Risk Assessment.

PURPOSE OF REVIEW: The central question of preoperative assessment is not "What can be done?" but "What should be done and how?" Predicting a patient's risk of unwanted outcomes is vital to answering this question. This review discusses risk prediction tools currently available and anticipates future developments. RECENT FINDINGS: Simple, parsimonious risk scales and scores are being replaced by complex risk prediction models as high-capacity information systems become ubiquitous. The accuracy of risk estimation will be further increased by improved assessment of physical fitness, frailty, and incorporation of existing and novel biomarkers. However, the limitations of risk prediction for individual patient care must be recognized. SUMMARY: Risk prediction is transforming from clinical estimation to statistical science. Predictions should be used within the context of a patient's baseline risk (life expectancy independent of surgery), personal circumstances, quality of life, their expectations and values, and consideration of outcomes that are meaningful for the patient.

Sequencing analysis of Mycoplasma gallisepticum wild strains in vaccinated chicken breeder flocks.

Mycoplasma gallisepticum (MG) infection is still of continuing economic concern in commercial broiler breeder chicken flocks in Egypt. MG infection continues to emerge despite the application of vaccination programs in breeder flocks. This prompted flock surveillance including MG isolation and molecular characterization of the circulating MG strains. The present study was concerned with 15 broiler breeder flocks of different ages (5-51 weeks). Three flocks were apparently healthy and 12 flocks were diseased. The aim of the study was to characterize the MG strains recovered from tracheal swabs. Four positive MG DNA extracts identified by rt-PCR and confirmed by isolation were subjected to sequencing of the mgc2 gene and intergenic spacer region (IGSR). The current molecular study demonstrated the presence of 3 different wild-type MG strains (RabE1-08, RabE2-09 and RabE3-09) in vaccinated diseased flocks, while the fourth strain (RabE4-08), which was isolated from a nonvaccinated apparently healthy breeder flock, scored 100% of homology and similarity to the F-strain vaccine by the sequence analysis of mgc2 and IGSR. It can be assumed that the vaccine F strain, which is supposed to replace field strains not only failed to do that, but also infected nonvaccinated flocks. Accordingly, there is a need to revise the control program including vaccine strategy in parallel with biosecurity measures.

Matrix metabolism rate differs in functionally distinct tendons.

Tendon matrix integrity is vital to ensure adequate mechanical properties for efficient function. Although historically tendon was considered to be relatively inert, recent studies have shown that tendon matrix turnover is active. During normal physiological activities some tendons are subjected to stress and strains much closer to their failure properties than others. Tendons with low safety margins are those which function as energy stores such as the equine superficial digital flexor tendon (SDFT) and human Achilles tendon (AT). We postulate therefore that energy storing tendons suffer a higher degree of micro-damage and thus have a higher rate of matrix turnover than positional tendons. The hypothesis was tested using tissue from the equine SDFT and common digital extensor tendon (CDET). Matrix turnover was assessed indirectly by a combination of measurements for matrix age, markers of degradation, potential for degradation and protein expression. Results show that despite higher cellularity, the SDFT has lower relative levels of mRNA for collagen types I and III. Non-collagenous proteins, although expressed at different levels per cell, do not appear to differ between tendon types. Relative levels of mRNA for MMP1, MMP13 and both pro-MMP3 and MMP13 protein activity were significantly higher in the CDET. Correspondingly levels of cross-linked carboxyterminal telopeptide of type I collagen (ICTP) were higher in the CDET and tissue fluorescence lower suggesting more rapid turnover of the collagenous component. Reduced or inhibited collagen turnover in the SDFT may account for the high level of degeneration and subsequent injury compared to the CDET.

Assessment of a register-based rheumatic heart disease secondary prevention program in an Australian Aboriginal community.

OBJECTIVE: To assess specific performance indicators relating to a register-based acute rheumatic fever and rheumatic heart disease (ARF/RHD) prevention program in a remote Australian Aboriginal community in order to identify the most appropriate avenues for improvements in delivery of services. METHODS: Information kept on the central ARF/RHD register was compared with an amalgamated dataset from three other sources. The community clinic charts of identified patients were reviewed for information regarding accuracy of diagnosis and the number of doses of benzathine penicillin received in the last year. Specific follow-up arrangements were assessed and compared with practice guidelines. RESULTS: The central ARF/RHD register contained the names of 58 of the 72 (81%) people identified in the community as eligible for inclusion. Only 42% (22/52) of people receiving antibiotic prophylaxis had received 80% or more of the recommended doses in the previous year; service delivery was significantly better for females than males (p = 0.004). Individuals in priority category 1 (most severe disease) were found to be receiving follow-up and investigation according to guidelines. About half the people in categories 2 (moderate disease) and 3 (mild disease) had been inadequately investigated and/or missed out on follow-up appointments. CONCLUSIONS: The ARF/RHD prevention program in this large remote Aboriginal community is struggling to deliver services to a substantial proportion of people who require them. Specific interventions, especially those related to men's health, may be required to correct the problems.