Palaeoparasitology confirms Early Lapita evidence of pig and dog at Kamgot, Bismarck Archipelago.

Little is known about helminth parasites of the Bismarck Archipelago, in either archaeological or modern contexts. This study presents a parasitological analysis of soil samples from Early Lapita habitation layers at Kamgot (3300-3000 BP). Evidence for the presence of pigs and dogs and the timing of their arrival in Early Lapita contexts have been contested in the literature. The finding of parasite eggs in samples from Kamgot supports the presence of pigs and dogs at the site. Six types of helminth eggs were identified: pig nematode Trichuris suis, dog nematode Toxocara canis, and cestode Dipylidium caninum, as well as two unknown trematodes and a possible anoplocephalid cestode, thereby indicating the local presence of other mammals or birds. This study represents the first confirmed record of ancient helminth parasites in tropical Oceania.

The cestode Stringopotaenia psittacea (Fuhrmann, 1904) (Cestoda: Anoplocephalidae) from a critically endangered New Zealand bird: New evidence from ancient coprolites.

New Zealand's kakapo parrot, once widespread, is now critically endangered due to habitat loss and introduced mammalian predators. Prior to major population decline, a unique kakapo cestode, Stringopotaenia psittacea, was found in the 1880s and first described in 1904. Here we report the discovery of eggs of this cestode in kakapo coprolites of pre-human settlement age from the Honeycomb Hill cave system, north-west Nelson. Analysis of 52 samples, including coprolites of post-human settlement age, from nine sites within six South Island locations across a wide geographic range, yielded only eight infected samples in this single cave system. Results suggest that prior to human settlement, S.psittacea was not widespread within and between kakapo populations, in marked contrast to other parasite types of the extinct moa spp. Intense management of the last remaining kakapo has endangered or possibly caused the extinction of this cestode. This is the first confirmed record of S.psittacea since its discovery in 1884.

Current practice of carotid endarterectomy in the UK.

BACKGROUND: Carotid endarterectomy (CEA) reduces the risk of stroke in patients with internal carotid stenosis of 50-99 per cent. This study assessed national surgical practice through audit of CEA procedures and outcomes. METHODS: This was a prospective cohort study of UK surgeons performing CEA, using clinical audit data collected continuously and reported in two rounds, covering operations from December 2005 to December 2007, and January 2008 to September 2009. RESULTS: Some 352 (92·6 per cent) of 380 eligible surgeons contributed data. Of 19,935 CEAs recorded by Hospital Episode Statistics, 12,496 (62·7 per cent) were submitted to the audit. A total of 10,452 operations (83·6 per cent) were performed for symptomatic carotid stenosis; among these patients, the presenting symptoms were transient ischaemic attack in 4507 (43·1 per cent), stroke in 3572 (34·2 per cent) and amaurosis fugax in 1965 (18·8 per cent). The 30-day mortality rate was 1·0 per cent (48 of 4944) in round 1 and 0·8 per cent (50 of 6151) in round 2; the most common cause of death was stroke, followed by myocardial infarction. The rate of death or stroke within 30 days of surgery was 2·5 per cent (124 of 4918) in round 1 and 1·8 per cent (112 of 6135) in round 2. CONCLUSION: CEA is performed less commonly in the UK than in other European countries and probably remains underutilized in the prevention of stroke. Increasing the number of CEAs done in the UK, together with reducing surgical waiting times, could prevent more strokes.

Outcome and safety of Aorfix™ stent graft in highly angulated necks - a prospective observational study (arbiter 2).

OBJECTIVES: Severe neck angulation is associated with poor outcome following endovascular aneurysm repair. The aim was to study the safety and early outcome of patients with infrarenal aortic aneurysms with severe neck angulation (60-90°) treated with the Aorfix™ endovascular stent graft. DESIGN/METHODS: This was a non-randomized prospective observational study of 30 patients with infra-renal abdominal aortic aneurysms with highly angulated necks. Outcomes were primary technical success, 30 day and short term (30 days-6 months) clinical success and other patient morbidity at 30 days. RESULTS: Median neck angulation was 81.2°. Initial technical success was 93.3% (n = 28) with 2 stents deployed too low. Intra-operatively 3 patients initially had type I endoleaks, but all were resolved by ballooning. 30 day clinical success was 96.7%: there were no type I or type III endoleaks observed, and no reports of graft thrombosis or migration. Early clinical failure was accounted for by one perioperative death (3% mortality). No aneurysm-related interventions were required during follow-up. At 6 months two patients were reported as having type I endoleaks, although both sacs have reduced in size. Neither has required intervention. No patient has died due to aneurysm rupture or required removal of the endograft. CONCLUSION: The results of this study support the continued application of the Aorfix™ graft to the highly angulated neck.

Use of the AorfixTM stent graft in patients with tortuous iliac anatomy.

AIM: Iliac limb occlusion following endovascular repair (EVAR) may result in limb threatening acute ischemia. The incidence is reported at up to 10% and is known to be influenced by iliac angulation and kinking of the stent graft. The aim of this study was to evaluate the performance of the AorfixTM graft in tortuous iliac anatomy and examine the impact of the graft on the rate of iliac limb thrombosis following EVAR in a single UK centre METHODS: We performed a retrospective review of all EVAR performed from May 1998 to May 2010. From November 2007, patients with highly angulated iliac anatomy were treated with the AorfixTM(Lombard) stent graft, or when a ZenithTM(Cook) main body was chosen, the AorfixTM iliac limbs were used with the ZenithTM(Cook) device. We compared the rate of iliac limb occlusions before (group 1) and after (group 2) the adoption of this policy. RESULTS: Two hundred and sixty seven patients underwent EVAR (group 1 n=129; group 2 n=138). In group 1, eight patients had a unilateral iliac limb occlusion (6.2%). Six of the patients had >90 degrees iliac angulation, one had an unrecognised limb stenosis, and one patient had the stent landed in the external iliac. In group 2 there were no limb occlusions. Of the 138 patients, 25 had iliac angulation of >90 degrees . Of these 25, eighteen were treated with the AorfixTM stent graft system because of iliac angulation, and 7 were treated with AorfixTM legs and ZenithTM bodies. CONCLUSION: The rate of early iliac limb occlusion following EVAR in patients with angulated iliac anatomy can be substantially reduced by using the flexible Aorfix stent graft system.

General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial.

BACKGROUND: The effect of carotid endarterectomy in lowering the risk of stroke ipsilateral to severe atherosclerotic carotid-artery stenosis is offset by complications during or soon after surgery. We compared surgery under general anaesthesia with that under local anaesthesia because prediction and avoidance of perioperative strokes might be easier under local anaesthesia than under general anaesthesia. METHODS: We undertook a parallel group, multicentre, randomised controlled trial of 3526 patients with symptomatic or asymptomatic carotid stenosis from 95 centres in 24 countries. Participants were randomly assigned to surgery under general (n=1753) or local (n=1773) anaesthesia between June, 1999 and October, 2007. The primary outcome was the proportion of patients with stroke (including retinal infarction), myocardial infarction, or death between randomisation and 30 days after surgery. Analysis was by intention to treat. The trial is registered with Current Control Trials number ISRCTN00525237. FINDINGS: A primary outcome occurred in 84 (4.8%) patients assigned to surgery under general anaesthesia and 80 (4.5%) of those assigned to surgery under local anaesthesia; three events per 1000 treated were prevented with local anaesthesia (95% CI -11 to 17; risk ratio [RR] 0.94 [95% CI 0.70 to 1.27]). The two groups did not significantly differ for quality of life, length of hospital stay, or the primary outcome in the prespecified subgroups of age, contralateral carotid occlusion, and baseline surgical risk. INTERPRETATION: We have not shown a definite difference in outcomes between general and local anaesthesia for carotid surgery. The anaesthetist and surgeon, in consultation with the patient, should decide which anaesthetic technique to use on an individual basis. FUNDING: The Health Foundation (UK) and European Society of Vascular Surgery.

The advantages of Aorfix for endovascular repair of abdominal aortic aneurysm.

AIM: The aim of this paper was to review the use of the Aorfix stent-graft in the endovascular repair of abdominal aortic aneurysms and to report the early results of a multicenter study conducted on patients receiving this endograft. METHODS: A retrospective review of 40 patients having the Aorfix stent-grafts for their aneurysm repair was undertaken at two centers. Patient notes and imaging findings were used to identify technical success, 30 day mortality, rupture rates during follow-up, postoperative complications including endoleaks, graft migration and any secondary interventions. RESULTS: All patients were treated successfully. Four patients required the use of proximal extensions due to severe neck angulation. There were neither deaths nor secondary interventions in the follow-up period. No incidence of graft migration or endoleaks was identified at 12 months after the procedure. CONCLUSIONS: Early data with the Aorfix stent-graft shows favorable results. The device's flexible design allows safe and accurate aneurysm sac exclusion in patients with highly challenging anatomy. This is likely to increase the number of patients considered suitable for endovascular aneurysm repair, who were previously excluded from this type of treatment and also reduce the levels of endoleaks.

Aggregated α-synuclein and complex I deficiency: exploration of their relationship in differentiated neurons.

α-Synuclein becomes misfolded and aggregated upon damage by various factors, for example, by reactive oxygen species. These aggregated forms have been proposed to have differential toxicities and their interaction with mitochondria may cause dysfunction within this organelle that contributes to the pathogenesis of Parkinson's disease (PD). In particular, the association of α-synuclein with mitochondria occurs through interaction with mitochondrial complex I and importantly defects of this protein have been linked to the pathogenesis of PD. Therefore, we investigated the relationship between aggregated α-synuclein and mitochondrial dysfunction, and the consequences of this interaction on cell survival. To do this, we studied the effects of α-synuclein on cybrid cell lines harbouring mutations in either mitochondrial complex I or IV. We found that aggregated α-synuclein inhibited mitochondrial complex I in control and complex IV-deficient cells. However, when aggregated α-synuclein was applied to complex I-deficient cells, there was no additional inhibition of mitochondrial function or increase in cell death. This would suggest that as complex I-deficient cells have already adapted to their mitochondrial defect, the subsequent toxic effects of α-synuclein are reduced.

Catalytic activity of ADAM28.

ADAMs are membrane-anchored glycoproteins containing a disintegrin and metalloprotease domain that have important roles in fertilization, development, and diseases such as Alzheimer's dementia. Here we present the first evidence for catalytic activity of ADAM28, a protein that is highly expressed in the epididymis and lymphocytes. Recombinant ADAM28 cleaves myelin basic protein at two sites. The catalytic activity of ADAM28 is not sensitive to tissue inhibitors of metalloproteases 1 and 2, but can be abolished by a mutation in the catalytic site. Catalytically active ADAM28 will be valuable for further studies of its role in sperm maturation and lymphocyte function.

Vascular surgical society of great britain and ireland: near-infrared spectroscopic monitoring of patients undergoing carotid endarterectomy under locoregional anaesthesia

BACKGROUND: The level of cerebral desaturation, which is associated with a change in level of consciousness during carotid endarterectomy, was measured by near-infrared spectroscopy. METHODS: Patients were recruited in two centres over 24 months. Surgery was performed under deep and superficial cervical block using 0.5 per cent bupivacaine, with temazepam as a premedication. Cerebral oxygenation was measured by Critikon 2020 near-infrared spectrophotometers (Johnson and Johnson Medical, Newport, UK). RESULTS: Forty-nine procedures were performed on 45 patients (39 men; age range 52-84 (mean 68) years). Recordings were made from the ipsilateral frontal site in 38 patients, from the ipsilateral temporal site in 23 and bifrontally in eight patients. Monitoring failed in three subjects. Percentage changes in regional cerebral oxygen saturation are detailed below. CONCLUSION: Significantly different levels of cerebral desaturation occur in patients with neurological compromise during carotid endarterectomy compared with those who are unaffected.

Vascular surgical society of great britain and ireland: Re-evaluation of criteria for reoperation in carotid endarterectomy using intraoperative duplex imaging

BACKGROUND: The aim of this study was to compare data obtained during surgery with data collected at 6 weeks after operation to evaluate appropriate criteria for reoperation. METHODS: One hundred and twenty consecutive patients undergoing carotid endarterectomy had duplex scans at operation and 6 weeks later. Neurological evaluation was also documented. RESULTS: Of 96 patients who had a normal intraoperative duplex scan by standard criteria, 91 had normal scans at 6 weeks. One occluded an internal carotid artery (ICA) at 6 weeks with no symptoms. Four had kinks or high-grade contralateral lesions leading to velocity enhancement but no filling defect. All were asymptomatic. Twenty-four patients had abnormal intraoperative scans. Thirteen patients had visible kinking of the ICA or reperfusion hyperaemia; 12 of these patients had normal 6-week scans and one had a mild residual kink but no symptoms. Eleven patients had visible colour-filling defects and significant velocity enhancement. Nine of these were reopened and refashioned. Subsequent duplex imaging was satisfactory in all cases and 6-week scans were normal. One patient had an occluded ICA at operation and developed a dense stroke after operation. Another had residual raised velocities distally which remained at 6 weeks. This patient had no symptoms. CONCLUSION: Intraoperative velocity measurements alone cannot be relied upon as an indication for reoperation. Significant velocity enhancement combined with a visible filling defect appears to represent a satisfactory criterion for reoperation. There were no complications as a result of reoperation. There was no early restenosis in the whole group and there were no neurological sequelae in any patient with a satisfactory scan using the above criteria.

A Doppler flowmeter for use in theatre.

We have developed a Doppler flowmeter based on a 10 MHz pencil probe and mean frequency estimator which overcomes many of the limitations of existing electromagnetic and ultrasonic flowmeters. The output of the flowmeter, which is proportional to the first moment of the Doppler power spectrum and hence mean blood velocity is linear from 1.3 to over 50 cm s-1 for pulsatile flow. Variation in vessel diameter and angle of insonation, which are the common sources of error in Doppler flowmetry, are minimised by constraining the vessel in a plastic cuff which fixes the probe angle at 50 degrees. A simple gauge is used to compress the vessel flat, before the cuff is applied, to measure the wall thickness to within 0.25 mm. The vessel internal diameter and hence blood flow can then be calculated using an experimentally determined calibration factor to compensate for non-even insonation. A range of sterilizable cuffs from 3-12 mm diameter have been built and the flowmeter is now being used routinely during all arterial reconstructive surgery. The accuracy and reproducibility of the system was tested for range of different sized silastic tubes on a hydraulic model and found to be less than 12% for vessels greater than 2 mm internal diameter. Satisfactory signals were easily obtained from all prosthetic materials with the exception of PTFE. The instantaneous output was compared to an electromagnetic flowmeter using a fast Fourier transform algorithm; the moduli of the harmonics were virtually identical but the Doppler system produced a smaller phase shift with increasing harmonics.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty gives good results in critical lower limb ischaemia. A 5-year follow-up in patients with known ankle pressure and diabetic status having femoropopliteal dilations.

137 consecutive patients with known ankle pressures and diabetic status had attempted femoro-popliteal dilatation for lower limb ischaemia in an English provincial teaching hospital. All except one were followed until failure or death to assess survival and amputation rates. Non-diabetic patients with critical limb ischaemia had a 5 year survival rate of 62.2% (SE 17.1) compared to 50.5% (SE 7.0) for claudicants, with no significant difference on logrank testing. Diabetics had a relative risk of amputation of 11.2 compared to nondiabetics. Patients with pre-treatment ankle pressures of 50 mm or less had a relative risk of amputation of 2.6 compared to those with higher resting pressures. It is concluded that angioplasty should be the treatment of first choice in critical lower limb ischaemia whenever it is technically possible. Including patients with rest pain in the critical ischaemia group does not significantly affect cumulative patency rates.

A comparison of the costs of vascular surgery and balloon dilatation in lower limb ischaemic disease.

The length of stay in hospital was recorded for 24 patients admitted for investigation and treatment of vascular disease of the lower limb and a detailed analysis of the costs incurred was made for 10 patients. It was found that the mean cost of angiography and surgery was pounds 1577 and of angiography and dilatation, pounds 301. The major factor in the cost difference was the shorter hospital stay for dilatation, with lesser factors being the use of fewer staff and the avoidance of general anaesthesia.

The effects of introducing balloon dilatation into vascular surgical practice.

The numbers of angiograms, balloon dilatations, reconstructive operations and amputations carried out annually over a 5-year period following the introduction of balloon dilatation have been counted and the change in estimated costs calculated. Over the 5-year period the numbers of angiograms and reconstructive operations carried out have doubled and the number of amputations has fallen from 52 in the first year to 39 in the fifth year. The number of dilatations has increased from six in five patients in the first year to 97 in 75 patients in the fifth year. The cost of investigation and treatment has doubled but since more patients are being treated effectively, the mean cost per patient treated has fallen from pounds 1855 to pounds 1277. The introduction of balloon dilatation into vascular practice causes patients to be investigated earlier in the progress of their disease and enables more patients to be treated effectively with greater cost-efficiency, but does not reduce the overall cost of investigation and treatment of ischaemic disease of the lower limb.

Randomized trial of laser-assisted passage through occluded femoro-popliteal arteries.

A randomized trial was carried out in patients with occlusions of the femoro-popliteal artery to compare the passage of metal-tipped optical fibres with guide wires and catheters through the occlusions, prior to balloon angioplasty. The study was in a provincial English teaching hospital providing a vascular service for the area. Fifty patients were entered; 25 into the "laser" group and 25 into the "control" group. End points were (a) the success in passage through the occlusion and (b) the outcome 1 month after passage. Comparison of the groups showed no appreciable difference between the two methods with regard to age, sex, symptoms, incidence of diabetes, or previous myocardial infarctions. Successful passage through the occlusion followed by dilatation was achieved in 18 (72%) patients in the laser group and 20 (80%) in the control group. After 1 month, 13 (52%) arteries in the laser group were patent compared to 13 (57%) in the control group. Confidence limits for the difference in success of passage are -15% to +31%, and -24% to +33% for patency after 1 month. Since these limits include zero, it is unlikely that a longer trial would alter the difference between the two methods. The results suggest that the laser system currently in use is no better than conventional methods.

An objective comparison of four stress tests in the assessment of "at risk" femoro-distal grafts.

Femoro-distal vein grafts for limb salvage have a 30% failure rate at 6 months. Graft surveillance may enable the "at risk" grafts to be recognised and corrected, but there remains the need for a simple test to identify these patients. The ankle pressure response to exercise and reactive hyperaemia has been investigated prospectively in 40 "at risk" femoro-distal non-reversed grafts (median age 73 years, range 51-87 years, M/F = 33:7), defined as those with a resting ankle brachial index less than 0.9 or a drop of greater than 0.2 following a stress test. Four different stress tests have been assessed; active ankle plantar-dorsiflexion for 2 minutes (I), occlusive calf cuff 50 mmHg above systolic pressure for 2 minutes (II), treadmill exercise test for 1 minute, slope = 10%, at 3 km/hr (III) and 4 km/hr (IV). Ankle brachial indices (ABI's) were recorded before and immediately following each test and expressed as mean % drop +/- standard error of mean. Test I was only tolerated by 45% of patients whereas 55% and 50% could complete tests III and IV respectively. By contrast, 85% of patients could tolerate occlusive cuff hyperaemia (test II). Test I produced a significantly lower mean percentage drop in ABI when compared with each of the others (p less than 0.02, Mann U Whitney). There was an excellent correlation between test II and both the 3 km/hr (r = 0.77, p less than 0.001) and 4 km/hr (r = 0.84, p less than 0.001) exercise tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Knowledge, values, attitudes and behavioural intent of Nova Scotia nurses toward AIDS and patients with AIDS.

To assess the knowledge, values, attitudes and behavioural intent of Nova Scotia nurses toward AIDS and patients with AIDS, questionnaires were sent to a random sample of 400 general duty nurses. Analysis of the 179 returned questionnaires (45%) showed that although 88% of the nurses indicated that they intended to nurse patients with AIDS, the quality of the nursing care might be inadequate because (1) there was lack of knowledge about AIDS, especially outside urban Halifax; (2) half the nurses were undecided and 10% were very negative toward homosexuals and patients with AIDS; (3) although nurses perceived staff in hospital as reflecting positive attitudes toward care of patients with AIDS, those closest to the nurse (spouse, family and friends) were perceived as negative to her caring for patients with AIDS; and (4) nurses found media sources of information about AIDS more helpful than professional sources.

The effects of platelet inhibitors on platelet uptake and restenosis after femoral angioplasty.

OBJECTIVE: To investigate the effects of two platelet inhibitors, aspirin and iloprost, on platelet uptake and restenosis at the site of angioplasty in patients undergoing femoral or popliteal angioplasty. EXPERIMENTAL DESIGN: Prospective, open, randomised group comparison. SETTING: Two university hospitals. PATIENTS: 43 patients undergoing femoral or popliteal angioplasty were randomised. INTERVENTIONS: Patients received either aspirin (300 mg/day), iloprost (8 hours/day i.v. infusion) or no antiplatelet medication during angioplasty and on the subsequent two days. MEASURES: Platelet uptake was measured using 111Indium-labelled platelets. Restenosis was assessed by repeat angiography at 3 months and clinical symptoms up to 12 months. RESULTS: Median changes in platelet uptake were similar in the three treatment groups, but all platelet radioactivity ratios > 2.0 occurred in the control group. Restenosis at 3 months was observed in 3 control, 5 aspirin and 1 iloprost patient. Further surgical intervention was performed in 3 control and 3 aspirin patients, but in none of the iloprost patients up to 12 months after angioplasty. CONCLUSIONS: Antiplatelet therapy may prevent large increases in platelet deposition at the angioplasty site, but the link between platelet deposition and restenosis was not substantiated in this study.

Distortion of teatree stems by twine as a means to determine the number of years that the stems have been used to support cannabis plants.

In New Zealand, stems of teatree (Kunzea/Leptospermum) growing around illicit cannabis plots have been used to anchor lengths of twine running through the plots to hold cannabis plants upright. Forensic examinations of distortions of teatree stems caused by the twine have been carried out to determine when the twine had been first tied around the stems, in order to estimate the number of years that plots have been in operation. In this experiment, baling twine was tied around stems of a teatree (Kunzea ericoides) and the effect monitored for a period of three years. Varying degrees of stem distortion occurred during the first year, caused initially by expansion of callus (a wound tissue) rather than constriction of the growth (annual) rings of the xylem. Although this callus has a type of growth ring, these are not annual, therefore cannot be used to determine the number of years that stems have had twine attached. Xylem growth rings of the teatree in this experiment were not restricted until the third year. Distortion of teatree stems allows the determination of a minimum (not absolute) number of years that twine has been attached.