Endovascular treatment of a Superior Mesenteric Artery Syndrome variant secondary to traumatic pseudoaneurysm

Pseudoaneurysms related to the superior mesenteric artery (SMA) are a recognised complication of trauma to the vessel, and successful treatment with stenting has been previously described. We report the case of a patient who presented with obstruction of the fourth part of the duodenum secondary to a traumatic pseudoaneurysm, a hitherto unreported variant of superior mesenteric artery syndrome. Exclusion of the pseudoaneurysm and relief of the duodenal obstruction were simultaneously achieved by placement of a covered stent

Short-term pre-operative high-intensity interval training does not improve fitness of colorectal cancer patients

Background: Preoperative cardiorespiratory fitness (CRF) in colorectal cancer patients has been shown to affect postoperative outcomes. The aim of this study was to test the feasibility of high-intensity interval training (HIT) for improving fitness in preoperative colorectal cancer (CRC) patients within the 31-day cancer waiting time targets imposed in the UK. Methods: Eighteen CRC patients (13 males, mean age: 67 years (range 52-77years) participated in supervised HIT on cycle ergometers 3 or 4 times each week prior to surgery. Exercise intensity during 5x1-minute HIT intervals (interspersed with 90-seconds recovery) was 100-120% maximum wattage achieved at a baseline cardiopulmonary exercise test (CPET). CPET before and after HIT was used to assess CRF. Results: Patients completed a mean of 8 HIT sessions (range 6-14) over 19 days (SD 7). There was no significant increase in VO2 peak (23.9±7.0 vs. 24.2±7.8 ml/kg/min (mean±SD), p=0.58) or anaerobic threshold (AT: 14.0±3.4 vs. 14.5±4.5 ml/kg/min, p=0.50) after HIT. There was a significant reduction in resting systolic blood pressure (152±19 vs. 142±19 mmHg, p=0.0005) and heart rate at submaximal intensities after HIT.Conclusions: A pragmatic HIT exercise program did not improve the preoperative fitness of CRC patients within the 31-day window available in the UK to meet cancer surgical waiting time targets

The acute transcriptional response to resistance exercise: impact of age and contraction mode

Optimization of resistance exercise (RE) remains a hotbed of research for muscle building and maintenance. However, the interactions between the contractile components of RE (i.e. concentric (CON) and eccentric (ECC)) and age, are poorly defined. We used transcriptomics to compare age-related molecular responses to acute CON and ECC exercise. Eight young (21±1 y) and eight older (70±1 y) exercise-naïve male volunteers had vastus lateralis biopsies collected at baseline and 5 h post unilateral CON and contralateral ECC exercise. RNA was subjected to next-generation sequencing and differentially expressed (DE) genes tested for pathway enrichment using Gene Ontology (GO). The young transcriptional response to CON and ECC was highly similar and older adults displayed moderate contraction-specific profiles, with no GO enrichment. Age-specific responses to ECC revealed 104 DE genes unique to young, and 170 DE genes in older muscle, with no GO enrichment. Following CON, 15 DE genes were young muscle-specific, whereas older muscle uniquely expressed 147 up-regulated genes enriched for cell adhesion and blood vessel development, and 28 down-regulated genes involved in mitochondrial respiration, amino acid and lipid metabolism. Thus, older age is associated with contraction-specific regulation often without clear functional relevance, perhaps reflecting a degree of stochastic age-related dysregulation.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.CSD was funded by a doctoral training studentship from Bournemouth University. This work was generously supported by the Wellcome Trust Institutional Strategic Support Award (WT105618MA). RMA is generously supported by the Wellcome Trust Institutional Strategic Support Award (WT105618MA) and an EPSRC/BBSRC Innovation Fellowship (EP/S001352/1). We acknowledge the Medical Research Council [grant number MR/P021220/1] [grant number MR/K00414X/1] and Arthritis Research UK [grant number 19891] as part of the MRC-ARUK Centre for Musculoskeletal Ageing Research awarded to the Universities of Nottingham and Birmingham, and the National Institute for Health Research, Nottingham Biomedical Research Centre. This work was supported by the Biotechnology and Biological Sciences Research Council [grant number BB/N015894/1]. This work was supported by a grant from the Swedish Research Council for Sport Science (dnr 2016/125 and dnr 2017/143). C.R.G.W is supported by the Biotechnology and Biological Sciences Research Council-funded South West Biosciences Doctoral Training Partnership [BB/J014400/1; BB/M009122/1].Published versio

A double-blind placebo controlled trial into the impacts of HMB supplementation and exercise on free-living muscle protein synthesis, muscle mass and function, in older adults

Age-related sarcopenia and dynapenia are associated with frailty and metabolic diseases. Resistance exercise training (RET) adjuvant to evidence-based nutritional intervention(s) have been shown as mitigating strategies. Given that HMB supplementation during RET improves lean body mass in younger humans (Wilson et al., 2014), and that we have shown that HMB acutely stimulates muscle protein synthesis (MPS) and inhibits breakdown; we hypothesized that chronic supplementation of HMB adjuvant to RET would enhance MPS and muscle mass/function in older people.We recruited 16 healthy older men (PLA: 68.5±1.0y, HMB: 67.8±1.1y) for a randomised double-blind-placebo (PLA) controlled trial (HMB 3 x 1g/day vs. PLA) involving a 6-week unilateral progressive RET regime (6 x 8 repetitions, 75% 1-RM, 3.wk-1). D2O dosing was performed over the first two weeks (0-2w) and last two weeks (4-6w) with bilateral vastus lateralis (VL) biopsies at 0-2 and 4-6 weeks (each time 75±2 min after a single bout of RE) for quantification of early and later MPS responses and post-RE myogenic gene expression. Thigh lean mass was measured by DXA, VL thickness and architecture (fibre length and pennation angle) by ultrasound at 0/3/6 weeks, and strength by knee extensor 1-RM testing and MVC by isokinetic dynamometry (approx. every 10 days).RET induced strength increases (1-RM) in the exercised leg in both groups (398±22N to 499±30N HMB vs. 396±29N to 510±43N PLA (both

Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Introduction Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups

National prospective cohort study of the burden of acute small bowel obstruction

Background Small bowel obstruction is a common surgical emergency, and is associated with high levels of morbidity and mortality across the world. The literature provides little information on the conservatively managed group. The aim of this study was to describe the burden of small bowel obstruction in the UK. Methods This prospective cohort study was conducted in 131 acute hospitals in the UK between January and April 2017, delivered by trainee research collaboratives. Adult patients with a diagnosis of mechanical small bowel obstruction were included. The primary outcome was in‐hospital mortality. Secondary outcomes included complications, unplanned intensive care admission and readmission within 30 days of discharge. Practice measures, including use of radiological investigations, water soluble contrast, operative and nutritional interventions, were collected. Results Of 2341 patients identified, 693 (29·6 per cent) underwent immediate surgery (within 24 h of admission), 500 (21·4 per cent) had delayed surgery after initial conservative management, and 1148 (49·0 per cent) were managed non‐operatively. The mortality rate was 6·6 per cent (6·4 per cent for non‐operative management, 6·8 per cent for immediate surgery, 6·8 per cent for delayed surgery; P = 0·911). The major complication rate was 14·4 per cent overall, affecting 19·0 per cent in the immediate surgery, 23·6 per cent in the delayed surgery and 7·7 per cent in the non‐operative management groups (P < 0·001). Cox regression found hernia or malignant aetiology and malnutrition to be associated with higher rates of death. Malignant aetiology, operative intervention, acute kidney injury and malnutrition were associated with increased risk of major complication. Conclusion Small bowel obstruction represents a significant healthcare burden. Patient‐level factors such as timing of surgery, acute kidney injury and nutritional status are factors that might be modified to improve outcomes

Assessment and moderation of the level 2 physics unit standards on the National Qualifications Framework.

The introduction of the National Qualifications Framework and the associated assessment against Physics Unit Standards represents a major paradigm shift in senior secondary school assessment. The trend away from norm-referenced external national exams towards internal standards-based assessment has significant implications for curriculum delivery, student learning and assessment and moderation practices. The New Zealand Qualifications Authority claims that the National Qualifications Framework is a technically sound and publicly acceptable alternative to the established system. Moderation is a key plank of the Framework which aims to establish and maintain national consistency of assessment across different providers, improve assessment practices, assist in the development of assessor expertise and establish public confidence in the new qualifications. Critics have expressed doubts that the perceived national consistency and public confidence in national examinations may be lacking in internal assessment against Unit Standards. The Post Primary Teachers' Association has expressed concern that the workload associated with the assessment, reassessment and administration of Unit Standards will adversely affect the quality of curriculum delivery and student learning. The present research is an attempt to evaluate these claims and counterclaims. In this thesis the assessment and moderation of the Physics Unit Standards is used as a context to answer the question: Is assessment against the Physics Unit Standards a valid, reliable and manageable way of assessing the achievement objectives of Physics in the New Zealand curriculum? A range of qualitative and quantitative techniques was employed to monitor the quality assurance of assessment and moderation of the physics Unit Standards over a three-year period and describe its impact on teachers and students. The research established that assessment against the Physics Unit Standards was generally valid but that doubts remain about its suitability to assess conceptual learning, the micro-definition of learning outcomes and the lack of recognition of different levels of achievement. The moderation action plan was found to be effective in establishing and maintaining satisfactory comparability between schools. After the initial implementation period the workload was manageable for teachers but concerns remained about dual assessment and excessive administrative requirements. Teachers felt that the resources provided by the NZQA were generally adequate. The research identified a number of areas for improving the quality of assessment against the Level 2 Physics Unit Standards. Chief recommendations related to the incorporation of higher level skills, a broadening of the performance criteria, the recognition of levels of achievement including excellence, the elimination of dual assessment and a reduction in the amount of assessment

Primary School Entry Assessment in New Zealand

There is a wide range of assessment tools used by schools to assess children at school entry in New Zealand. The lack of consistency of uptake and reporting of results leads to sporadic national data. This highlights a need for a national standardised assessment which can be used as a reliable baseline of what New Zealand children know when they start school and how they progress in their first year. The Performance Indicators in Primary Schools (PIPS) assessment is a valid, reliable and internationally respected school entry assessment. The Centre for Evaluation and Monitoring at the University of Canterbury used PIPS to collect data on 3916 students' early literacy and numeracy skills when they started school and followed up on their progress 12 months later. This provides a useful baseline of the literacy and numeracy skills New Zealand children have when they start school. The data is useful for the early identification of special learning needs and can be used to gauge the effectiveness of year 1 programmes