Management of obstetric anal sphincter injury: a systematic review & national practice survey

BACKGROUND: We aim to establish the evidence base for the recognition and management of obstetric anal sphincter injury (OASI) and to compare this with current practice amongst UK obstetricians and coloproctologists. METHODS: A systematic review of the literature and a postal questionnaire survey of consultant obstetricians, trainee obstetricians and consultant coloproctologists was carried out. RESULTS: We found a wide variation in experience of repairing acute anal sphincter injury. The group with largest experience were consultant obstetricians (46.5% undertaking ≥ 5 repairs/year), whilst only 10% of responding colorectal surgeons had similar levels of experience (p < 0.001). There was extensive misunderstanding in terms of the definition of obstetric anal sphincter injuries. Overall, trainees had a greater knowledge of the correct classification (p < 0.01). Observational studies suggest that a new 'overlap' repair using PDS sutures with antibiotic cover gives better functional results. However, our literature search found only one randomised controlled trial (RCT) on the technique of repair of OASI, which showed no difference in incidence of anal incontinence at three months. Despite this, there was a wide variation in practice, with 337(50%) consultants, 82 (55%) trainees and 80 (89%) coloproctologists already using the 'overlap' method for repair of a torn EAS (p < 0.001). Although over 50% of colorectal surgeons would undertake long-term follow-up of their patients, this was the practice of less than 10% of obstetricians (p < 0.001). Whilst over 70% of coloproctologists would recommend an elective caesarean section in a subsequent pregnancy, only 22% of obstetric consultants and 14% of trainees (p < 0.001). CONCLUSION: An agreed classification of OASI, development of national guidelines, formalised training, multidisciplinary management and further definitive research is strongly recommended

Wear of highly crosslinked polyethylene acetabular components: a review of RSA studies

Background and purpose - Wear rates of highly crosslinked polyethylene (XLPE) acetabular components have varied considerably between different published studies. This variation is in part due to the different techniques used to measure wear and to the errors inherent in measuring the relatively low amounts of wear in XLPE bearings. We undertook a scoping review of studies that have examined the in vivo wear of XLPE acetabular components using the most sensitive method available, radiostereometric analysis (RSA). Methods - A systematic search of the PubMed, Scopus, and Cochrane databases was performed to identify published studies in which RSA was used to measure wear of XLPE components in primary total hip arthroplasty (THA). Results - 18 publications examined 12 primary THA cohorts, comprising only 260 THAs at 2-10 years of follow-up. The mean or median proximal wear rate reported ranged from 0.00 to 0.06 mm/year. However, differences in the manner in which wear was determined made it difficult to compare some studies. Furthermore, differences in RSA methodology between studies, such as the use of supine or standing radiographs and the use of beaded or unbeaded reference segments, may limit future meta-analyses examining the effect of patient and implant variables on wear rates. Interpretation - This scoping review confirmed the low wear rates of XLPE in THA, as measured by RSA. We make recommendations to enhance the standardization of reporting of RSA wear results, which will facilitate early identification of poorly performing implants and enable a better understanding of the effects of surgical and patient factors on wear.Stuart A Callary, Lucian B Solomon, Oksana T Holubowycz, David G Campbell, Zachary Munn, and Donald W Howi

減價ノ計算法

Metabolic engineering is the science of rewiring the metabolism of cells to enhance production of native metabolites or to endow cells with the ability to produce new products. The potential applications of such efforts are wide ranging, including the generation of fuels, chemicals, foods, feeds, and pharmaceuticals. However, making cells into efficient factories is challenging because cells have evolved robust metabolic networks with hard-wired, tightly regulated lines of communication between molecular pathways that resist efforts to divert resources. Here, we will review the current status and challenges of metabolic engineering and will discuss how new technologies can enable metabolic engineering to be scaled up to the industrial level, either by cutting off the lines of control for endogenous metabolism or by infiltrating the system with disruptive, heterologous pathways that overcome cellular regulation

Paléoanthropologie d’Hadar, Éthiopie

Les recherches de terrain sur les dépôts fossilifères de la dépression de l’Afar ont commencé dans les années 1970. Avant cela, les fossiles d’homininés vieux de plus de 3,0 Ma consistaient seulement en une poignée de fragments. Durant la phase I, l’International Afar Research Expedition à Hadar, en Éthiopie, a récolté quelque 240 homininés fossiles, sur un intervalle de temps de 3 à 3,4 Ma. Outre les fossiles d’homininés de Laetoli, une nouvelle espèce a été mise en évidence, Australopithecus afarensis. Ce taxon a été considéré comme le dernier ancêtre commun à la lignée d’Australopithecus et d’Homo en Afrique orientale. La phase II de recherche dans le cadre du projet de recherche Hadar a permis de renforcer les résultats de la phase I, en incluant la première association d’Homo fossile à des outils de pierre à 2,4 Ma. Cette présentation est un bref synopsis quant à l’importance et aux implications des fossiles d’homininés collectés à Hadar au cours des 34 dernières années.Field research at the fossil-bearing deposits in the Afar Depression began in the 1970s. Prior to this, hominin fossils older than 3.0 Mya consisted of only a handful of fragments. During Phase I, the International Afar Research Expedition to Hadar, Ethiopia collected some 240 fossil hominins from Hadar over a time range of 3.0–3.4 Mya. Along with hominin fossils from Laetoli, they were deemed a new species, Australopithecus afarensis. This taxon was posited as the last common ancestor to robust Australopithecus and the Homo lineage in eastern Africa. Phase II research under the Hadar Research Project has added strength to the Phase I results, including the first association of a Homo fossil with stone tools at 2.4 Mya. This presentation is a cursory synopsis of the importance and implications of the hominin fossils recovered at Hadar during over the last 34 years.</p

Sustaining and transforming a community network: The information continuum model and the case of VICNET

The paper explores a case in the sustainability of community networks through perspectives both of theory and policy. It introduces the information continuum model (ICM), a teaching and research model developed and used at Monash University since about 1997 . The diagnostic potentialities of the ICM are critically explored by applying them to the case of VICNET, the main community networking agency of Victoria which, after ten years of successful operation, finds itself at a policy and funding crossroads. The model offers a framework for analysing sustainability and transformation. The paper concludes by identifying strategies for VICNETs future, and foreshadowing work required further to develop the ICM as analytical tool in community informatics

Blueprints: solving the mystery of evolution/ Edey

x, 418 hal.: ill.; 23 cm