A tailored approach to abdominoperineal resection for rectal cancer: multicentre analysis of short-term outcomes and impact on oncological survival.

PURPOSE: Abdominoperineal resection of the rectum has evolved over the last century, with few modifications until 2007, when extralevator abdominoperineal resection was introduced, which improved local disease control but resulted in a significant rise in perineal complications. We adopted a modified approach in which dissection was tailored according to magnetic resonance-defined tumour involvement. The aim of this study was to assess short-term and long-term oncological outcomes following a tailored abdominoperineal resection (APR) approach. METHODS: This study was a retrospective review of prospectively maintained databases at three centres: Portsmouth NHS Trust (UK), Poole General Hospital (UK) and Champalimaud's Cancer Foundation, Portugal. The study included consecutive patients who underwent abdominoperineal resection from October 2008 until April 2018 under the supervision of the senior author. Oncological outcomes, including overall survival and disease-free survival, were used as the main outcome measures. RESULTS: A total of 584 patients underwent rectal cancer surgery during the study period. The APR ratio was 65/584 (11%). The median age was 66 years. Neoadjuvant treatment was administered to 74% of patients. Of the patients, 91% underwent surgery via a minimally invasive approach. The median hospital stay was 7 days. Patients were followed up for a median of 41 months. Only four patients had positive resection margins. The 5-year overall and disease-free survival rates were 64% and 62%, respectively. CONCLUSION: Our data suggest that tailored APR has similar short-term and long-term oncological outcomes compared with extralevator abdominoperineal resection but reduced perineal wound complications. We believe this approach could be a safe alternative but recommend a larger sample size to accurately assess its effectiveness.

Expert consensus on a train-the-trainer curriculum for robotic colorectal surgery.

AIM: Robotic techniques are being increasingly used in colorectal surgery. There is, however, a lack of training opportunities and structured training programmes. Robotic surgery has specific problems and challenges for trainers and trainees. Ergonomics, specific skills and user-machine interfaces are different from those in traditional laparoscopic surgery. The aim of this study was to establish expert consensus on the requirements for a robotic train-the-trainer curriculum amongst robotic surgeons and trainers. METHOD: This is a modified Delphi-type study involving 14 experts in robotic surgery teaching. A reiterating 19-item questionnaire was sent out to the same group and agreement levels analysed. A consensus of 0.8 or higher was considered to be high-level agreement. RESULTS: Response rates were 93-100% and most items reached high levels of agreement within three rounds. Specific requirements for a robotic faculty development curriculum included maximizing dual-console teaching, theatre team training, nontechnical skills training, patient safety, user-machine interface training and telementoring. CONCLUSION: A clear need for the development of a train-the-trainer curriculum has been identified. Further research is needed to assess feasibility, effectiveness and clinical impact of a robotic train-the-trainer curriculum.

Comparative efficacy of ivermectin and Nigella sativa against helminths in Aseel chickens (Gallus gallus domesticus).

In this study, we evaluated the in vivo comparative efficacy of ivermectin and Nigella sativa extract against helminths in Aseel chickens, and the effects of helminths on blood parameters before and after treatment in Aseel chickens. Forty naturally infected adult Aseel chickens were randomly divided into four groups (n = 10 each): group A (ivermectin at 300 µg/kg); group B (N. sativa extract at 200 mg/kg); group C (ivermectin at 300 µg/kg + N. sativa extract at 200 mg/kg); group D was kept as a positive control to monitor time-related changes. On day 28 post treatment, the mean percentages of faecal egg-count reduction (FECR %) in groups A, B and C were recorded as 93.58, 88.09 and 100.00%, respectively. Further data analysis showed significantly higher efficacy in group C (100 ± 0.00%) than in groups A and B (P < 0.001). Highly significant (P < 0.001) improvements in mean percentage values of packed cell volume (PCV %) were recorded in groups A and C on days 14 and 28 post treatment. Meanwhile, the improvements in mean values of haemoglobin (Hb) concentration in groups A, B and C were highly significant (P < 0.001) when compared to that of group D on day 28 post treatment. The synergistic combination of ivermectin and N. sativa extract possessed greater efficacy than either ivermectin or N. sativa extract used alone. Furthermore, both PCV % and Hb concentration values gradually increased in the treated groups compared to the control group, in which PCV % and Hb concentration gradually decreased throughout the trial.

Pathological effect on naturally infected kidneys of freshwater murrels by Euclinostomum heterostomum metacercariae.

Present investigation was carried out to study the histo-pathological alterations induced by metacercariae of digenetic trematode, Euclinostomum heretostomum on the kidney of Channa striatus and Channa marulius in natural condition. Histo-architectural alterations induced by parasite included reduced size of glomeruli, severe degeneration and necrosis of haemopoietic tissue and tubule cells with hypertrophied nuclei in C. striatus. Whereas, infected kidney of C. marulius exhibited the development of several melano-macrophage centers, hypertrophied nuclei of tubule cells and detached epithelial cells of renal tubules. Therefore an attempt has been made to record the first naturally occurring pathogenicity of E. heterostomum in kidney of freshwater murrels.

A discerning approach to simple aesthetic orthodontics.

There is currently considerable interest from general dental practitioners (GDPs) in the use of simple orthodontics to treat adult malocclusions. There is controversy in this, particularly in relation to 'quick fixes', simple orthodontics and 'straight teeth in six months' as opposed to more conventional treatment where the whole malocclusion is treated. This article will present a case for the use of simple aesthetic adult orthodontics in a measured and planned way. It will discuss the processes, planning and the importance of consent. It will also highlight how digital technology is used to preview, consent and execute an aesthetic result. Many of the recent systems emerging, have been as a result of the demand and supply of cosmetic dentistry. This, to a degree, has not helped since the implication of a 'quick-fix' is associated with this field. There has also been discussion on what the limits of GDP orthodontics should be. There is variability in how GDPs approach orthodontics, their experience, skill and ability to treat to an acceptable standard. Short courses may be one way of delivering orthodontic training but some of these courses are not regulated and the amount of internal mentoring is variable. This article highlights some of the systems in use, and potential upsides and downsides of this approach.

A systematic review and meta-analysis evaluating the role of laparoscopic surgical resection of transverse colon tumours.

OBJECTIVES: A meta-analysis of published literature comparing outcomes after laparoscopic resection (LR) with open resection (OR) for transverse colon tumours. METHODS: Medline, PubMed, CINAHL, EMBASE and Cochrane were searched from inception to October 2013. The text words "minimally invasive", "keyhole surgery" and "transverse colon" were used in combination with the medical subject headings "laparoscopy" and "colon cancer". Outcome variables were chosen based upon whether the included articles reported results. A meta-analysis was performed to obtain a summative outcome. RESULTS: Six comparatives involving 444 patients were analysed. Of them 245 patients were in the LR group and 199 in the OR group. There was a significant increase in operative time in the LR group compared with the OR group [random effects model: SMD = -0.65, 95% CI (-1.01, -0.30), z = -3.60, p < 0.001] but there was significant heterogeneity amongst trials (Q = 15.51, df = 5, p = 0.008, I(2) = 68). There was less blood loss in the LR group [fixed effects model: SMD = 0.70, 95% CI (0.47, 0.93), z = 6.01, p < 0.001] and patients returned to oral diet earlier [random effects model: SMD = 0.78, 95% CI (0.40, 1.16), z = 4.01, p < 0.001] and had a reduced time to functioning bowel [fixed effects model: SMD = 0.86, 95% CI (0.60, 1.11), z = 6.63, p < 0.001]. No difference was seen for overall morbidity (p = 0.76) or mortality (p = 0.58). CONCLUSIONS: LR of transverse colon tumours is a safe and effective technique. Although there is an increase in operating time, operative and clinical outcomes of intraoperative blood loss and faster recovery are seen with laparoscopic procedures.

Pathological effects of Eustrongylides sp. larvae (Dioctophymatidae) infection in freshwater fish, Glossogobius giuris (Ham.) with special reference to ovaries.

Present study was conducted to investigate the pathological effects of Dioctophymatid nematode (Eustrongylides sp.) in the freshwater fish, Glossogobius giuris. It is bright red colored nematode, measuring 30-55.26 mm in length and 0.525-0.630 mm in width, was found encapsulated or free in the body muscles, swim bladder, liver, intestine and ovaries of host fish. The overall prevalence of parasite was 38.47 ± 18.234 % and high prevalence of 68.75 and 50.0 % was observed in month of November, 2008 and March, 2008 respectively i.e. maximum infection of parasite was during pre-spawning and post-spawning period. Only the ovaries of host fish were found infected with encapsulated larvae. Ovaries showed 11.2 ± 0.088 % of prevalence and 0.259 ± 1.176 of relative intensity. The gonado-somatic index and fecundity of infected fishes were observed to decrease as compared to the uninfected ones. The histo-pathological damage caused by parasites in ovaries is characterized by damaged and disrupted germinal epithelium, damaged oocytes showing the sign of necrosis, liquification of yolk globules and reduction in the formation of yolk. The present observation attributes towards the reduction in fecundity and further decline in the population of the host fish.

Angiotensin I-converting enzyme-inhibitory activity of the Norwegian autochthonous cheeses Gamalost and Norvegia after in vitro human gastrointestinal digestion.

The angiotensin I-converting enzyme (ACE) inhibitory activity of Gamalost cheese, its pH 4.6-soluble fraction, and Norvegia cheese was monitored before and after digestion with human gastric and duodenal juices. Both Gamalost and Norvegia cheeses showed an increased ACE-inhibitory activity during gastrointestinal digestion. However, only Norvegia showed pronounced increased activity after duodenal digestion. More peptides were detected in digested Gamalost compared with digested Norvegia. Most of the peptides in Gamalost were derived from ß-casein (CN), some originated from α(s1)-CN, and only a very few originated from α(s2)-CN and κ-CN. In general, the number of peptides increased during gastrointestinal digestion, whereas some peptides were further degraded and disappeared; however, surprisingly, a few peptides remained stable. The aromatic amino acids, such as Tyr, Phe, and Trp; the positively charged amino acids (Arg and Lys); and Leu increased after simulated gastrointestinal digestion of Gamalost and Norvegia. After in vitro gastrointestinal digestion, both Gamalost and Norvegia showed high ACE-inhibitory activity, which may contribute in lowering of mild hypertension.

Histo-architectural alterations induced by Euclinostomum heterostomum (metacercariae) infected liver of Channa punctata (Bloch).

Present investigation was carried out to study the effect of digenetic trematode, Euclinostomum heretostomum on the histo-architecture of liver of Channa punctata. In case of mild infection, the metacercariae were found attached to the external surface of hepatic tissue. While in case of acute or chronic infection, the encysted metacercariae of Euclinostomum heterostomum were found deeply embedded in the entire hepatic tissue due to which liver appeared thin, compressed and pale with yellowish- black nodules of encysted metacercariae. A space occupying cavity is created by the metacercarial cysts due to which tissue appeared in the form of lumps. Histo-architectural alterations induced by parasite included degeneration, compression and loosening of hepatic tissue with enucleated and deshaped hepatocytes.

Seasonal variation in physicochemical parameters and heavy metals in water of Upper Lake of Bhopal.

Heavy metal pollution of fresh water is the single most important environmental threat to the future. Upper Lake is a freshwater lake, which is the major source of drinking water in the city of Bhopal, the capital city of M.P., the central province of India, but due to anthropogenic activities this lake is being polluted. During the investigation heavy metals and physicochemical parameters were analyzed to determine the water quality seasonally in the year of 2006 and 2007. All the physicochemical parameters except DO (6.50-6.97 mg l⁻¹), Free CO2 (0.8-1.6 mg l⁻¹) and BOD (5.47-6.85 mg l⁻¹) were below the prescribed limit as recommended by Bureau of Indian Standards (BIS) for drinking water standards. In case of heavy metals, Ni (0.173-0.253 mg l⁻¹) and Cr (0.047-0.087 mg l⁻¹) were found beyond the prescribed limits (0.02 and 0.05 mg l⁻¹, respectively), whereas Pb (0.057-0.087 mg l⁻¹), Cu (0.016-0.020 mg l⁻¹) and Hg (0.0006-0.0011 mg l⁻¹) were within the safe limit. This study reveals that water of upper lake is partially polluted with heavy metals. It is recommended that strict vigilance and constant monitoring are needed to maintain water quality of the lake, which is a major source of potable water for the Bhopal city.

The magnetism of surgery: small bowel obstruction in an 8-year-old boy.

An 8-year-old boy with Asperger's syndrome presented with right-sided abdominal pain, which was consistent with a probable appendicitis, but revisiting the history with a high index of suspicion confirmed multiple foreign body ingestion to be the cause of his symptoms. An emergency laparotomy was performed. Multiple toy magnets and other metal objects were found, which were causing small bowel obstruction with interloop fistulation. Following removal and repair, the patient made an excellent recovery.