Hormonal residues in chicken and cattle meat: A risk threat the present and future consumer health.

The study was designated to determine some hormonal residues (estradiol, progesterone, and testosterone) in chicken and cattle meat as well as assess the risk of these residues for adult and child consumer health. A total of 92 chicken meat samples were collected from four different chicken farm sales outlets, and 56 cattle meat samples from two brands were collected from markets through 2022 in Assiut City, Egypt. An enzyme-linked immunosorbant assay (ELISA) was used to measure the hormonal residues. Results showed that the estimated daily intake (EDI) of estradiol exceeded acceptable daily intakes (ADIs) in all analyzed samples except four chicken farm meat samples for adults only, which were below 0.05 µg/kg bw, and the hazard index (HI) of estradiol and testosterone residues for adults and children exceeded 1 in all examined samples of the study. The U.S. Food and Drug Administration (FDA) set safe limits for these anabolic hormones to ensure high food quality and quantity for humans, but in Egypt, monitoring and assessment of hormonal residues in food became very urgent as no safe limits have been set till now.

Health risk assessment of metals in chicken meat and liver in Egypt.

This study aimed to evaluate the concentration of metals such as aluminum (Al), cadmium (Cd), lead (Pb), barium (Ba), bismuth (Bi), cobalt (Co), nickel (Ni), chromium (Cr), iron (Fe), copper (Cu), zinc (Zn), and selenium (Se) in 360 samples of poultry meat and liver from six brands (A, B, C, D, E, and F) in Assiut, Egypt; compare these concentrations with Egyptian and world permissible limits; and determine their safety for human consumption according to health risk assessment. Chest, thigh muscles, and liver were collected randomly from Assiut city markets, and the concentration of heavy metals was measured in the central laboratory of the faculty of agriculture at Assiut University using inductively coupled plasma mass spectrometry (ICP-MS). All the analyzed samples were positive for the tested metals and were far below the allowed maximum permissible limits except for Pb and Fe, which exceeded the Egyptian Organization for Standardization (EOS) permissible limits with 33% and 67%, respectively, as well as Pb and Cd, which exceeded FAO/WHO permissible limits with 94% and 17%, respectively. Health risk assessment revealed the safety and minimum health risk for human consumption of metal residues in poultry tissues and liver using estimated daily intake (EDI), target hazard quotient (THQ), hazard index (HI), and target cancer risk (TR). Even though the THQ and HI values were significantly lower than 1.0 during our study, heavy metal monitoring in poultry products and byproducts is required for human security and safety.

Fasting and surgery timing (FaST) audit.

BACKGROUND & AIMS: International guidance advocates the avoidance of prolonged preoperative fasting due to its negative impact on perioperative hydration. This study aimed to assess the adherence to these guidelines for fasting in patients undergoing elective and emergency surgery in the East Midlands region of the UK. METHODS: This prospective audit was performed over a two-month period at five National Health Service (NHS) Trusts across the East Midlands region of the UK. Demographic data, admission and operative details, and length of preoperative fasting were collected on adult patients listed for emergency and elective surgery. RESULTS: Of the 343 surgical patients included within the study, 50% (n = 172) were male, 78% (n = 266) had elective surgery and 22% (n = 77) underwent emergency surgery. Overall median fasting times (Q1, Q3) were 16.1 (13.0, 19.4) hours for food and 5.8 (3.5, 10.7) hours for clear fluids. Prolonged fasting >12 h was documented in 73% (n = 250) for food, and 21% (n = 71) for clear fluids. Median fasting times from clear fluids and food were longer in the those undergoing emergency surgery when compared with those undergoing elective surgery: 13.0 (6.4, 22.6) vs. 4.9 (3.3, 7.8) hours, and 22.0 (14.0, 37.4) vs. 15.6 (12.9, 17.8) hours respectively, p < 0.0001. CONCLUSIONS: Despite international consensus on the duration of preoperative fasting, patients continue to fast from clear fluids and food for prolonged lengths of time. Patients admitted for emergency surgery were more likely to fast for longer than those having elective surgery.

Hollow aluminum microspheres with high mass extinction coefficients in the long wave infrared.

Previous electromagnetic computations of multilayered dielectric/metallic spheres identified the ideal dimensions and composition for achieving optimized mass extinction coefficients (m2/g). A hollow metallic sphere, with a thin metallic shell, is one such example of a spherical structure that can theoretically achieve high mass extinction coefficients in the long wave infrared (LWIR) region (8-12 µm). To this end, we endeavored to demonstrate a cost-effective and scalable manufacturing approach for synthesizing and experimentally validating the mass extinction coefficients of hollow metallic spheres. Specifically, we detail a novel approach for fabricating hollow aluminum spheres using radio frequency (RF) magnetron sputter deposition. Sacrificial high-density polyethylene polymer microspheres were used as substrates for the deposition of thin layers of aluminum. The core shell structures were subsequently thermally processed to form the hollow micron sized aluminum shells. The mass extinction coefficients of the hollow aluminum spheres were subsequently measured and compared to computational results. A strong agreement between experimental and theoretical predictions was observed. Finally, the LWIR mass extinction coefficients of the hollow spheres were compared to high aspect ratio brass flakes, a common pigment used for LWIR attenuation, and other materials and geometries that are used for LWIR filtering applications. This comparison of both performance and availability revealed that the fabricated hollow aluminum spheres exhibited competitive LWIR properties using a more scalable and cost-effective manufacturing approach.

Vitamin D Signaling in Inflammation and Cancer: Molecular Mechanisms and Therapeutic Implications.

Vitamin D and its active metabolites are important nutrients for human skeletal health. UV irradiation of skin converts 7-dehydrocholesterol into vitamin D3, which metabolized in the liver and kidneys into its active form, 1α,25-dihydroxyvitamin D3. Apart from its classical role in calcium and phosphate regulation, scientists have shown that the vitamin D receptor is expressed in almost all tissues of the body, hence it has numerous biological effects. These includes fetal and adult homeostatic functions in development and differentiation of metabolic, epidermal, endocrine, neurological and immunological systems of the body. Moreover, the expression of vitamin D receptor in the majority of immune cells and the ability of these cells to actively metabolize 25(OH)D3 into its active form 1,25(OH)2D3 reinforces the important role of vitamin D signaling in maintaining a healthy immune system. In addition, several studies have showed that vitamin D has important regulatory roles of mechanisms controlling proliferation, differentiation and growth. The administration of vitamin D analogues or the active metabolite of vitamin D activates apoptotic pathways, has antiproliferative effects and inhibits angiogenesis. This review aims to provide an up-to-date overview on the effects of vitamin D and its receptor (VDR) in regulating inflammation, different cell death modalities and cancer. It also aims to investigate the possible therapeutic benefits of vitamin D and its analogues as anticancer agents.

Mutagenic effect of imidacloprid insecticide: The ameliorative effect of pre and post exposure to olive oil.

Imidacloprid, a systemic chloro-nicotinyl insecticide belong to neonicotinoid insecticides. In this study 120 rats were divided into four groups, the first group used as a control group, the second group was administered imidacloprid at a dose of 22.5 mg/kg b.w. for 4, 8, and 12 weeks. The third group was treated with olive oil (OLO) in a dose of 10 ml/kg body weight for 2 weeks before the oral dose of imidacloprid for 4, 8, and 12 weeks. The fourth group was given OLO in a dose of 10 ml/kg b.w. for 2 weeks after exposure to imidacloprid for 4, 8, and 12 weeks. Bone marrow was collected for micronucleus and chromosomal aberrations assays. The results revealed that imidacloprid induced a mutagenic effect in the 8th and 12th weeks of exposure and OLO decreased the mutagenic effect of imidacloprid in albino rats but not completely revert them to normal. PRACTICAL APPLICATIONS: Using OLO as a protective or therapeutic agent due to it has an ameliorative effect on mutagenicity induced by IMI.

A randomized, controlled, double-blind crossover study on the effects of isoeffective and isovolumetric intravenous crystalloid and gelatin on blood volume, and renal and cardiac hemodynamics.

BACKGROUND & AIMS: Blood volume expanding properties of colloids are superior to crystalloids. In addition to oncotic/osmotic properties, the electrolyte composition of infusions may have important effects on visceral perfusion, with infusions containing supraphysiological chloride causing hyperchloremic acidosis and decreased renal blood flow. In this non-inferiority study, a validated healthy human subject model was used to compare effects of colloid (4% succinylated gelatin) and crystalloid fluid regimens on blood volume, renal function, and cardiac output. METHODS: Healthy male participants were given infusions over 60 min > 7 days apart in a randomized, crossover manner. Reference arm (A): 1.5 L of Sterofundin ISO, isoeffective arm (B): 0.5 L of 4% Gelaspan®, isovolumetric arm (C): 0.5 L of 4% Gelaspan® and 1 L of Sterofundin ISO (all B. Braun, Melsungen, Germany). Participants were studied over 240 min. Changes in blood volume were calculated from changes in weight and hematocrit. Renal volume, renal artery blood flow (RABF), renal cortex perfusion and diffusion, and cardiac index were measured with magnetic resonance imaging. RESULTS: Ten of 12 males [mean (SE) age 23.9 (0.8) years] recruited, completed the study. Increase in body weight and extracellular fluid volume were significantly less after infusion B than infusions A and C, but changes in blood volume did not significantly differ between infusions. All infusions increased renal volume, with no significant differences between infusions. There was no significant difference in RABF across the infusion time course or between infusion types. Renal cortex perfusion decreased during the infusion (mean 18% decrease from baseline), with no significant difference between infusions. There was a trend for increased renal cortex diffusion (4.2% increase from baseline) for the crystalloid infusion. All infusions led to significant increases in cardiac index. CONCLUSIONS: A smaller volume of colloid (4% succinylated gelatin) was as effective as a larger volume of crystalloid at expanding blood volume, increasing cardiac output and changing renal function. Significantly less interstitial space expansion occurred with the colloid. TRIAL REGISTRATION: The protocol was registered with the European Union Drug Regulating Authorities Clinical Trials Database (https://eudract.ema.europa.eu) (EudraCT No. 2013-003260-32).

Hyperosmolar dehydration: A predictor of kidney injury and outcome in hospitalised older adults.

BACKGROUND & AIMS: Hospitalised older adults are vulnerable to dehydration. However, the prevalence of hyperosmolar dehydration (HD) and its impact on outcome is unknown. Serum osmolality is not measured routinely but osmolarity, a validated alternative, can be calculated using routinely measured serum biochemistry. This study aimed to use calculated osmolarity to measure the prevalence of HD (serum osmolarity >300 mOsm/l) and assess its impact on acute kidney injury (AKI) and outcome in hospitalised older adults. METHODS: This retrospective cohort study used data from a UK teaching hospital retrieved from the electronic database relating to all medical emergency admissions of patients aged ≥ 65 years admitted between 1st May 2011 and 31st October 2013. Using these data, Charlson comorbidity index (CCI), National Early Warning Score (NEWS), length of hospital stay (LOS) and mortality were determined. Osmolarity was calculated using the equation of Krahn and Khajuria. RESULTS: A total of 6632 patients were identified; 27% had HD, 39% of whom had AKI. HD was associated with a median (Q1, Q3) LOS of 5 (1, 12) days compared with 3 (1, 9) days in the euhydrated group, P < 0.001. Adjusted Cox-regression analysis demonstrated that patients with HD were four-times more likely to develop AKI 12-24 h after admission [Hazards Ratio (95% Confidence Interval) 4.5 (3.5-5.6), P < 0.001], and had 60% greater 30-day mortality [1.6 (1.4-1.9), P < 0.001], compared with those who were euhydrated. CONCLUSION: HD is common in hospitalised older adults and is associated with increased LOS, risk of AKI and mortality. Further work is required to assess the validity of osmolality or osmolarity as an early predictor of AKI and the impact of HD on outcome prospectively.

Winter cancellations of elective surgical procedures in the UK: a questionnaire survey of patients on the economic and psychological impact.

OBJECTIVES: To quantify the economic and psychological impact of the cancellation of operations due to winter pressures on patients, their families and the economy. DESIGN: This questionnaire study was designed with the help of patient groups. Data were collected on the economic and financial burden of cancellations. Emotions were also quantified on a 5-point Likert scale. SETTING: Five NHS Hospital Trusts in the East Midlands region of England. PARTICIPANTS: We identified 796 participants who had their elective operations cancelled between 1 November 2017 and 31 March 2018 and received responses from 339 (43%) participants. INTERVENTIONS: Participants were posted a modified version of a validated quality of life questionnaire with a prepaid return envelope. MAIN OUTCOME MEASURES: The primary outcome measures were the financial and psychological impact of the cancellation of elective surgery on patients and their families. RESULTS: Of the 339 respondents, 163 (48%) were aged <65 years, with 111 (68%) being in employment. Sixty-six (19%) participants had their operations cancelled on the day. Only 69 (62%) of working adults were able to return to work during the time scheduled for their operation, with a mean loss of 5 working days (SD 10). Additional working days were lost subsequently by 60 (54%) participants (mean 7 days (SD 10)). Family members of 111 (33%) participants required additional time off work (mean 5 days (SD 7)). Over 30% of participants reported extreme levels of sadness, disappointment, anger, frustration and stress. At least moderate concern about continued symptoms was reported by 234 (70%) participants, and 193 (59%) participants reported at least moderate concern about their deteriorating condition. CONCLUSIONS: The cancellation of elective surgery during the winter had an adverse impact on patients and the economy, including days of work lost and health-related anxiety. We recommend better planning, and provision of more notice and better support to patients.

The Influence of Mechanical Rubbing on the Dissolution of Blood Clots.

Mechanical rubbing of blood clots is a potential minimally-invasive method for clearing clogged blood vessels. In this work, we investigate the influence of the interaction of the tip of a helical robot with blood clots. This interaction enables the dissolution of the blood clot and the release of the entrapped red blood cells and platelets from its three-dimensional fibrin fiber network. We analyze the pre- and post-conditions of the blood clots following 40 minutes of mechanical rubbing, under the influence of a rotating magnetic field in the frequency range of 20 Hz to 45 Hz. Our measurements show that the weight of the blood clots is decreased by 22.5 ± 11.1% at frequency of 25 Hz. We also validate the influence of mechanical rubbing using cell count and spectrophotometric analysis on phosphate buffered saline samples past the robot and the clot. The maximum cell count is measured as 654 ± 108 × 104 cells/m1 and 54 ± 12 × 104 cells/m1, whereas the absorbance is measured as 4. 35 × 10-6 mol and 1. 05 × 10-6 mol under the influence of mechanical rubbing and without mechanical rubbing, respectively.

Epstein-Barr Virus-Associated Malignancies: Roles of Viral Oncoproteins in Carcinogenesis.

The Epstein-Barr virus (EBV) is the first herpesvirus identified to be associated with human cancers known to infect the majority of the world population. EBV-associated malignancies are associated with a latent form of infection, and several of the EBV-encoded latent proteins are known to mediate cellular transformation. These include six nuclear antigens and three latent membrane proteins (LMPs). In lymphoid and epithelial tumors, viral latent gene expressions have distinct pattern. In both primary and metastatic tumors, the constant expression of latent membrane protein 2A (LMP2A) at the RNA level suggests that this protein is the key player in the EBV-associated tumorigenesis. While LMP2A contributing to the malignant transformation possibly by cooperating with the aberrant host genome. This can be done in part by dysregulating signaling pathways at multiple points, notably in the cell cycle and apoptotic pathways. Recent studies also have confirmed that LMP1 and LMP2 contribute to carcinoma progression and that this may reflect the combined effects of these proteins on activation of multiple signaling pathways. This review article aims to investigate the aforementioned EBV-encoded proteins that reveal established roles in tumor formation, with a greater emphasis on the oncogenic LMPs (LMP1 and LMP2A) and their roles in dysregulating signaling pathways. It also aims to provide a quick look on the six members of the EBV nuclear antigens and their roles in dysregulating apoptosis.

Antitumor Activities of the Novel Isosteviol Derivative 10C Against Liver Cancer.

BACKGROUND/AIM: Hepatocellular carcinoma (HCC) is the most common type of liver cancer and the fifth most common primary malignancy with worldwide increasing incidence. The current study aimed to investigate the anticancer activities of novel isosteviol derivatives towards human HepG2 hepatocellular cancer cells and in an animal model of hepatocellular carcinoma. MATERIALS AND METHODS: Twelve isosteviol derivatives were screened for their anti-proliferative activities against HepG2 and IC50 was calculated for all designed derivatives. The impact of the potent isosteviol derivative 10C on HepG2 cells was further studied by MTT assay, Annexin V/PI staining, flow cytometry and western blotting. In vivo studies were performed to assess the anticancer effect of isosteviol derivative 10C on Diethyl Nitrosamine-induced liver cancer in female rats by evaluating the physiological processes. RESULTS: isosteviol derivative 10C induced growth inhibition with IC50 of 2 µM mainly through induction of apoptosis in HepG2 cells. Additionally, isosteviol derivative 10C induced G1 phase arrest, which was further confirmed by increased expression of cyclin dependent kinase inhibitor 1A (CDKN1A, p21). It also increased BAX, BID and PARP-1 and while it reduced pro-CASPASE-3 expression and phosphorylation levels of AKT in HepG2 cells. Furthermore, western blotting data showed that E-cadherin, ß-catenin, VEGF and COX-2 expressions were suppressed by isosteviol derivative 10C in HepG2 cells. The in vivo study demonstrated that dose-dependent treatment of isosteviol derivative 10C led to significant reduction in tumor size compared to the untreated group after the fourth injection with no significant effects on major physiological processes. CONCLUSION: Taken together, in vitro and in vivo studies revealed that isosteviol derivative 10C induced apoptosis in HepG2 cells, blocked angiogenic signaling and it did not induce any apparent toxicity towards the treated hosts which merits further investigation at clinical level.

Hydration amongst nurses and doctors on-call (the HANDS on prospective cohort study).

BACKGROUND & AIMS: Dehydration of as little 2% of total body weight may impair physical and cognitive performance. The aim of this study was to investigate the prevalence of dehydration at the start and end of shifts in nurses and doctors on-call. The secondary aims were to assess the relation between hydration status and cognitive function. METHODS: This prospective cohort study was conducted on nurses and doctors working on medical and surgical admissions wards at a university teaching hospital. Participants arrived on the ward approximately 20 min before their shift and were asked to provide a urine sample. Height and weight were then measured. A 10 mL blood sample was analysed for full blood count, serum urea and electrolytes, and blood glucose. Cognitive function was assessed using a series of computer-based tests including the Stroop Colour Naming Interference Test and Sternberg Memory Paradigm. Participants then worked normally but were asked to keep a fluid diary for the duration of their shift and fluid balance was estimated. Tests were repeated at the end of the shift. Dehydration was defined as urine osmolality >800 mOsmol/kg and oliguria was defined as urine output <0.5 ml/kg/hour. RESULTS: We recruited 92 nurses and doctors, of whom 88 completed the study, amounting to 130 shifts. 52% participated for one shift, and 48% for two shifts. Thirty-six percent of participants were dehydrated at the start of the shift and 45% were dehydrated at the end of their shift. Mean (SD) urinary osmolality was significantly greater at the end of the shift when compared with the start [720 (282) vs. 622 (297) mOsm/kg, P = 0.031). Moreover, 41% were oliguric at the end of the shift. Single number and five-letter Sternberg short-term memory tests were significantly impaired in dehydrated participants (P < 0.05). CONCLUSIONS: This study highlights that a significant proportion of nurses and doctors were dehydrated at the start and end of medical and surgical shifts. Dehydration was associated with some impairment of cognitive function.

Acute and chronic effects of hydration status on health.

Maintenance of fluid and electrolyte balance is essential to healthy living as dehydration and fluid overload are associated with morbidity and mortality. This review presents the current evidence for the impact of hydration status on health. The Web of Science, MEDLINE, PubMed, and Google Scholar databases were searched using relevant terms. Randomized controlled trials and large cohort studies published during the 20 years preceding February 2014 were selected. Older articles were included if the topic was not covered by more recent work. Studies show an association between hydration status and disease. However, in many cases, there is insufficient or inconsistent evidence to draw firm conclusions. Dehydration has been linked with urological, gastrointestinal, circulatory, and neurological disorders. Fluid overload has been linked with cardiopulmonary disorders, hyponatremia, edema, gastrointestinal dysfunction, and postoperative complications. There is a growing body of evidence that links states of fluid imbalance and disease. However, in some cases, the evidence is largely associative and lacks consistency, and the number of randomized trials is limited.

Hydration and outcome in older patients admitted to hospital (The HOOP prospective cohort study).

BACKGROUND: Older adults are susceptible to dehydration due to age-related pathophysiological changes. We aimed to investigate the prevalence of hyperosmolar dehydration (HD) in hospitalised older adults, aged ≥65 years, admitted as an emergency and to assess the impact on short-term and long-term outcome. METHODS: This prospective cohort study was performed on older adult participants who were admitted acutely to a large U.K. teaching hospital. Data collected included the Charlson comorbidity index (CCI), national early warning score (NEWS), Canadian Study of Health and Aging (CSHA) clinical frailty scale and Nutrition Risk Screening Tool (NRS) 2002. Admission bloods were used to measure serum osmolality. HD was defined as serum osmolality >300 mOsmol/kg. Participants who were still in hospital 48 h after admission were reviewed, and the same measurements were repeated. RESULTS: A total of 200 participants were recruited at admission to hospital, 37% of whom were dehydrated. Of those dehydrated, 62% were still dehydrated when reviewed at 48 h after admission. Overall, 7% of the participants died in hospital, 79% of whom were dehydrated at admission (P = 0.001). Cox regression analysis adjusted for age, gender, CCI, NEWS, CSHA and NRS demonstrated that participants dehydrated at admission were 6 times more likely to die in hospital than those euhydrated, hazards ratio (HR) 6.04 (1.64-22.25); P = 0.007. CONCLUSIONS: HD is common in hospitalised older adults and is associated with poor outcome. Coordinated efforts are necessary to develop comprehensive hydration assessment tools to implement and monitor a real change in culture and attitude towards hydration in hospitalised older adults.

Postoperative ileus: Recent developments in pathophysiology and management.

BACKGROUND & AIMS: Postoperative ileus (POI) is a frequent occurrence after abdominal and other types of surgery, and is associated with significant morbidity and costs to health care providers. The aims of this narrative review were to provide an update of classification systems, preventive techniques, pathophysiological mechanisms, and treatment options for established POI. METHODS: The Web of Science, MEDLINE, PubMed and Google Scholar databases were searched using the key phrases 'ileus', 'postoperative ileus' and 'definition', for relevant studies published in English from January 1997 to August 2014. RESULTS: POI is still a problematic and frequent complication of surgery. Fluid overload, exogenous opioids, neurohormonal dysfunction, and gastrointestinal stretch and inflammation are key mechanisms in the pathophysiology of POI. Evidence is supportive of thoracic epidural analgesia, avoidance of salt and water overload, alvimopan and gum chewing as measures for the prevention of POI, and should be incorporated into perioperative care protocols. Minimal access surgery and avoidance of nasogastric tubes may also help. Novel strategies are emerging, but further studies are required for the treatment of prolonged POI, where evidence is still lacking. CONCLUSIONS: Although POI is often inevitable, methods to reduce its duration and facilitate recovery of postoperative gastrointestinal function are evolving rapidly. Utilisation of standardised diagnostic classification systems will help improve applicability of future studies.

Effect of metformin on sleep disorders in adolescent girls with polycystic ovarian syndrome.

OBJECTIVE: Patients with polycystic ovarian syndrome (PCOS) have a high prevalence of sleep disorders. Metformin is an antidiabetic drug that may have a role in treatment of the manifestations of PCOS. The aim of this study was to assess the presence of sleep disorders in adolescent girls with PCOS and to study the effects of using metformin on sleep disorders in these girls. METHODS: This study was carried out on 90 adolescent girls aging from 12 to 18 years who were divided into 3 equal groups: control untreated group, untreated PCOS group, and PCOS + metformin group. Body weight, height, body mass index, hirsutism score, fasting and postprandial blood glucose, fasting serum insulin, Homeostatic Model Assessment (HOMA) index, sleep disturbances scale, and Epworth sleepiness scale were measured. RESULTS: Metformin administration resulted in significant decrease in the body weight, body mass index, hirsutism score, fasting and postprandial blood glucose, fasting serum insulin, HOMA index, sleep disturbances scale, and Epworth sleepiness scale compared to the untreated PCOS group. CONCLUSION: Metformin can reduce the incidence of sleep disorders and excessive daytime sleepiness in adolescent girls with PCOS.

Arteriovenous fistula formations: key to vascular surgical training.

PURPOSE: To highlight missed training opportunities in daycase surgery for trainees to acquire competency in vascular anastomosis by performing arteriovenous fistula (AVF) formations. METHODS: Operative Room Management Information System records were reviewed for AVF procedures in daycase and general theatres at a UK Foundation Trust between 2007 and 2012. Data collected included procedure, procedure time (PT), patient length of stay (LOS), readmissions within 30 days of procedure and lead and assistant surgeons involved. RESULTS: Of 199 daycase AVF procedures reviewed, 59.3% (n=118) were brachiocephalic formations and 34.2% (n=68) radiocephalic formations. Trainees attended 41.2% of daycase AVF procedures and were lead surgeon in 7.3% of these. Mean PT was 64 minutes for consultants compared with 56 minutes for trainees, with no significant difference (p=0.297). Median patient LOS was less than 24 hours for both groups. Six daycase AVF procedures resulted in patient readmission within 30 days; five of these were operated on by consultants and one by a staff grade. During the same period, 258 AVF procedures were performed in general theatres. Trainees attended 64.3% of AVF formations performed in general theatres and were lead surgeon in 5.8% of these. CONCLUSIONS: Trainees attended and led few daycase AVF formations despite no significant difference in PT, patient LOS or readmission rate between consultant-led and trainee-led cases. Trainees attended more AVF formations performed in general theatres than daycase. However, trainees led a greater proportion of daycase AVF formations, possibly due to a less complex case mix that is more suitable for training.

The pathophysiology of fluid and electrolyte balance in the older adult surgical patient.

BACKGROUND & AIMS: Age-related physiological changes predispose even the healthy older adult to fluid and electrolyte abnormalities which can cause morbidity and mortality. The aim of this narrative review is to highlight key aspects of age-related pathophysiological changes that affect fluid and electrolyte balance in older adults and underpin their importance in the perioperative period. METHODS: The Web of Science, MEDLINE, PubMed and Google Scholar databases were searched using key terms for relevant studies published in English on fluid balance in older adults during the 15 years preceding June 2013. Randomised controlled trials and large cohort studies were sought; other studies were used when these were not available. The bibliographies of extracted papers were also searched for relevant articles. RESULTS: Older adults are susceptible to dehydration and electrolyte abnormalities, with causes ranging from physical disability restricting access to fluid intake to iatrogenic causes including polypharmacy and unmonitored diuretic usage. Renal senescence, as well as physical and mental decline, increase this susceptibility. Older adults are also predisposed to water retention and related electrolyte abnormalities, exacerbated at times of physiological stress. Positive fluid balance has been shown to be an independent risk factor for morbidity and mortality in critically ill patients with acute kidney injury. CONCLUSIONS: Age-related pathophysiological changes in the handling of fluid and electrolytes make older adults undergoing surgery a high-risk group and an understanding of these changes will enable better management of fluid and electrolyte therapy in the older adult.

A simplified technique for orientation of a bone anchored auricular prostheses: a clinical report.

BACKGROUND: A simple technique was presented in this clinical report for orientation of a bone anchored auricular prosthesis. METHODS: The proposed technique includes drawing the intact ear on a transparent celluloid paper or radiographic film and flipping it to the opposite side and relating it to the fixed anatomical features on the face of patient. RESULTS: The drawing, by this way provides a simple and easy way to duplicate and transfer the exact size and position of the intact ear to the defect side. CONCLUSIONS: This technique provides a simple, safe, inexpensive and time saving yet, an accurate and effective surgical template that orients the craniofacial implants to the confines of the definitive auricular prosthesis. It is indicated for restoration of single missing external ear either in aplasia, injuries and total resection.