Video assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomised clinical trials

<b>Objectives</b> To determine if video assisted thoracic surgery is associated with better clinical outcomes than thoracotomy for three common procedures: surgery for pneumothorax, minor resections, and lobectomy. <b>Design</b> Systematic review of randomised clinical trials. <b>Data sources</b> Medline, Embase, Cochrane database of systematic reviews, Cochrane controlled trials register. Reference lists of relevant articles and reviews. <b>Methods</b> Criteria for inclusion were random allocation of patients and no concurrent use of another experimental medication or device. At least two authors performed and confirmed data abstraction and analyses. Information on quality of trials, demographics, frequency of the events, and numbers randomised were collected. <b>Results</b> 12 trials randomised 670 patients. Video assisted thoracic surgery was associated with shorter length of stay (reduction ranged from 1.0 to 4.2 days) and less pain or use of pain medication than thoracotomy in the five out of seven trials in which the technique was used for pneumothorax or minor lung resection. In the treatment of pneumothorax, video assisted thoracic surgery was associated with substantially fewer recurrences than pleural drainage in two trials (from 20 to 53 events prevented per 100 treated patients). No substantial advantages were observed for video assisted thoracic surgery in lobectomies. <b>Conclusions</b> Video assisted thoracic surgery is associated with better outcomes and seems to have a complication profile comparable with that of thoracotomy for the treatment of pneumothorax and minor resections. As for lobectomy, further studies are needed to determine how it compares with thoracotomy

Intestinal barrier function and absorption in pigs after waeaning: a review

Under commercial conditions, weaning of piglets is associated with social, environmental and dietary stress. Consequently, small-intestinal barrier and absorptive functions deteriorate within a short time after weaning. Most studies that have assessed small-intestinal permeability in pigs after weaning used either Ussing chambers or orally administered marker probes. Paracellular barrier function and active absorption decrease when pigs are weaned at 3 weeks of age or earlier. However, when weaned at 4 weeks of age or later, the barrier function is less affected, and active absorption is not affected or is increased. Weaning stress is a critical factor in relation to the compromised paracellular barrier function after weaning. Adequate feed intake levels after weaning prevent the loss of the intestinal barrier function. Transcellular transport of macromolecules and passive transcellular absorption decrease after weaning. This may reflect a natural intestinal maturation process that is enhanced by the weaning process and prevents the pig from an antigen overload. It seems that passive and active absorption after weaning adapt accurately to the new environment when pigs are weaned after 3 weeks of age. However, when weaned at 3 weeks of age or earlier, the decrease in active absorption indicates that pigs are unable to sufficiently adapt to the new environment. To improve weaning strategies, future studies should distinguish whether the effect of feed intake on barrier function can be directed to a lack of a specific nutrient, i.e. energy or protein

Suvarnadvîpa and the Chrysê Chersonêsos

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Increasing weaning age of piglets from 4 to 7 weeks reduces stress, increases post-weaning feed intake but does not improve intestinal functionality

This study tested the hypothesis that late weaning and the availability of creep feed during the suckling period compared with early weaning, improves feed intake, decreases stress and improves the integrity of the intestinal tract. In this study with 160 piglets of 16 litters, late weaning at 7 weeks of age was compared with early weaning at 4 weeks, with or without creep feeding during the suckling period, on post-weaning feed intake, plasma cortisol (as an indicator of stress) and plasma intestinal fatty acid binding protein (I-FABP; a marker for mild intestinal injury) concentrations, intestinal morphology, intestinal (macro)molecular permeability and intestinal fluid absorption as indicators of small intestinal integrity. Post-weaning feed intake was similar in piglets weaned at 4 weeks and offered creep feed or not, but higher (P <0.001) in piglets weaned at 7 weeks with a higher (P <0.05) intake for piglets offered creep feed compared with piglets from whom creep feed was witheld. Plasma cortisol response at the day of weaning was lower in piglets weaned at 7 weeks compared with piglets weaned at 4 weeks, and creep feed did not affect cortisol concentration. Plasma I-FABP concentration was not affected by the age of weaning and creep feeding. Intestinal (macro)molecular permeability was not affected by the age of weaning and creep feeding. Both in uninfected and enterotoxigenic Escherichia coli-infected small intestinal segments net fluid absorption was not affected by the age of weaning or creep feeding. Creep feeding, but not the age of weaning, resulted in higher villi and increased crypt depth. In conclusion, weaning at 7 weeks of age in combination with creep feeding improves post-weaning feed intake and reduces weaning stress but does not improve functional characteristics of the small intestinal mucos

Bioactivity of tempe by inhibiting adhesion of ETEC to intestinal cells, as influenced by fermentation substrates and starter pure cultures

Soya bean tempe is known for its bioactivity in reducing the severity of diarrhoea in piglets. This bioactivity is caused by an inhibition of the adhesion of enterotoxigenic Escherichia coli (ETEC) to intestinal cells. In this paper, we assessed the bioactive effect of soya tempe on a range of ETEC target strains, as well as the effect of a range of cereal and leguminous substrates and starter pure cultures. Soya bean tempe extracts strongly inhibited the adhesion of ETEC strains tested. All tempe made from other leguminous seeds were as bioactive as soya bean tempe, whereas tempe made from cereals showed no bioactivity. Using soya beans as substrate, fermentation with several fungi (Mucor, Rhizopus spp. and yeasts) as well as Bacillus spp. resulted in bioactive tempe, whereas fermentation with lactobacilli showed no bioactivity. The active component is releasedor formed during the fermentation and is not present in microbial biomass and only partly in unfermented substrates. The bioactivity being not specific for a single ETEC strain, makes the bioactive tempe relevant for applications in animal husbandry

Survival after liver transplantation in the United Kingdom and Ireland compared with the United States

&lt;b&gt;Background and Aim&lt;/b&gt;: Surgical mortality in the US is widely perceived to be superior to that in the UK. However, previous comparisons of surgical outcome in the two countries have often failed to take sufficient account of case-mix or examine long-term outcome. The standardised nature of liver transplantation practice makes it uniquely placed for undertaking reliable international comparisons of surgical outcome. The objective of this study is to undertake a risk-adjusted disease-specific comparison of both short- and long-term survival of liver transplant recipients in the UK and Ireland with that in the US. &lt;b&gt;Design, setting and participants&lt;/b&gt;: Multi-centre cohort study using two high quality national databases including all adults who underwent a first single organ liver transplant in the UK and Ireland (n=5,925) and the US (n=41,866) between March 1994 and March 2005. &lt;b&gt;Main outcome measures&lt;/b&gt;: Post-transplant mortality during the first 90 days, 90 days-1 year and beyond the first year, adjusted for donor and recipient characteristics. &lt;b&gt;Results&lt;/b&gt;: Risk-adjusted mortality in the UK and Ireland was generally higher than in the US during the first 90 days (hazard ratio 1.17 95%CI 1.07-1.29), both for patients transplanted for acute liver failure (hazard ratio 1.27 95%CI 1.01-1.60) as well as those transplanted for chronic liver disease (hazard ratio 1.18 95% CI 1.07- 1.31). Between 90 days and 1 year post-transplantation, no statistically significant differences in overall risk- adjusted mortality were noted between the two cohorts. Survivors of the first post-transplant year in the UK and Ireland had lower overall risk-adjusted mortality than those transplanted in the US (hazard ratio 0.88 95% CI 0.81- 0.96). This difference was observed among patients transplanted for chronic liver disease (hazard ratio 0.88 95%CI 0.81-0.96) but not those transplanted for acute liver failure (hazard ratio 1.02 95%CI 0.70- 1.50). &lt;b&gt;Conclusions&lt;/b&gt;: Whilst risk adjusted mortality is higher in the UK and Ireland during the first 90 days following liver transplantation, it is higher in the US among those liver transplant recipients who survived the first post- transplant year. Our results are consistent with the notion that the US has superior acute peri-operative care whereas the UK appears to provide better quality chronic care following liver transplantation surgery

Groei en bloei in West-Friesland

West-Friesland onderscheidt zich op een aantal punten van andere bloembollencentra. Het is met ongeveer 4.700 ha na 'De Noord' (het zandgebied in de kop van Noord-Holland) het belangrijkste teeltgebied van bloembollen en na de Bollenstreek het belangrijkste handelscentrum voor bloembollen

Is there overutilisation of cataract surgery in England?

&lt;b&gt;Objectives:&lt;/b&gt; Following a 3.7-fold increase in the rate of cataract surgery in the UK between 1989 and 2004, concern has been raised as to whether this has been accompanied by an excessive decline in the threshold such that some operations are inappropriate. The objective was to measure the impact of surgery on a representative sample of patients so as to determine whether or not overutilisation of surgery is occurring. &lt;b&gt;Design:&lt;/b&gt; Prospective cohort assessed before and 3 months after surgery. &lt;b&gt;Setting:&lt;/b&gt; Ten providers (four NHS hospitals, three NHS treatment centres, three independent sector treatment centres) from across England. &lt;b&gt;Participants:&lt;/b&gt; 861 patients undergoing first eye (569) or second eye (292) cataract surgery provided preoperative data of whom 745 (87%) completed postoperative questionnaires. &lt;b&gt;Main outcome measures:&lt;/b&gt; Patient-reported visual function (VF-14); general health status and quality of life (EQ5D); postoperative complications; overall view of the operation and its impact. &lt;b&gt;Results:&lt;/b&gt; Overall, visual function improved (mean VF-14 score increased from 83.2 (SD 17.3) to 93.7 (SD 13.2)). Self-reported general health status deteriorated (20.3% fair or poor before surgery compared with 25% afterwards) which was reflected in the mean EQ5D score (0.82 vs 0.79; p = 0.003). At least one complication was reported by 66 (8.9%) patients, though this probably overestimated the true incidence. If the appropriateness of surgery is based on an increase in VF-14 score of 5.5 (that corresponds to patients’ reporting being "a little better"), 30% of operations would be deemed inappropriate. If an increase of 12.2 (patients’ reports of being "much better") is adopted, the proportion inappropriate is 49%. Using a different approach to determining a minimally important difference, the proportion inappropriate would be closer to 20%. Although visual function (VF-14) scores were unchanged or deteriorated in 25% of patients, 93.1% rated the results of the operation as "good," "very good" or "excellent," and 93.5% felt their eye problem was "better." This partly reflects inadequacies in the validity of the VF-14. &lt;b&gt;Conclusions:&lt;/b&gt; Improvement in the provision of cataract surgery has been accompanied by a reduction in the visual function threshold. However, methodological difficulties in measuring the impact of cataract surgery on visual function and quality of life mean it is impossible to determine whether or not overutilisation of cataract surgery is occurring. N Black1, J Browne1, J van der Meulen1, L Jamieson2, L Copley2 and J Lewsey