We compared the clinical efficacy, safety and patient acceptability of SA, with closed haemorrhoidectomy (CH). PATIENTS AND METHODS: 182 patients with symptomatic haemorrhoids (grades II, III, IV) were randomly assigned to receive SA or CH and were followed for up to 1 year (6, 12, 24, 48 weeks) after operation. Postoperative pain, symptom control, complications, re-treatment rates, patient satisfaction, and quality of life were compared on an intention-to-treat basis. RESULTS: Postoperative pain in the SA group (n = 91) was significantly lower (p = 0.004, Mann-Whitney U test). At 1 year there were no significant differences in the symptom load, symptom severity or the disease severity between the two groups. Overall complication rates were similar but faecal urgency was reported more frequently following SA (p = 0.093, Fisher's exact test). Despite a similar rate of residual symptoms, prolapse control was better with CH (p = 0.087, Fisher's exact test), and more patients in the SA group required re-treatment for residual prolapse at 1 year (p = 0.037, Fisher's exact test). However, more patients rated SA as an excellent operation at 6 and 12 weeks (p = 0.008 and 0.033, binary logistic regression) and were willing to undergo a repeat procedure if required (p = 0.018, Fisher's exact test). CONCLUSION: Stapled anopexy offers a significantly less painful alternative to excisional haemorrhoidectomy and achieves a higher patient acceptability. Although the overall symptom control and safety are similar in the majority of the patients, the re-treatment rate for recurrent prolapse at 1 year is higher following SA when compared to CH.

Semen quality in captive Houbara bustard, Chlamydotis undulata undulata.

Semen quality in captive-bred Houbara bustards, Chlamydotis undulata undulata, was assessed during three consecutive breeding seasons. In any one season, sperm quality, in terms of the proportion of eosin-permeable spermatozoa and of spermatozoa with abnormally large nuclei, varied among individual males, but not among their ejaculates. Neither the proportion of spermatozoa with large nuclei, nor those permeable to eosin were related to the total sperm output of males. The fertilizing ability of males was related to their mean seasonal proportion of eosin-permeable spermatozoa, but not the proportion of spermatozoa with large nuclei. The ranking of males on the basis of the proportion of spermatozoa with large nuclei in their ejaculates was significantly positively correlated between seasons, although ranking on the basis of sperm eosin-permeability was not. The cause or consequence of producing spermatozoa with large nuclei (and excess DNA) remains to be elucidated, but appears to be a trait that is characteristic of houbara bustard males that is maintained between breeding seasons.

Measuring sperm:egg interaction to assess breeding efficiency in chickens and turkeys.

Systems used to measure fertility in poultry have themselves presented a major impediment to progress in maintaining or improving fertility. Generally, these systems have been time-consuming, quantitatively inadequate, or both. A simplistic illustration of the basis of the problem is that if six fertile eggs were laid by a turkey hen during 1 wk after insemination, then all we know is what happened to six sperm: they fertilized the eggs. If 100 million sperm were inseminated, then information on the other 999,999,994 is missing. A better approach for quantitating breeding efficiency is to estimate the numbers of sperm that interact with the egg in the infundibulum. These can be identified in laid eggs, as sperm in the outer perivitelline layer (OPVL sperm), or holes produced by sperm in the inner perivitelline layer (IPVL holes). Eggs can contain up to 250,000 OPVL sperm, so the scale improves on binary estimation of fertilization status. The number of spermatozoa interacting with the perivitelline layer is related to the artificial insemination (AI) dose, the number of oviducal sperm, and the probability of fertilization, not just for one egg, but for subsequent eggs laid by the same hen. Practical applications of sperm:egg interaction measurements include: replacement of fertility trials for evaluation of semen; general fertility evaluation; and monitoring breeding efficiency of commercial turkey and broiler breeders. Furthermore, studies of sperm transfer into eggs raise interesting questions about the efficiency of turkey hens' response to AI or mating frequency of broiler hens in commercial flocks.

Factors influencing theoretical knowledge and practical skill acquisition in student nurses: an empirical experiment.

A previous qualitative study [Nurse Education Today 20 (2000) 499] investigated perceptions of nurse teachers, student nurses and preceptors of the theory-practice gap said to exist within nursing. One theme was views of how the theory-practice gap could be closed. A subsequent quantitative study is reported here, in which this theme was translated into three factors. A full factorial experimental design was used to study the effect of these factors on theoretical knowledge and practical skill acquisition in a sample of first year undergraduate student nurses from one institution of higher education (n=19). The effect of whether a nurse teacher or preceptor taught students theoretical elements relating to a clinical specialty, whether the nurse teacher and preceptor collaborated on the content of what was taught to students and whether students went straight to, or delayed the clinical specialty following theoretical input, was examined. The results demonstrated preceptors were more effective than nurse teachers in promoting theoretical knowledge relating to their clinical specialty. Collaboration between the preceptors and nurse teachers on teaching content was ineffective at increasing theoretical knowledge. Delay between theoretical input and clinical experience was not detrimental for medical placements and for rehabilitation placements, resulted in an improved theoretical knowledge.

Assessing the breeding efficiency of broiler breeder flocks by measuring sperm transfer into laid eggs.

1. The breeding efficiency of broiler flocks was assessed by estimating the numbers of spermatozoa trapped in a 5.5 mm2 area of the perivitelline layer of laid eggs. 2. In samples of approximately 60 eggs taken from flocks on the same day, the numbers of spermatozoa ranged from 0 to several hundred. 3. Within each sample of eggs, there appeared to be two distinct populations: eggs in which perivitelline spermatozoa could not be found; and eggs containing spermatozoa for which the logarithm of the number of perivitelline spermatozoa can be approximated by a normal distribution. 4. When data from 15 flocks were considered, the overall flock fertility was linearly correlated with: the median of the number of spermatozoa per 5.5 mm2 of perivitelline layer (r = 0.678); the mean of positive values of the logarithm of the number of spermatozoa (r = 0.620); and the proportion of sampled eggs in which the number of perivitelline spermatozoa was greater than 0 (r = 0.714). 5. Flock age was the major factor influencing fertility and all the variables of perivitelline sperm distribution.

Assessing the efficiency of mating in broiler breeder flocks by enumerating the spermatozoa which penetrate the inner perivitelline layer over the germinal disc.

1. The frequency distribution of points of hydrolysis produced by spermatozoa in the perivitelline layer from directly over the germinal disc was examined in 60 samples of 60 eggs from commercial broiler breeder flocks. 2. Typically, these distributions were positively skewed, although log transformation of the data revealed 2 populations: one representing eggs which contained no evidence of spermatozoa and another in which the data were, generally, normally distributed. 3. Problem flocks with low fertility had more eggs without evidence of spermatozoa and, compared to control flocks with acceptable fertility, a lower median and mean before and after log transformation, respectively. 4. In 4 flocks studied between 30 to 55 weeks of age, the median number of points-of-hydrolysis in samples of eggs fell from around 200 at peak to less that 20 at 55 weeks, whilst the mean proportion of fertile eggs laid by the whole flocks fell from 94% at peak to around 79% at 55 weeks. 5. A log-linear relationship was demonstrated between flock fertility and the median points-of-hydrolysis from the inner perivitelline layer over the germinal disc in samples of 60 eggs (R2=0.79). 6. The main advantages of this system for measuring sperm-in-eggs are that it is technically simple and presents a more expanded scale than fertility, so that an estimation of whole flock fertility can be derived from a sample of 60 eggs.

Weekly monitoring of broiler breeder flock mating efficiency by sperm transfer into eggs.

1. Sample fertility and the median number of points of hydrolysis produced by spermatozoa in the perivitelline layer from the germinal disc area were determined in samples of 60 eggs taken weekly from each of two commercial broiler breeder flocks. 2. Flock fertility remained above 90% from weeks 30 to 45, after which it fell in both flocks, reaching 85% in Flock A by week 51 and 76% in Flock B by week 55. 3. Sample fertility, as assessed by the Kosin test, followed a similar trend, but showed more variation; the same was true for the proportion of eggs with at least one perivitelline hole. 4. In Flock A, the median number of perivitelline holes in samples increased from 145 in week 30 to reach a maximum of 323 on week 39, thereafter falling to 109 in week 51; for Flock B, the equivalent figures for weeks 30, 36 and 55 were 160, 266 and 29, respectively. A quadratic model confirmed that the weekly sample median perivitelline holes peaked at weeks 40 and 37 in Flocks A and B, respectively. 5. The results show that transfer of spermatozoa by males into females and subsequently into eggs begins to decline 8 (Flock A) to 9 (Flock B) weeks before it is noticeable as a significant reduction in flock fertility and that mating efficiency, unlike fertility, is never in apparent equilibrium, but rises to a peak before 40 weeks and then falls. 6. The pattern of sperm transfer suggests that the reduction in fertility of broiler flocks could well be for social or for physiological reasons other than those associated with 'ageing'.

Characterization and application of an avian in vitro spermatozoa-egg interaction assay using the inner perivitelline layer from laid chicken eggs.

The inner perivitelline layer, separated from laid chicken eggs, was investigated as readily available material for studying the spermatozoa-egg interaction in vitro. This layer was found to have a similar response to hydrolysis by spermatozoa as the inner perivitelline layer from ovulated and follicular ova, in terms of the numbers of points of hydrolysis made by spermatozoa during a 5 min incubation at 40 degrees C. Initiation of hydrolysis of the inner perivitelline layer was found to occur within 2.5 min, after which the size, but not the number of holes, increased with time. The frequency of the points of hydrolysis per unit area of the inner perivitelline layer was positively correlated with the concentration of spermatozoa in the incubation medium. The perivitelline hydrolysis assay was able to detect more damaged spermatozoa in samples that had been either stored at 5 degrees C or cryopreserved in liquid N2 than did other tests of sperm quality, which are known to overestimate the fertilizing ability of stored avian semen.

Quantification of a sperm-egg interaction for estimating the mating efficiency of broiler breeder flocks.

1. The frequency distribution of points of sperm hydrolysis (or holes) produced per unit area of the inner perivitelline layer was examined in samples of approximately 60 laid eggs, taken on the same day from each of 19 flocks of broiler breeder hens. 2. The holes counted in samples of perivitelline layer from eggs varied from 0 to greater than 100; lower numbers being found in eggs from flocks with lower fertility. 3. The median frequency of holes in the inner perivitelline layer was strongly correlated (r = 0.92) with the median frequency of spermatozoa found trapped in the corresponding outer perivitelline layer. 4. The median frequency of holes in the inner perivitelline layer and of spermatozoa in the outer perivitelline layer were both strongly correlated (r = 0.80 and 0.77, respectively) with flock fertility. 5. It is suggested that counting 'holes' in the inner perivitelline layer of laid eggs is a more convenient method for assessing breeding efficiency and predicting flock fertility than counting spermatozoa trapped in the outer perivitelline layer.

Variability in the size of the nucleus in spermatozoa from Houbara bustards, Chlamydotis undulata undulata.

Semen collected from 3-year-old male Houbara bustards contained large proportions (6-40%) of spermatozoa with large nuclei. In these spermatozoa, the length of the nucleus was up to twice the mean length of the nucleus in normal spermatozoa. The lengths of the acrosome, midpiece and flagella were all normally distributed, but the length of the nucleus formed a bimodal distribution. The proportion of spermatozoa with large nuclei varied among males, but not among different semen samples collected from the same male throughout the breeding season. The proportion of motile spermatozoa with large nuclei was half that of normal spermatozoa, but their velocity was significantly greater. After insemination into females, spermatozoa with large nuclei were observed in the outer perivitelline layer of eggs laid, indicating that they were stored and transported within the oviduct and reached the egg at about the time of fertilization. Furthermore, there was no difference in the ability to produce viable progeny in females that were mated with males producing greater proportions of spermatozoa with large nuclei compared with those producing 'normal' spermatozoa. Thus, the abnormal spermatozoa did not appear to impede fertility. There were no signs of triploidy in the males that produced spermatozoa with large nuclei, or in their progeny, as demonstrated by the size of erythrocytes. Therefore, it appears that the spermatozoa with large nuclei were the result of aberrant spermatogenesis.