Validation of the emergency surgery score (ESS) in a UK patient population and comparison with NELA scoring: a retrospective multicentre cohort study.

INTRODUCTION: Accurate risk scoring in emergency general surgery (EGS) is vital for consent and resource allocation. The emergency surgery score (ESS) has been validated as a reliable preoperative predictor of postoperative outcomes in EGS but has been studied only in the US population. Our primary aim was to perform an external validation study of the ESS in a UK population. Our secondary aim was to compare the accuracy of ESS and National Emergency Laparotomy Audit (NELA) scores. METHODS: We conducted an observational cohort study of adult patients undergoing emergency laparotomy over three years in two UK centres. ESS was calculated retrospectively. NELA scores and all other variables were obtained from the prospectively collected Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) database. The primary and secondary outcomes were 30-day mortality and postoperative intensive care unit (ICU) admission, respectively. RESULTS: A total of 609 patients were included. Median age was 65 years, 52.7% were female, the overall mortality was 9.9% and 23.8% were admitted to ICU. Both ESS and NELA were equally accurate in predicting 30-day mortality (c-statistic=0.78 (95% confidence interval (CI), 0.71-0.85) for ESS and c-statistic=0.83 (95% CI, 0.77-0.88) for NELA, p=0.196) and predicting postoperative ICU admission (c-statistic=0.76 (95% CI, 0.71-0.81) for ESS and 0.80 (95% CI, 0.76-0.85) for NELA, p=0.092). CONCLUSIONS: In the UK population, ESS and NELA both predict 30-day mortality and ICU admission with no statistically significant difference but with higher c-statistics for NELA score. Both scores have certain advantages, with ESS being validated for a wider range of outcomes.

Prognostic impact of genomic instability in colorectal cancer.

BACKGROUND: The prognostic impact of an indication of chromosomal instability (CIN) is evaluated in a consecutive series of 952 colorectal cancer patients treated at Aker University Hospital, Norway, during 1993-2003. Microsatellite instability (MSI) in this case series has recently been reported and made it possible to find the co-occurrence and compare the prognostic significance of CIN and MSI. METHODS: Data sets for overall survival (OS; n=855) and time to recurrence (TTR; n=579) were studied. To reveal CIN we used automated image cytometry (ICM). Non-diploid histograms were taken as indicative of the presence of CIN. PCR-based measures of MSI in this material have already been described. RESULTS: As with MSI, CIN was found to be an independent predictor of early relapse and death among stage II patients (TTR: n=278: HR 2.19 (95% CI: 1.35-3.55), P=0.002). Of the MSI tumours (16%), 71% were found to be DNA diploid, 21% were DNA tetraploid and 8% were DNA aneuploid. Among microsatellite stable tumours, 24% were DNA diploid, 15% were DNA tetraploid and 61% were DNA aneuploid. CONCLUSION: For patients presenting with stage II disease, genomic instability as detected by DNA image cytometry has the potential to provide a useful biomarker for relapse and cancer-related death following surgery with curative intent.

Visual color and doneness indicators and the incidence of premature brown color in beef patties cooked to four end point temperatures.

An interlaboratory study was undertaken to assess the frequency that cooked color of ground beef patties appeared brown at internal temperatures of 52.7 degrees C (135 degrees F), 65.6 degrees C (150 degrees F), 71.1 degrees C (160 degrees F), and 79.4 degrees C (175 degrees F). In general, as internal cooked temperature of the patties increased, the following results were observed in the patties: (i) more brown meat color, (ii) less pink or red juice color, and (iii) more cooked texture. However, brown meat color occurred prematurely at the two lower internal temperatures (57.2 degrees C/135 degrees F and 65.6 degrees C/150 degrees F) that are insufficient to eliminate foodborne pathogens without holding times. The common consumer practice of freezing bulk ground beef, followed by overnight thawing in a refrigerator, led to substantial premature brown color in patties cooked from this product. In addition, at 71.1 degrees C (160 degrees F), recognized to be the lowest temperature for cooking ground beef safely in the home, meat color, juice color, and texture appearance were not fully apparent as doneness indicators. In fact, at no temperature studied did 100% of the patties appear done when evaluated by the criteria of no red or pink in the meat, no red or pink in the juices, or by texture appearance. Patties in this study were evaluated under a set protocol for forming the products, cooking, and viewing under the same lighting conditions. Other preparation conditions are possible and may produce different results. Thus, temperature to which patties have been cooked cannot be judged by color and appearance. This study provided the evidence to support the message to consumers regarding cooking of beef patties of "use an accurate food thermometer and cook beef patties to 160 degrees F (71.1 degrees C)" in place of messages based on consumer judgment of cooked color.

Metabolic rate, respiratory exchange ratio, and apneas during meditation.

We tested the hypothesis that a drop in metabolic rate (MR) causes the apneas observed in some subjects during transcendental meditation (TM). We measured O2 consumption (VO2) and CO2 production (VCO2) in three groups of experienced meditators and one group of nonmeditating controls. Measurements were made before, during, and after TM for the meditators and before, during, and after eyes-closed relaxation for the nonmeditating controls. The three groups of meditators consisted of 1) those showing little change in the frequency of ventilation (f) with meditation, 2) those showing a marked decline in f, and 3) those showing numerous apneas and a marked fall in f. There were significant trial effects but no group or interaction effects for the decline in VO2. Thus we concluded that a drop in MR is not the cause of the apneas. However, there were significant trial and interaction effects for the changes in VCO2 and the respiratory exchange ratio (R), with a significant drop in R for the meditators but not for the controls. We report additional evidence and speculate that the drop in R is a consequence of mild hypoventilation.

A new procedure for improving body mechanics: an experimental test.

We report the results of a preliminary test of a simple, easily learned procedure which facilitates improvement in body mechanics. It lessens the common tendency for hyperextension of the neck and for the use of the lower back as a major joint in sitting and standing. The resulting improvement in level of fixation of neck and pelvis should facilitate the body's defense against the force of gravity. The concept is supported here by the observed changes in physiological parameters which followed practice of the new procedure, which we call the Mitzvah Exercise.

The compliance of contracting skeletal muscle.

1. The method of controlled releases was used to obtain tension-extension curves in toad (Bufo bufo) sartorii under a variety of conditions at 0 degrees C.2. The curves obtained were approximately linear over a considerable range of force (0.4P(0) to P(0)) if the releases were given from the plateau of tetanic tension. The slope of this linear region was little affected by changes of release velocity in the range 10-120 mm/sec.3. Such changes as did occur with alterations in release velocity could be quantitatively accounted for in terms of the internal shortening predicted by A. V. Hill's two-component model.4. As the muscles were stretched above l(0), we found that the maximum stiffness of the tetanized muscles fell in much the same way as the maximum developed force, P(0).5. In another series of experiments we found a rapid change in the overall shape of the tension-extension curve during the early phase of force development in an isometric tetanus. The stiffness of the muscle increased with increasing developed force during this period.6. The force-velocity curve in these muscles was measured by two methods, both giving a similar result. Surprisingly, toad muscle appears to have about the same intrinsic speed as frog muscle at 0 degrees C. The a.b product from our experiments is considerably greater than the reported values for the maintenance heat rate at 0 degrees C in these muscles.7. The probable site of the variable compliance in active muscle is discussed. It seems most likely that this is within the A-band, perhaps in the cross-bridges themselves.

On the increase in rate of heat production caused by stretch in frog's skeletal muscle.

1. The increase in rate of heat production caused by stretch in the unstimulated frog's sartorius (stretch response) has been measured using a conventional thermopile technique.2. The rate of heat production was found constant between l(0) (the distance in vivo between the tendons when the legs were in a straight line) and 1.2 l(0), and rose rapidly above this length to reach 3-5 times the basal rate at 1.3 l(0). Stretching to greater lengths appeared to damage the muscles.3. The stretch response is increased by several substances which increase the duration of the active state.4. Unlike the rate of heat production at l(0), the stretch response is increased by procaine; while the presence of CO(2) greatly reduces it.5. Evidence is presented supporting the hypothesis that the stretch response is associated with the appearance of tension in the sarcolemma.