The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

The wheat Em promoter drives reporter gene expression in embryo and aleurone tissue of transgenic barley and rice

The early methionine (Em) proteins are members of the late embryogenesis abundant (LEA) group of proteins that have been considered to be embryo specific. The ability of a 646-bp wheat Em promoter to control green fluorescent protein (gfp) expression was investigated in transgenic barley and rice. Seeds of transgenic plants expressed gfp in the developing embryo but also in the aleurone layer. The 646-bp Em promoter also directed strong gfp expression in cells comprising the junction between the endosperm transfer cells and cells of the aleurone layer. Em-gfp expression in transgenic barley showed differences in spatial and temporal control when compared with that observed in transgenic rice. Em-gfp expression was also detected in mature aleurone cells of transgenic barley and rice with and without abscisic acid (ABA) treatment. Reverse transcriptase-polymerase chain reaction (RT-PCR) results indicated the presence of Em and Em-homologous transcript in embryo, aleurone and endosperm tissues of wheat and of barley and rice, respectively. These results suggest that Em proteins may be expressed in both the embryo and aleurone during seed development, possibly providing protection against desiccation in these two tissues that survive seed drying. They may also have a similar role in these tissues during germination. The Em promoter from wheat may be useful in the expression of novel genes in cereal grains, as an embryo- and aleurone-specific promoter complementing other available endosperm- and pericarp-specific promoters to collectively increase the expression of transgenes in seeds