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

Plant growth promotion and biological control of Pythium aphanidermatum, a pathogen of cucumber, by endophytic actinomycetes

Aims: To evaluate the potential of Actinoplanes campanulatus, Micromonospora chalcea and Streptomyces spiralis endophytic in cucumber roots, to promote plant growth and to protect seedlings and mature plants of cucumber from diseases caused by Pythium aphanidermatum, under greenhouse conditions. Methods and Results: Three endophytic isolates, out of 29, were selected through tests aimed at understanding their mechanisms of action as biocontrol agents and plant growth promoters. When applied individually or in combination, they significantly promoted plant growth and reduced damping-off and crown and root rot of cucumber. The combination of the three isolates resulted in significantly better suppression of diseases and plant growth promotion, than where the plants were exposed to individual strains. Conclusions: The three selected actinomycete isolates colonized cucumber roots endophytically for 8 weeks, promoted plant growth and suppressed pathogenic activities of P. aphanidermatum on seedling and mature cucumber plants. Significance and Impact of the Study: The results clearly show that the endophytic, glucanase-producing actinomycetes used, especially as a combined treatment, could replace metalaxyl, which is the currently recommended fungicide for Pythium diseases in the United Arab Emirates. These endophytic isolates also have the potential to perform as plant growth promoters, which is a useful attribute for crop production in nutrient impoverished soils

Fish emulsion as a food base for rhizobacteria promoting growth of radish (Raphanus sativus L. var. sativus) in a sandy soil

Commercial fish emulsion was evaluated as a plant growth medium and as a nutrient base to enhance radish (Raphanus sativus L. var. sativus) growth by bacterial and actinomycete isolates. Six bacterial isolates including three actinomycetes were selected from a screening of 54 bacteria (including 23 actinomycetes) based on their ability to produce plant growth regulators (PGRs) and to colonize radish roots. These isolates were tested in the presence and absence of autoclaved or non-autoclaved fish emulsion or inorganic fertilizers. The nutrient contents and types and levels of PGRs in tissues of treated plants were assayed to determine the basis of growth promotion. Fish emulsion was found to support plant growth in a sandy soil as effectively as an applied inorganic fertilizer. The plant growth promotion by bacterial and actinomycete isolates was most pronounced in the presence of autoclaved or non-autoclaved fish emulsion than in the presence of the inorganic fertilizers. The bacterial and actinomycete isolates were capable of producing auxins, gibberellins and cytokinins and appeared to use fish emulsion as a source of nutrients and precursors for PGRs. PGR levels in planta following combined treatments of the bacterial and actinomycete isolates and fish emulsion were found to be significantly enhanced over other treatments. The effect of fish emulsion appears to be more related to its role as a nutrient base for the bacterial and actinomycete isolates rather than to the increased activity of the general microflora of treated soil. This is the first report of fish emulsion as a nutrient base for plant growth promoting rhizobacteria. These results also indicate that the successful treatment can be effective and economical for horticultural production in sandy soils such as those found in the United Arab Emirates where fish emulsion is already in use as a substitute or supplement for inorganic fertilizer

A twofold genetic increase of ACE expression has no effect on the development of spontaneous hypertension

BACKGROUND: To study the regulation of a naturally occurring genetic variant of high angiotensin-converting enzyme (ACE) gene (Ace in rat) expression, i.e., the Ace allele of the normotensive Wistar-Kyoto (WKY) rat, in the hypertensive background of stroke-prone spontaneously hypertensive (SHRSP) rats. METHODS: We analyzed a congenic strain termed SHRSP.WKY-Ace derived from SHRSP in which a chromosomal fragment of rat chromosome 10 including Ace was replaced by the WKY locus. We compared blood pressures by radiotelemetry, measured plasma ACE activity, tissue ACE messenger RNA (mRNA) and enzyme activities in lung, kidney, and left ventricle (LV) of the heart in adult animals. RESULTS: Congenic animals demonstrated a twofold increase in plasma ACE activity in comparison to SHRSP (P < 0.05) and thus similar levels to WKY. The increased tissue expression of ACE mRNA and enzyme activities in lung, kidney, and LV observed in WKY were similarly found in congenic animals when compared to SHRSP (P < 0.05, respectively). Systolic and diastolic blood pressures were not different between congenic and SHRSP animals. Analysis of renin in plasma and angiotensin peptides in LV tissues indicated the induction of compensatory mechanisms by downregulation of renin and angiotensin I (Ang I) concentrations in congenic animals. CONCLUSIONS: We demonstrated that genetically determined high ACE expression linked to WKY Ace remains unchanged in the hypertensive background of SHRSP.WKY-Ace. Our data indicate that buffering mechanisms in the renin-angiotensin system contribute to the finding that the development of spontaneous hypertension is not affected, despite an average twofold higher expression of ACE in congenic animals

Biological control of Sclerotinia minor using a chitinolytic bacterium and actinomycetes

Isolates of 85 bacteria and 94 streptomycete and 35 nonstreptomycete actinomycetes were obtained from a lettuce-growing field in Al-Ain, United Arab Emirates, on colloidal chitin agar, and screened for their ability to produce chitinase. Twenty-three bacteria and 38 streptomycete and 15 nonstreptomycete actinomycete isolates produced high levels of chitinase and were examined in vitro for their ability to suppress the growth of Sclerotinia minor, a pathogen causing basal drop disease of lettuce. The three most suppressive isolates were examined further for their production of β-1,3-glucanase and antifungal activity as well as their ability to colonize the roots and rhizosphere of lettuce in vitro and in planta. The three isolates, Serratia marcescens, Streptomyces viridodiasticus and Micromonospora carbonacea, significantly reduced the growth of S. minor in vitro, and produced high levels of chitinase and β-1,3-glucanase. Streptomyces viridodiasticus also produced antifungal metabolite(s) that significantly reduced the growth of the pathogen in vitro. When the pathogen was presented as the sole carbon source, all three isolates caused extensive hyphal plasmolysis and cell wall lysis. Serratia marcescens and St. viridodiasticus were competent to varying degrees in colonizing the roots of lettuce seedlings after 8 days on agar plates and the rhizosphere within 14 days in pots, with their competency being superior to that of M. carbonacea. All three isolates, individually or in combination, were antagonistic to S. minor and significantly reduced incidence of disease under controlled glasshouse conditions

Vaginoscopic resection of vaginal septum

We report the resection of a vaginal septum while preserving the virginity of a 12-year-old girl with Herlyn-Werner-Wunderlich Syndrome (HWWS) having a didelphys uterus, obstructed hemivagina, and an ipsilateral renal agenesis with follow-up at 18 months. Successful resection of the vaginal septum with conservation of the hymenal ring and complete drainage of both the hematocolpos and the hematometra were achieved. Cyclic dysmenorrhea and pelvic pain were completely resolved on follow-up visits at 4, 6, and 18 months. Office hysteroscopy performed during the last follow-up visit revealed a patent vaginal vault without evidence of adenosis or recurrence of the vaginal septum. Vaginoscopy is a safe, convenient, and efficient diagnostic and therapeutic modality that can be used in the management of patients with an obstructed hemivagina. It maintains the patient's virginity and it is useful in patients with a restrictive vaginal opening or narrow vaginal canal. Furthermore, the hysteroscopic excision of the vaginal septum offers minimal risk of recurrence of the septal defect