Anal Injectable and Implantable Bulking Agents for Faecal Incontinence

Faecal incontinence (FI) is a common condition, the prevalence of which increases with age. It is associated with a negative impact on the quality of one’s life. The aetiology is multifactorial; hence, both the diagnosis and the treatment of faecal incontinence may be challenging. A variety of surgical treatments for faecal incontinence have emerged over the years. One of these is the use of anal bulking agents. Anal bulking agents have been available for over 25 years, with various studies being published. Initial results were disappointing, mainly due to lack of efficacy and reliability as well as concerns about safety. Great strides have been made recently with the introduction of the anal implants Gatekeeper (GK) and Sphinkeeper (SK). This chapter explores the evolution of anal injectables and implants, discusses operative techniques and provides a critical analysis of the results of the various studies to date

A prospective analysis of sleep deprivation and disturbance in surgical patients

Introduction: Sleep deprivation has a potentially deleterious effect on postoperative recovery. The aim of our prospective study was to identify the factors contributing to postoperative sleep deprivation and disturbance in order to recommend improvements in postoperative care. Methods: 102 consecutive patients attending for elective general and orthopaedic surgery were interviewed preoperatively (baseline) and postoperatively on their duration of sleep, number of wakenings during the night, factors contributing to sleep loss and the use of analgesia and night sedation. Results: Patients woke up a median of 5 times in the first postoperative night compared to a median of 3 times preoperatively (p = 0.01). Pain was the predominant factor preventing sleep, affecting 39% of patients preoperatively and 48% of patients on the first postoperative day. Other factors included noise from other patients and nursing staff, and using the toilet. Analgesia was taken by more than 90% of patients in the first two days, this number gradually reducing over the postoperative period. On the other hand, in the first two postoperative days, only about 5% of patients had night sedation. Discussion and conclusions: Apart from highlighting the need for effective pain management postoperatively, we believe that our study supports the drive towards single bed bays, where steps can be taken to minimize the impact of environmental factors on sleep

Surgery for Colorectal Cancer in Older People

Life expectancy has been increasing, and an increasing number of older patients are presenting with colorectal cancer. Surgical management of colorectal cancer in these patients poses a unique challenge, requiring a multidisciplinary team approach, as they have more comorbidities and lower functional reserves. An accurate diagnosis, a thorough patient assessment and individualized treatment is crucial in order to achieve the best possible outcome. While the overall postoperative mortality rates were significantly higher in the over 75 age group, it seems that age itself is not a risk factor for surgery. Older patients presented with more locally advanced disease, a factor that increased the overall postoperative mortality. Comorbid conditions increase the risk of postoperative mortality in these patients. When comparing different age groups with similar American Society of Anesthesiologists (ASA) scores, no significant difference was found in postoperative mortality. Laparoscopic surgery was shown to be beneficial for the elderly, with low morbidity and mortality and a shortened hospital stay. Patients with rectal cancer benefit from transanal endoscopic surgery as a primary procedure or as part of a ‘watch and wait’ strategy following neoadjuvant chemoradiotherapy. Early elective surgery and the avoidance of emergency major surgery whenever possible, by for example the use of stents followed by elective resection in cases of colonic obstruction, will help improve outcomes

The customers’ brand identification with luxury hotels : a social identity perspective

This study explores the relationships between the consumer-brand identification (CBI) construct and the customers’ satisfaction, commitment, trust and loyalty toward hospitality brands. The methodology included a confirmatory factor analysis (CFA) that assessed the reliability and validity of previous tried and tested measures in marketing sciences. This study has supported the scales' content validity. A two-step structural equation modelling approach was used to analyze the relationships among the latent and observed constructs. The findings have reported a satisfactory fit for this study's research model. The empirical results shed light on the direct and indirect effects on brand loyalty. This contribution implies that brand trust had the highest effect on brand loyalty, and this was followed my other determinants, including; consumer-brand identification, consumer satisfaction and commitment. In conclusion, this paper identifies its research limitations and puts forward possible research avenues.peer-reviewe

Piezo buffers mechanical stress via modulation of intracellular Ca 2+ handling in the Drosophila heart

Throughout its lifetime the heart is buffeted continuously by dynamic mechanical forces resulting from contraction of the heart muscle itself and fluctuations in haemodynamic load and pressure. These forces are in flux on a beat-by-beat basis, resulting from changes in posture, physical activity or emotional state, and over longer timescales due to altered physiology (e.g. pregnancy) or as a consequence of ageing or disease (e.g. hypertension). It has been known for over a century of the heart’s ability to sense differences in haemodynamic load and adjust contractile force accordingly[1-4]. These adaptive behaviours are important for cardiovascular homeostasis, but the mechanism(s) underpinning them are incompletely understood. Here we present evidence that the mechanically-activated ion channel, Piezo, is an important component of the Drosophila heart’s ability to adapt to mechanical force. We find Piezo is a sarcoplasmic reticulum (SR)-resident channel and is part of a mechanism that regulates Ca2+ handling in cardiomyocytes in response to mechanical stress. Our data support a simple model in which Drosophila Piezo transduces mechanical force such as stretch into a Ca2+ signal, originating from the SR, that modulates cardiomyocyte contraction. We show that Piezo mutant hearts fail to buffer mechanical stress, have altered Ca2+ handling, become prone to arrhythmias and undergo pathological remodelling