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

Targeting of cholera toxin and Escherichia coli heat labile toxin in polarized epithelia: role of COOH-terminal KDEL

Vibrio cholerae and Escherichia coli heat labile toxins (CT and LT) elicit a secretory response from intestinal epithelia by binding apical receptors (ganglioside G(M1)) and subsequently activating basolateral effecters (adenylate cyclase), We have recently proposed that signal transduction in polarized cells may require transcytosis of toxin-containing membranes (Lencer, W, I., G. Strohmeier, S. Moe, S, L, Carlson, C, T. Constable, and J, L,, Madara, 1995. Proc. Natl. Acad. Sci. USA. 92:10094-10098). Targeting of CT into this pathway depends initially on binding of toxin B subunits to G(M1) at the cell. surface, The anatomical compartments in which subsequent steps of CT processing occur are less clearly defined, However, the enzymatically active A subunit of CT contains the ER retention signal KDEL (RDEL in LT), Thus if the KDEL motif were required for normal CT trafficking, movement of CT from the Golgi to ER would be implied. To test this idea, recombinant wild-type (wt) and mutant CT and LT were prepared. The COOH-terminal KDEL sequence in CT was replaced by seven unrelated amino acids: LEDERAS. In LT, a single point mutation replacing leucine with valine in RDEL was made. Wt and mutant toxins displayed similar enzymatic activities and binding affinities to G(M1) immobilized on plastic. Biologic activity of recombinant toxins was assessed as a Cl- secretory response elicited from the polarized human epithelial cell line T84 using standard electrophysiologic techniques, Mutations in K(R)DEL of both CT and LT delayed the time course of toxin-induced Cl- secretion. At T1/2, dose dependencies for K(R)DEL-mutant toxins were increased greater than or equal to 10-fold. KDEL-mutants displayed differentially greater temperature sensitivity. In direct concordance with a slower rate of signal transduction, KDEL-mutants were trafficked to the basolateral membrane more slowly than wt CT (assessed by selective cell surface biotinylation as transcytosis of B subunit). Mutation in K(R)DEL had no effect on the rate of toxin endocytosis, These data provide evidence that CT and LT interact directly with endogenous KDEL-receptors and imply that both toxins may require retrograde movement through Golgi cisternae and ER for efficient and maximal biologic activity

Number counts and clustering properties of bright distant red galaxies in the UKIDSS Ultra Deep Survey Early Data Release

We describe the number counts and spatial distribution of 239 distant red galaxies ( DRGs), selected from the Early Data Release of the UKIDSS Ultra Deep Survey. The DRGs are identified by their very red infrared colours with (J - K)(AB) > 1.3, selected over 0.62 deg(2) to a 90 per cent completeness limit of K(AB) similar or equal to 20.7. This is the first time that a large sample of bright DRGs has been studied within a contiguous area, and we provide the first measurements of their number counts and clustering. The population shows strong angular clustering, intermediate between those of K-selected field galaxies and optical/infrared-selected extremely red galaxies. Adopting the redshift distributions determined from other recent studies, we infer a high correlation length of r(0) similar to 11 h(-1) Mpc. Such strong clustering could imply that our galaxies are hosted by very massive dark matter haloes, consistent with the progenitors of present-day L greater than or similar to L(*) elliptical galaxies

The colour selection of distant galaxies in the UKIDSS Ultra Deep Survey Early Data Release

We investigate colour selection techniques for high-redshift galaxies in the UKIRT Infrared Deep Sky Survey (UKIDSS) Ultra Deep Survey Early Data Release (UDS EDR). Combined with very deep Subaru optical photometry, the depth (KAB= 22.5) and area (0.62 deg2) of the UDS EDR allow us to investigate optical/near-infrared selection using a large sample of over 30 000 objects. By using the B−z′, z′−K colour–colour diagram (the BzK technique) we identify over 7500 candidate galaxies at z > 1.4, which can be further separated into passive and star-forming systems (pBzKs and sBzKs respectively). Our unique sample allows us to identify a new feature not previously seen in BzK diagrams, consistent with the passively evolving track of early-type galaxies at z 1 galaxies over a narrow redshift range

The evolution of the near-infrared galaxy luminosity function and colour bimodality up to z \~= 2 from the UKIDSS Ultra Deep Survey Early Data Release

We present new results on the cosmological evolution of the near-infrared galaxy luminosity function, derived from the analysis of a new sample of \~22,000 K(AB) < 22.5 galaxies selected over an area of 0.6 square degrees from the Early Data Release of the UKIDSS Ultra Deep Survey (UDS). Our study has exploited the multi-wavelength coverage of the UDS field provided by the new UKIDSS WFCAM K and J-band imaging, the Subaru/XMM-Newton Deep Survey and the Spitzer-SWIRE Survey. The unique combination of large area and depth provided by this new survey minimises the complicating effect of cosmic variance and has allowed us, for the first time, to trace the evolution of the brightest sources out to z~2 with good statistical accuracy. In agreement with previous studies we find that the characteristic luminosity of the near-infrared luminosity function brightens by 1 magnitude between z=0 and z~2, while the total density decreases by a factor ~2. Using the rest-frame (U-B) colour to split the sample into red and blue galaxies, we confirm the classic luminosity-dependent colour bimodality at z<1. However, the strength of the colour bimodality is found to be a decreasing function of redshift, and seems to disappear by z>1.5. Due to the large size of our sample we are able to investigate the differing cosmological evolution of the red and blue galaxy populations. It is found that the space density of the brightest red galaxies (M_K < -23) stays approximately constant with redshift, and that these sources dominate the bright-end of the luminosity function at redshifts z<1. In contrast, the brightening of the characteristic luminosity and mild decrease in space density displayed by the blue galaxy population leads them to dominate the bright-end of the luminosity function at redshifts z>1.Comment: 12 pages, 8 figures, accepted for publication in MNRA