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

Photosystem 2 Remains Capable of Oxygen Evolution After Losing 1/4 of its Initial Manganese Content

Photosystem 2 (PS 2) membranes were treated with CaCl2 to remove extrinsic polypeptides. After resuspension in a chloride-free buffer, manganese was extracted by leaching or with EDTA. Measurements made using three different methods (electron paramagnetic resonance, kinetics, and direct Mn analysis) agreed that one-fourth of the initial Mn content was lost and that the membrane preparation remained homogenous. Upon readdition of extrinsic polypeptides, the Mn-depleted membranes were capable of oxygen evolution. Thus not all the Mn in PS 2 is necessary for the oxygen evolution function

The Spatial Distribution of Chloroplast Water in Acer plantanoides Sun and Shade Leaves

We evaluated a new, two‐dimensional (2‐D) nuclear magnetic resonance (NMR) imaging technique as a method for measuring the distribution of chloroplasts in leaves. NMR images that showed the distribution of chloroplast water and of total water as a function of depth into Acer platanoides sun and shade leaves were compared with the distribution of chlorophyll in the same leaf types (as measured by fluorescence microscopy), with the cellular structure (by scanning electron microscopy), and with published information. Results showed that the volume fraction of chloroplast water was much larger in shade than in sun leaves, and that it averaged about one‐third larger in the palisade than in the spongy parenchyma region of both leaf types. Chlorophyll fluorescence was more intense in shade than in sun leaves. In sun leaves, fluorescence was maximal in the palisade region near the junction with the spongy parenchyma, while in shade leaves, fluorescence was maximal in the upper part of the spongy layer. We concluded that 2‐D NMR imaging reliably indicates the location of chloroplast water

Nuclear magnetic resonance study of the conformation and dynamics of ß-casein at the oil/water interface in emulsions.

A (13)C and (31)P nuclear magnetic resonance (NMR) study has been carried out on beta-casein adsorbed at the interface of a tetradecane/water emulsion. (13)C NMR spectra show signals from the carbonyl, carboxyl, aromatic, and C alpha carbons in beta-casein, well resolved from solvent resonances. Only a small fraction of all carbon atoms in beta-casein contribute to detectable signals; intensity measurements show that the observable spectrum is derived from about 30 to 40 amino acid residues.(31)P NMR spectra show signals from the five phosphoserines on the hydrophilic N-terminal part of the protein. Analysis of T(1) relaxation times of these nuclei, using the model free approach for the spectral density function and the line shape of the alpha-carbon region, indicates that a large part of the protein is in a random coil conformation with restricted motion and a relatively long internal correlation time. The NMR results show that the conformation and dynamics of the N-terminal part of beta-casein are not strongly altered at the oil/water interface, as compared to beta-casein in micelle-like aggregates in aqueous solution