Estimated cumulative X-ray exposure and additional cancer risk during the evaluation and treatment of scoliosis in children and young people requiring surgery.

INTRODUCTION: Clinicians and patients must weigh the benefits of radiological imaging against the risks of radiation exposure in the diagnosis and treatment of scoliosis. This report aims to estimate the cumulative absorbed and equivalent dose of radiation in patients undergoing surgical treatment for scoliosis, and to present this as an estimated risk of cancer compared to background radiation levels. METHODS: Retrospective review of estimated absorbed dose on the Computerised Radiology Information System (CRIS®). Patients undergoing surgical correction of scoliosis (age ≤ 25) from August 2010 to August 2015 investigated. Estimated absorbed dose [milligrays (mGy)] recorded. Pedicle screws inserted using image intensification. Equivalent dose [millisieverts (mSv)] and additional cancer risk calculated from the National Research Council document 'Health risks from exposure to low levels of ionising radiation' (2006). RESULTS: 271 patients identified. Mean age 15 (range 2-25). Mean total absorbed dose 2136 mGy [standard deviation (SD) 1700 mGy]. Mean number of plain spine radiographs was 8 (SD 3) with total 1884 mGy exposure (SD 1609 mGy). Additional dose provided by CT (mean 0.17 episodes), plain chest and abdominal radiographs and image intensification. Mean number of image intensification episodes was 1.1 with mean estimated exposure 180 mGy (SD 238 mGy). Image intensification accounted for 8% of the estimated absorbed dose during treatment. Estimated mean effective dose delivered was 20.952 mSv equating to an additional cancer risk of 0.27-0.45%. CONCLUSION: Additional cancer risk from cumulative imaging is small and equivalent to approximately 8 years of natural background radiation. Use of image intensification for pedicle screw insertion is a minor contribution (8%) to the total patient dose.

Plant growth-promoting endophytic bacteria augment growth and salinity tolerance in rice plants.

Salt stress negatively affects growth and development of plants. However, it is hypothesized that plant growth-promoting endophytic bacteria can greatly alleviate the adverse effects of salinity and can promote growth and development of plants. In the present research, we aimed to isolate endophytic bacteria from halotolerant plants and evaluate their capacity for promoting crop plant growth. The bacterial endophytes were isolated from selected plants inhabiting sand dunes at Pohang beach, screened for plant growth-promoting traits and applied to rice seedlings under salt stress (NaCl; 150 mm). Out of 59 endophytic bacterial isolates, only six isolates, i.e. Curtobacterium oceanosedimentum SAK1, Curtobacterium luteum SAK2, Enterobacter ludwigii SAK5, Bacillus cereus SA1, Micrococcus yunnanensis SA2, Enterobacter tabaci SA3, resulted in a significant increase in the growth of Waito-C rice. The cultural filtrates of bacterial endophytes were tested for phytohormones, including indole-3-acetic acid, gibberellins and organic acids. Inoculation of the selected strains considerably reduced the amount of endogenous ABA in rice plants under NaCl stress, however, they increased GSH and sugar content. Similarly, these strains augmented the expression of flavin monooxygenase (OsYUCCA1) and auxin efflux carrier (OsPIN1) genes under salt stress. In conclusion, the pragmatic application of the above selected bacterial strains alleviated the adverse effects of NaCl stress and enhanced rice growth attributes by producing various phytohormones.

Cross-disciplinarity in the advance of Antarctic ecosystem research.

The biodiversity, ecosystem services and climate variability of the Antarctic continent and the Southern Ocean are major components of the whole Earth system. Antarctic ecosystems are driven more strongly by the physical environment than many other marine and terrestrial ecosystems. As a consequence, to understand ecological functioning, cross-disciplinary studies are especially important in Antarctic research. The conceptual study presented here is based on a workshop initiated by the Research Programme Antarctic Thresholds - Ecosystem Resilience and Adaptation of the Scientific Committee on Antarctic Research, which focussed on challenges in identifying and applying cross-disciplinary approaches in the Antarctic. Novel ideas and first steps in their implementation were clustered into eight themes. These ranged from scale problems, through risk maps, and organism/ecosystem responses to multiple environmental changes and evolutionary processes. Scaling models and data across different spatial and temporal scales were identified as an overarching challenge. Approaches to bridge gaps in Antarctic research programmes included multi-disciplinary monitoring, linking biomolecular findings and simulated physical environments, as well as integrative ecological modelling. The results of advanced cross-disciplinary approaches can contribute significantly to our knowledge of Antarctic and global ecosystem functioning, the consequences of climate change, and to global assessments that ultimately benefit humankind.

Enterobacter asburiae KE17 association regulates physiological changes and mitigates the toxic effects of heavy metals in soybean.

This study aimed to elucidate the role played by Enterobacter asburiae KE17 in the growth and metabolism of soybeans during copper (100 µm Cu) and zinc (100 µm Zn) toxicity. When compared to controls, plants grown under Cu and Zn stress exhibited significantly lower growth rates, but inoculation with E. asburiae KE17 increased growth rates of stressed plants. The concentrations of plant hormones (abscisic acid and salicylic acid) and rates of lipid peroxidation were higher in plants under heavy metal stress, while total chlorophyll, carotenoid content and total polyphenol concentration were lower. While the bacterial treatment reduced the abscisic acid and salicylic acid content and lipid peroxidation rate of Cu-stressed plants, it also increased the concentration of photosynthetic pigments and total polyphenol. Moreover, the heavy metals induced increased accumulation of free amino acids such as aspartic acid, threonine, serine, glycine, alanine, leucine, isoleucine, tyrosine, proline and gamma-aminobutyric acid, while E. asburiae KE17 significantly reduced concentrations of free amino acids in metal-affected plants. Co-treatment with E. asburiae KE17 regulated nutrient uptake by enhancing nitrogen content and inhibiting Cu and Zn accumulation in soybean plants. The results of this study suggest that E. asburiae KE17 mitigates the effects of Cu and Zn stress by reprogramming plant metabolic processes.

The role of needle tip position on the accuracy of diagnostic selective nerve root blocks in spinal deformity.

PURPOSE: The specificity of a selective nerve root block (SNRB) is dependant on isolating only the required nerve root whilst avoiding injectate flow to traversing nerves. Needle tip position is therefore crucial. Nerve root blocks (SNRBs) in the presence of deformity can be particularly technically challenging to perform. The aims of this study were to document the relationship of needle tip position and SNRB accuracy in patients with and without spinal deformity. METHODS: Over an 8-month period, all SNRBs performed by one spinal surgeon were included. Patients with radiographic evidence of spinal deformity were analysed separately and their lumbar deformity graded using the Schwab grading system. Needle tip position in relation to the superior pedicle and flow of contrast was documented. RESULTS: 76 patients received 85 injections without deformity, 26 patients with deformity underwent 30 SNRBs. In the normal spinal alignment group, there was on overall accuracy of 70.1% regardless of needle tip position, which improved to 91.8% for a lateral needle tip position (P < 0.001). In patients with deformity, the overall accuracy was significantly lower irrespective of needle tip position 36 versus 70%, respectively (P < 0.0019). CONCLUSIONS: Selective nerve root blocks are accurate in patients without deformity where a needle tip placement lateral to the middle third of the pedicle is achieved. The presence of spinal deformity significantly reduces the accuracy of SNRBs with a higher chance of epidural infiltration.

Interleukin-17 Expression in the Barrett's Metaplasia-Dysplasia-Adenocarcinoma Sequence.

Introduction. This pilot study evaluated the expression of the proinflammatory cytokine IL-17 along the Barrett's metaplasia-dysplasia-adenocarcinoma sequence by establishing the expression levels of IL-17 in columnar epithelium, intestinal metaplastic cells, and dysplastic/glandular neoplastic cells. Immunohistochemical techniques were used to examine the accumulation of the proinflammatory cytokine IL-17 in forty (n = 40) formalin-fixed, paraffin-embedded oesophageal archived specimens across a range of endoscopic diagnostic categories, and a highly significant difference was found, where P ≤ 0.001, in IL-17 expression (Kruskall Wallis and Mann-Whitney U) between all the cell types examined. There was also a strong positive correlation (Spearman's rank correlation) between disease progression and IL-17 expression (r s = 0.883, P < 0.001, n = 29), IL-17 expression was absent or absent/weak in columnar epithelium, weak to moderate in columnar metaplastic cells, and moderate to strong in dysplastic/neoplastic cells, which demonstrated that the elevation of IL-17 expression occurs in the progression of the disease. Understanding the differential expression of IL-17 between benign and malignant tissue potentially has a significant diagnostic, prognostic, and therapeutic value. Ultimately, this selective biomarker may be employed in routine clinical practice for the screening of oesophageal adenocarcinoma.

Altered gastric corpus expression of tissue inhibitors of metalloproteinases in human and murine Helicobacter infection.

BACKGROUND: Matrix metalloproteinases (MMPs) have roles in inflammation and other processes relevant to the architectural disturbances seen in the gastric mucosa in response to Helicobacter pylori infection. Upregulation of MMPs has been reported in H pylori infection, but there are no detailed reports regarding altered production of their inhibitors, the tissue inhibitors of metalloproteinases (TIMPs). AIMS: To investigate changes in the abundance of TIMPs in human gastric corpus mucosa and murine stomach in Helicobacter infection, and to study cellular sources in man. METHODS: Gastric corpus biopsy samples were assessed for abundance of mRNA or protein for TIMP-1 to -4 by real-time quantitative PCR or western blotting, respectively. Antral and corpus biopsies were processed for histology, H pylori status and inflammatory scoring. Cellular sources of TIMP-1, -3 and -4 were examined by indirect immunohistochemistry. Circulating gastrin was measured by radioimmunoassay. Also, abundance of TIMP-1, -3 and -4 mRNA in the stomach of Helicobacter felis infected mice post-infection was compared with that of uninfected control animals. RESULTS: Compared with uninfected patients, mRNA and protein for TIMP-1, -3 and -4 were significantly more abundant in the gastric corpus of H pylori infected subjects. Gastric TIMP expression did not differ significantly between hyper- and normogastrinaemic subjects within the H pylori negative and positive groups. There was no difference in mRNA abundance for MMP-3 or -8. Immunohistochemistry showed TIMP proteins localised to gastric epithelial, stromal cells and inflammatory cells. Murine H felis infection was associated with upregulation of TIMP-1 and -3 mRNA. CONCLUSIONS: Helicobacter infection is associated with upregulation of specific TIMPs (TIMP-1 and -3) in glandular epithelium and stroma. It is suggested that increased expression of specific protease inhibitors in the corpus mucosa may exert important effects on extracellular matrix remodelling and influence the outcome of H pylori infection.

Factors influencing the development of wound infection following free-flap reconstruction for intra-oral cancer.

Wound infection following tissue transfer in head and neck oncology is common. Factors known to be associated with infective complications include blood transfusion, pre-operative radiotherapy, duration of surgery, duration of pre-operative stay and a history of smoking. The present study specifically examined 100 consecutive patients on a standard antibiotic protocol undergoing free flap reconstruction following resection of cancers of the oral cavity or oropharynx. Despite prophylactic antibiotics, 21 patients developed a head and neck wound infection. No statistically significant association was found between infective wound complications and a history of smoking, pre-operative radiotherapy or chemotherapy, length of pre-operative hospital stay, duration of surgery, or number of units of blood transfused. We conclude that, in this group of patients, wound infection is a common and difficult problem, but with no statistically significant association with any of the variables studied.

The role of the intra-aortic balloon pump counterpulsation (IABP) in emergency surgery.

Elective surgical procedures are often delayed for up to six months in patients who have suffered a myocardial infarction (MI) because of the substantial risk of re-infarction and high peri-operative mortality. The optimal management of patients who have sustained a recent myocardial infarction and who require an emergency abdominal operation, however, has yet to be defined. The use of an intraaortic balloon pump (IABP) may play a role in such patients by improving the function of the injured heart. Three cases are presented in which IABP was used in patients who had recently sustained a myocardial infarction and who required emergency abdominal surgery. A review of the literature is presented and the application of IABP in such circumstances is discussed. Although clinical experience is limited, the use of the IABP may be useful in selected patients who have sustained a recent MI and who require emergency surgery.

Do intraoral radial forearm free flaps re-mucosalise and is candida infection relevant?

Eleven patients, with a mean age of 57 years, who had undergone radial forearm flap reconstruction following the excision of intraoral carcinoma, underwent flap biopsy at a mean of 45 months postoperatively. Seven of the patients had received postoperative radiotherapy. In eight patients the clinical appearance of the flap was similar in colour to that of adjacent normal oral mucosa; the remaining flaps retained the appearance of normal volar forearm skin. Histological examination of the flaps showed varying degrees of telangiectasia and mild chronic inflammation. In only two patients was superficial infection by candida hyphae identified. Intraoral free flaps, although clinically resembling oral mucosa, retain histological features of skin, at least within the period under study. The erythematous clinical appearance was not correlated with the presence of chronic fungal infection, but reflected the presence of vascular repair tissue, telangiectasia and mild residual chronic inflammation.

Stromal tumour within a Meckel's diverticulum: CT and ultrasound findings.

The incidence of tumours within a Meckel's diverticulum is 0.5-3.2%. Their pre-operative diagnosis is rare. We report a case of an incidentally found gastrointestinal stromal tumour within a Meckel's diverticulum in a patient presenting with acute appendicitis. The tumour was demonstrated pre-operatively by ultrasound and CT.

Peri-operative acute phase response and cytokine releasein women with breast cancer: modulation bypolyadenylic-polyuridylic acid.

AIMS: Acute phase reactants (APRs) are believed to play an important biological role in trauma, sepsis and malignant disease. We have investigated the induction of the APR, C-reactive protein (CRP), by the biological response modifier, polyadenylic-polyuridylic acid (PAPU) during the peri-operative period. METHODS: Twenty post-menopausal women with breast cancer undergoing mastectomy were randomized into a double blind, placebo-controlled, parallel group pilot study. PAPU (150 mg) or placebo was given intravenously the day prior to surgery (D -1), the day of surgery (D 0) and post-operatively on days (D 1, 3, 5, 7 and 14). Blood samples were collected on eight different days (D -2, -1, 0, 1, 2, 4, 6 and 18). CRP was significantly elevated in the PAPU group (P<0.05) on days 2 and 4, when compared with patients receiving placebo. The serum levels of cytokines believed to induce hepatic APRs, were also measured. RESULTS: The serum concentration of IL-6 was elevated on days 1, 2, 4 and 6 (P<0.05), TNF- alpha and IL-1 beta levels were increased on days 1 and 2 (P<0.05), respectively, while the serum level of soluble interleukin-2 receptor (sIL-2R) was elevated above the baseline on days 0, 2, 4, 6 and 18 in the PAPU group, when compared with the baseline. CONCLUSIONS: This modulation of acute phase response may have important implications for patients with cancer undergoing surgery.

Sequestrated tubular duplication of the ileum.

Duplication of the small bowel is uncommon, and a sequestrated tubular duplication of the ileum that is isolated from the normal bowel and mesentry has not been previously described in the literature. We report one case of such a sequestrated duplication.

Polyadenylic-polyuridylic acid enhances the natural cell-mediated cytotoxicity in patients with breast cancer undergoing mastectomy.

BACKGROUND: Surgical procedures suppress host antitumor defense mechanisms, which may increase the risk of metastatic tumor dissemination. We have evaluated the effects of the biologic response modifier polyadenylic-polyuridylic acid (PAPU) on natural cytotoxicity in patients with breast cancer undergoing operation. METHODS: PAPU (150 mg) or placebo was given intravenously during the perioperative period (preoperative, days -1 and 0; postoperative, days 1, 3, 5, 7, and 14). The function (chromium release assay) and number (flow cytometry) of natural killer (NK) cells were measured before operation (days -2 and -1), on the day of operation (day 0), and after operation (days 1, 2, 4, 6, and 18). RESULTS: Surgical procedures suppressed NK cell cytotoxicity in the placebo group on postoperative days 1 (p < 0.001), 4, 6, and 18 (p < 0.05), whereas inhibition on postoperative day 2 failed to reach significance. PAPU abolished this immunosuppression after operation. The NK cell activity was elevated when compared with the control group; it was significant (p < 0.05) on postoperative days 1, 2, 4, 6, and 18. Surgical procedures also reduced circulating NK cell numbers during the first postoperative week in the placebo group; the decrease was statistically significant on day 4. The decrease in NK cell numbers in the PAPU group was insignificant. CONCLUSIONS: PAPU prevented the decrease in the circulating number and cytotoxic activity of NK cells that occurred after operation and enhanced NK cell cytotoxicity. This may have important implications for patients with cancer undergoing major operation.

Intravenous cholangiography and operative cholangiography: implications for laparoscopic cholecystectomy.

There has been a resurgence of interest in the potential role of intravenous cholangiography with the advent of laparoscopic cholecystectomy. A retrospective review of a historical group of 185 patients undergoing cholecystectomy in whom the results of both intravenous cholangiography (IVC) and routine operative cholangiography (OC) were available was carried out. The common bile duct (CBD) was explored in 31 (16.7%) patients and choledocholithiasis confirmed in 25 (81%). IVC had shown calculi in 17 of these 25 patients (sensitivity, 68%) whereas OC demonstrated calculi in 24 (sensitivity 96%). Out of the six negative duct explorations, IVC suggested stones in two patients (specificity 66%) and OC in four patients (specificity 33%). Ultrasound scan had a sensitivity of only 48% for bile duct calculi. The accuracy of IVC was 68% and OC 84%. Intravenous cholangiography has no routine role in the preoperative assessment in patients undergoing elective cholecystectomy. In high-risk patients, alternative imaging techniques should be used.

Synthetic polyribonucleotides: current role and potential use in oncological practice.

Polyadenylic-polyuridylic acid (PAPU) has a wide range of effects on various immunological cells and functions. It has been shown to enhance cellular and humoral immunity, in particular anti-cancer host defences, in both animals and man. In a small number of clinical trials (breast and stomach cancers) it appears to have a beneficial adjuvant effect, in terms of prolongation of disease-free and overall survival. Side effects with PAPU are minimal. The precise mode of action of PAPU is unclear and the most beneficial therapeutic regimen has yet to be established. PAPU, therefore, merits further careful consideration and evaluation. This article reviews its present status and considers further priority areas for investigation.

Surgical management of the septic complications of diverticular disease.

This retrospective study has reviewed the surgical management of the septic complications of diverticular disease involving the left colon in 77 patients who presented between 1980 and 1992. Over this period, Hartmann's resection continued to be the predominant surgical procedure. The overall mortality and morbidity rates in the study period were 10% and 31%, respectively. However, a marked improvement in survival was recorded in the latter half of the study (17% vs 6%). The mortality from Hartmann's resection was also reduced substantially in the second half of the study (24% vs 7.5%). These improvements occurred despite having a higher number of poor-risk patients (APACHE II score) with more severe pathology (generalised peritonitis, 35% vs 50%; faecal peritonitis, 9% vs 25%) in the latter half. There was a significantly worse survival in patients who were over 70 years of age (P < 0.03), those who had a severe concomitant medical illness (P < 0.02), those who had a generalised peritonitis (P < 0.02), and in those patients who had an APACHE II score of over 11 (P < 0.05) (Fisher's exact test). There was no difference in outcome (morbidity, mortality) between the various grades of surgeon involved in performing the emergency surgical procedures.

Reversal of Hartmann's colostomy.

From January 1980 to December 1992, sixty-two Hartmann's procedures were performed for septic complications of sigmoid diverticular disease, in the Professorial Unit at Aberdeen Royal Infirmary. Colorectal continuity was subsequently restored in 53% of the fifty-three surviving patients. The overall morbidity and mortality was 34% and 0% respectively. There were two anastomotic leaks (7%) while two patients (7%) developed anastomotic stenoses requiring multiple dilations. Closure of Hartmann's colostomy was carried out by consultants (48%), senior registrars (38%) and registrars with consultant supervision (14%). Fifteen anastomoses were hand sewn and fourteen were stapled. Twenty-one per cent of patients had closure of colostomy in less than 3 months, 48% between 3 and 6 months and 31% of reversals were carried out more than 6 months following their formation. The grade of surgeon had no influence on the outcome of reversal. Although the numbers were small, the morbidity was found to be highest in those patients in whom colostomy closure was carried out within 3 months of colostomy formation. Also, there was an increased incidence (7%) of anastomotic stenoses in the stapled anastomosis group.