After-hours colorectal surgery: a risk factor for anastomotic leakage

__Purpose:__ This study aims to increase knowledge of colorectal anastomotic leakage by performing an incidence study and risk factor analysis with new potential risk factors in a Dutch tertiary referral center. __Methods:__ All patients whom received a primary colorectal anastomosis between 1997 and 2007 were selected by means of operation codes. Patient records were studied for population description and risk factor analysis. __Results:__ In total 739 patients were included. Anastomotic leakage (AL) occurred in 64 (8.7%) patients of whom nine (14.1%) died. Median interval between operation and diagnosis was 8 days. The risk for AL was higher as the anastomoses were constructed more distally (p = 0.019). Univariate analysis showed duration of surgery (p = 0.038), BMI (p = 0.001), time of surgery (p = 0.029), prophylactic drainage (p = 0.006) and time under anesthesia (p = 0.012) to be associated to AL. Multivariate analysis showed BMI greater than 30 kg/m2(p = 0.006; OR 2.6 CI 1.3-5.2) and "after hours" construction of an anastomosis (p = 0.030; OR 2.2 CI 1.1-4.5) to be independent risk factors. __Conclusion:__ BMI greater than 30 kg/m2and "after hours" construction of an anastomosis were independent risk factors for colorectal anastomotic leakage

Virulence Potential and Genomic Mapping of the Worldwide Clone Escherichia coli ST131

Recently, the worldwide propagation of clonal CTX-M-15-producing Escherichia coli isolates, namely ST131 and O25b:H4, has been reported. Like the majority of extra-intestinal pathogenic E. coli isolates, the pandemic clone ST131 belongs to phylogenetic group B2, and has recently been shown to be highly virulent in a mouse model, even though it lacks several genes encoding key virulence factors (Pap, Cnf1 and HlyA). Using two animal models, Caenorhabditis elegans and zebrafish embryos, we assessed the virulence of three E. coli ST131 strains (2 CTX-M-15- producing urine and 1 non-ESBL-producing faecal isolate), comparing them with five non-ST131 B2 and a group A uropathogenic E. coli (UPEC). In C. elegans, the three ST131 strains showed intermediate virulence between the non virulent group A isolate and the virulent non-ST131 B2 strains. In zebrafish, the CTX-M-15-producing ST131 UPEC isolates were also less virulent than the non-ST131 B2 strains, suggesting that the production of CTX-M-15 is not correlated with enhanced virulence. Amongst the non-ST131 B2 group isolates, variation in pathogenic potential in zebrafish embryos was observed ranging from intermediate to highly virulent. Interestingly, the ST131 strains were equally persistent in surviving embryos as the non-ST131-group B2 strains, suggesting similar mechanisms may account for development of persistent infection. Optical maps of the genome of the ST131 strains were compared with those of 24 reference E. coli strains. Although small differences were seen within the ST131 strains, the tree built on the optical maps showed that these strains belonged to a specific cluster (86% similarity) with only 45% similarity with the other group B2 strains and 25% with strains of group A and D. Thus, the ST131 clone has a genetic composition that differs from other group B2 strains, and appears to be less virulent than previously suspected

Optimization of foraging and diet by the piscivorous Othos dentex (Serranidae)

The aim of this study was to determine the dietary characteristics and mouth morphology of Othos dentex and to use these data, together with in situ observations of feeding behaviour, to elucidate how foraging and diet are optimized by this piscivorous serranid. Seasonal spear and line fishing over reefs in south‐western Australia yielded 426 O. dentex (total length, LT, 183–605 mm), among which the stomachs of 95 contained food. The food in the stomachs of 76 fish was sufficiently undigested to be seen to contain, almost invariably, a single fish prey, which was typically identifiable to family and often to species. The prey of O. dentex, which were measured (LT), represented 10 families, of which the Labridae and Pempheridae constituted nearly two‐thirds of the prey volume. Two‐way crossed analysis of similarities of volumetric data for stomach contents showed that the dietary compositions of the different length classes of O. dentex in the various seasons were significantly related to length class of prey, but not to prey family, length class within the various prey families or season. Furthermore, an inverse (Q‐mode) analysis, including one‐way analysis of similarities, showed that the patterns in the prey consumed by the different length classes of O. dentex in the various seasons were related more strongly to length class than prey family. The former trend is exemplified in a shade plot, by a marked diagonality of the length classes of prey with increasing predator size. The ingestion of typically a single teleost prey, whose body size increases as that of O. dentex increases, reduces the frequency required for seeking prey, thus saving energy and reducing the potential for intraspecific competition for food. The ability of O. dentex to ingest large prey is facilitated by its possession of a very large gape, prominent recurved teeth, dorsal and independently‐moveable eyes, cryptic colouration and effective ambush behaviour. Othos dentex has thus evolved very cost‐effective mechanisms for optimizing its foraging and diet

Opecoelidae (Digenea) in northern Great Barrier Reef goatfishes (Perciformes: Mullidae)

The Opecoelidae (Digenea) of eight species of goatfishes (Perciformes: Mullidae) were studied off Lizard Island on the northern Great Barrier Reef (GBR). Host species included Mulloidichthys flavolineatus (Lacépède), M. vanicolensis (Valenciennes), Parupeneus barberinus (Lacépède), P. ciliatus (Lacépède), P. cyclostomus (Lacépède), P. indicus (Shaw), P. multifasciatus (Quoy & Gaimard), P. spilurus (Bleeker) and P. trifasciatus (Lacépède). Seven opecoelid species were found, of which Paropecoelus corneliae n. sp., Pa. leonae n. sp. and Pseudopecoeloides engeleri n. sp. are described as new. Paropecoelus elongatus (Ozaki, 1928), Pa. sogandaresi Pritchard, 1966 and Podocotyloides parupenei (Manter, 1963) are recorded and a description is provided for each. A second species of Pseudopecoeloides remains unnamed for want of sufficient morphological material. The seven species were distinguished on the basis of morphology and molecular analysis of 56 ITS2 rDNA sequences. Sequences differed by nine to 68 base pairs between species combinations recognised by morphology; no intraspecific variation was detected. Each opecoelid species infected between two and five mullid species, but none of the species has been found in non-mullid hosts. Every mullid species was infected with at least one species of opecoelid and Parupeneus ciliatus had all seven species. The Opecoelidae of GBR goatfishes are consistent with the typical pattern of stenoxenicity seen for trematodes of GBR fishes