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Cuff SM, Reeves N, Lewis E, Jones E, Baker S, Karategos A, Morris R, Torkington J, Eberl M. Inflammatory biomarker signatures in post-surgical drain fluid may detect anastomotic leaks within 48 hours of colorectal resection. Tech Coloproctol 2023; 27:1297-1305. [PMID: 37486461 PMCID: PMC10638112 DOI: 10.1007/s10151-023-02841-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The optimal treatment of colorectal cancer is surgical resection and primary anastomosis. Anastomotic leak can affect up to 20% of patients and creates significant morbidity and mortality. Current diagnosis of a leak is based on clinical suspicion and subsequent radiology. Peritoneal biomarkers have shown diagnostic utility in other conditions and could be useful in providing earlier diagnosis. This pilot study was designed to assess the practical utility of peritoneal biomarkers after abdominal surgery utilising an automated immunoassay system in routine use for quantifying cytokines. METHODS Patients undergoing an anterior resection for a rectal cancer diagnosis were recruited at University Hospital of Wales, Cardiff between June 2019 and June 2021. A peritoneal drain was placed in the proximity of the anastomosis during surgery, and peritoneal fluid was collected at days 1 to 3 post-operatively, and analysed using the Siemens IMMULITE platform for interleukin (IL)-1β, IL-6, IL-10, CXCL8, tumour necrosis factor alpha (TNFα) and C-reactive protein (CRP). RESULTS A total of 42 patients were recruited (22M:20F, median age 65). Anastomotic leak was detected in four patients and a further five patients had other intra-abdominal complications. The IMMULITE platform was able to provide robust and reliable results from the analysis of the peritoneal fluid. A metric based on the combination of peritoneal IL-6 and CRP levels was able to accurately diagnose three anastomotic leaks, whilst correctly classifying all negative control patients including those with other complications. CONCLUSIONS This pilot study demonstrates that a simple immune signature in surgical drain fluid could accurately diagnose an anastomotic leak at 48 h postoperatively using instrumentation that is already widely available in hospital clinical laboratories.
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Affiliation(s)
- S M Cuff
- Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - N Reeves
- University Hospital of Wales, Cardiff & Vale University Health Board, Cardiff, UK.
| | - E Lewis
- Technical Operations, Siemens Healthineers, Llanberis, UK
| | - E Jones
- Technical Operations, Siemens Healthineers, Llanberis, UK
| | - S Baker
- Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - A Karategos
- University Hospital of Wales, Cardiff & Vale University Health Board, Cardiff, UK
| | - R Morris
- Technical Operations, Siemens Healthineers, Llanberis, UK
| | - J Torkington
- University Hospital of Wales, Cardiff & Vale University Health Board, Cardiff, UK
| | - M Eberl
- Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Systems Immunity Research Institute, Cardiff University, Cardiff, UK
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Williams N, Reeves N, Chandler S, Jones H. TH3.8 Retrospective study on the use of colonic stents in malignancy; a bridge to surgery or the end of the line? Br J Surg 2022. [DOI: 10.1093/bjs/znac248.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim
Colonic stenting is a management option for obstructed left sided colorectal malignancy in the emergency and elective setting. Stenting can provide a bridge to curative surgery or to adjuvant treatment. The aim of this study was to assess the role of colonic stenting in management of obstructed colorectal cancer.
Methods
This retrospective cohort study analyses prospectively collected data from two centres within one Health Board in Wales. Patients were recorded in a cancer database, who underwent colonic stenting for left sided colonic malignancy between January 2008 and December 2021. Patient demographics, treatment pathways, length of admission, stoma formation rates and morbidity were recorded.
Results
In total, 98 patients, with a mean age of 73.5 years (range 37–97) underwent a colonic stent. The majority were elective 55% (n=54). The sigmoid colon was the commonest site of tumour in 33 patients, with metastatic disease in 82% (n=80). The study found 86% (n=84) of patients were successfully stented. The mean length of admission was 13 days. The complication rate was 23% (n=23), most commonly stent obstruction (n=6). Stenting was a bridge to curative surgery for 3 patients, and 47% (n=46) received adjuvant treatment. Five-year survival was 19.3% (n=19). The overall stoma rate was 10.2% (10 patients).
Conclusion
This study shows colonic stenting is a viable alternative in surgical management for advanced obstructing colorectal malignancy but not as a bridge to surgery. The majority of this cohort returned home following stenting, had a low overall stoma rate and 19% survival at 5 years.
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Affiliation(s)
| | - N Reeves
- Aneurin Bevan University Healthboard
| | | | - H Jones
- Aneurin Bevan University Healthboard
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Tang AM, Chandler S, Reeves N, Silva L, Harris DA, Dhruva Rao PK. SP4.1.5The use of Faecal Immunochemical Testing (FIT) and Minimal Preparation Computed Tomography (MPCT) during COVID-19 for Urgent Suspected Cancer (USC) referrals in patients with lower gastro-intestinal symptoms. Br J Surg 2021. [PMCID: PMC8574423 DOI: 10.1093/bjs/znab361.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Aims The COVID-19 pandemic necessitated introduction of revised diagnostic pathways for assessing Urgent Suspected Cancer (USC) referrals. Combinations of FIT and MPCT were used to manage referrals and prioritise access to clinical services or invasive tests. The effectiveness of these pathways are evaluated in this study. Methods All consecutive patients referred from primary care on the USC pathway between 15th March – 15th June 2020 were included to reflect the effect of full lockdown measures. Data collected included demographics, presenting symptom(s), investigations and timelines and patient outcomes up to 90 days following initial referral. Results 816 patients across 8 sites in Wales were included in this initial analysis. 52.7% of patients were female with median age 69 (21 – 97) years. Of the 50.7% who had first-line clinical review, 70.5% were virtual consultations. 49.3% had primary investigations, with FIT in 31% of patients and MPCT in 18.3%. This was compliant with locally agreed pathways for 77.3% of referrals. COVID-response pathways achieved a 28.5% reduction in use of colonoscopy as first-line investigation and 84.3% of patients avoided face-to-face consultations altogether during this first wave of the pandemic. Overall, 5.6% of USC referrals were diagnosed with CRC. Median timescale from diagnosis to treatment for CRC was 82 (4 – 175) days. The NPV for FIT in this cohort was 99.5%. MPCT as the first modality had a NPV of 99%. Conclusion A modified investigation pathway maintained cancer diagnosis during the pandemic with improved resource utilisation to that used previously.
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Affiliation(s)
- A M Tang
- Swansea Bay University Health Board
| | | | - N Reeves
- Cardiff and Vale University Health Board
| | - L Silva
- Cardiff and Vale University Health Board
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Mazumdar E, Reeves N, Witherspoon J. 1500 Chyle Leakage Following Laparoscopic Cholecystectomy: A Problematic Post-Operative Complication. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Symptomatic choleliathiasis is a common surgical issue affecting 10% of the British population, of which laparoscopic cholecystectomy is the gold standard treatment. Asymptomatic chyle leakage post-laparoscopic cholecystectomy is an extremely rare complication.
Case Report
A 56-year-old man presents with right upper quadrant pain after recurrent episodes of acute cholecystitis. An MRCP showed small stones in the gallbladder and a stone in the distal common bile duct. The management was an urgent in-patient laparoscopic cholecystectomy. At operation, he was found to have significant gallbladder inflammation and a drain was left in-situ. On post-operative day 1, there was a triglyceride rich milky white drain fluid output, which was confirmed as chyle.
Method
The patient was asymptomatic and systematically well, so a conservative approach was taken. A strict low-fat diet resulted in resolution of the chyle leak, and the drain was removed on post-operative day 4. Follow-up at 8 weeks confirmed full recovery.
Conclusions
There are four recorded cases of such a phenomenon and is suggested it is caused by iatrogenic injury to the gallbladder fossa which may contain lymphatic vessels. The gold standard investigation is lymphoscintography, although drain fluid analysis and computed tomography imaging are more attainable investigations. Conservative management includes a fat-free diet, total parenteral nutrition and ocreotide whereas surgical management includes identifying the site of leakage and suturing it or applying fibrin glue. Lessons from this unexpected complication include treating the patient, cautiously monitoring the drain and considering surgical intervention if conservative management fails.
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Affiliation(s)
- E Mazumdar
- University Hospital of Wales, Cardiff, United Kingdom
| | - N Reeves
- University Hospital of Wales, Cardiff, United Kingdom
| | - J Witherspoon
- University Hospital of Wales, Cardiff, United Kingdom
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Vogel I, Reeves N, Tanis PJ, Bemelman WA, Torkington J, Hompes R, Cornish JA. Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: a systematic review and meta-analysis. Tech Coloproctol 2021; 25:751-760. [PMID: 33792822 PMCID: PMC8187190 DOI: 10.1007/s10151-021-02436-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/10/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Impaired bowel function after low anterior resection (LAR) for rectal cancer is a frequent problem with a major impact on quality of life. The aim of this study was to assess the impact of a defunctioning ileostomy, and time to ileostomy closure on bowel function after LAR for rectal cancer. METHODS We performed a systematic review based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Comprehensive literature searches were conducted using PubMed, Embase and Cochrane databases for articles published from 1989 up to August 2019. Analysis was performed using Review Manager (version 5.3) using a random-effects model. RESULTS The search yielded 11 studies (1400 patients) that reported on functional outcome after LAR with at least 1 year follow-up, except for one study. Five scales were used: the Low Anterior Resection Syndrome (LARS) score, the Wexner score, the Memorial Sloan Kettering Cancer Centre Bowel Function Instrument, the Fecal Incontinence Quality of Life scale, and the Hallbook questionnaire. Based on seven studies, major LARS occurred more often in the ileostomy group (OR 2.84, 95% CI, 1.70-4.75, p < 0.0001: I2 = 60%, X2 = 0.02). Based on six studies, a longer time to stoma closure increased the risk of major LARS with a mean difference in time to closure of 2.39 months (95% CI, 1.28-3.51, p < 0.0001: I2 = 21%, X2 = 0.28) in the major vs. no LARS group. Other scoring systems could not be pooled, but presence of an ileostomy predicted poorer bowel function except with the Hallbook questionnaire. CONCLUSIONS The risk of developing major LARS seems higher with a defunctioning ileostomy. A prolonged time to ileostomy closure seems to reinforce the negative effect on bowel function; therefore, early reversal should be an important part of the patient pathway.
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Affiliation(s)
- I Vogel
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK.
| | - N Reeves
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - R Hompes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J A Cornish
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
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Abstract
INTRODUCTION The COVID-19 pandemic stimulated a national lockdown in the UK. The public were advised to avoid unnecessary hospital attendances and health professionals were advised to avoid aerosol-generating procedures wherever possible. The authors hypothesised that these measures would result in a reduction in the number of patients presenting to hospital with acute appendicitis and alter treatment choices. METHODS A multicentred, prospective observational study was undertaken during April 2020 to identify adults treated for acute appendicitis. Searches of operative and radiological records were performed to identify patients treated during April 2018 and April 2019 for comparison. RESULTS A total of 190 patients were treated for acute appendicitis pre-lockdown compared with 64 patients treated during lockdown. Patients treated during the pandemic were more likely to have a higher American Society of Anesthesiology (ASA) score (p = 0.049) and to have delayed their presentation to hospital (2 versus 3 days, p = 0.03). During the lockdown, the use of computed tomography (CT) increased from 36.3% to 85.9% (p < 0.001), the use of an antibiotic-only approach increased from 6.2% to 40.6% (p < 0.001) and the rate of laparoscopic appendicectomy reduced from 85.3% to 17.2% (p < 0.001). The negative appendicectomy rate decreased from 21.7% to 7.1% during lockdown (p < 0.001). CONCLUSIONS The COVID-19 lockdown was associated with a decreased incidence of acute appendicitis and a significant shift in the management approach. The increased use of CT allows the identification of simple appendicitis for conservative treatment and decreases the negative appendicectomy rate.
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Affiliation(s)
| | - L Hurt
- Morriston Hospital, Swansea, UK
| | | | - N Reeves
- University Hospital of Wales, Cardiff, UK
| | | | | | - J Cornish
- University Hospital of Wales, Cardiff, UK
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8
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Hallam S, Rickard F, Reeves N, Messenger D, Shabbir J. Compliance with enhanced recovery protocols in elderly patients undergoing colorectal resection. Ann R Coll Surg Engl 2018; 100:570-579. [PMID: 29909672 DOI: 10.1308/rcsann.2018.0102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction Enhanced recovery after surgery (ERAS) is associated with reduced length of stay (LOS) and improved outcomes in colorectal surgery. It is unclear whether ERAS can be safely implemented in elderly patients undergoing complex colorectal resections. The aim of this study was to evaluate the feasibility of ERAS in patients of all ages undergoing colorectal surgery. Methods A prospective database of a consecutive series of patients undergoing colorectal resections with ERAS between August 2012 and December 2014 was evaluated. Patients were divided into four age groups. Outcomes studied were compliance with ERAS elements, LOS, morbidity and mortality. Results Of the 294 patients in the study cohort, 79 were <60 years, 81 were 60-69 years, 86 were 70-79 years and 48 were ≥80 years of age. There was no significant difference between age groups in compliance with ERAS elements. Age was not predictive of delayed discharge (LOS >6 days) or morbidity. Factors that were predictive of delayed discharge on multivariate analysis were open surgery (odds ratio [OR]: 2.23, p=0.003), conversion to open surgery (OR: 3.23, p=0.017), stoma formation (OR: 2.10, p=0.019) and chronic obstructive pulmonary disease (OR: 4.12, p=0.038). Factors predictive of morbidity on multivariate analysis comprised conversion to open surgery (OR: 7.72, p=0.004), high creatinine (OR: 1.03 per unit increase in creatinine, p=0.008) and stoma education (OR: 0.31, p=0.030). Conclusions ERAS can be successfully implemented in older patients. There was equal compliance with the ERAS programme across the four age groups and no significant effect of age on LOS or morbidity.
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Affiliation(s)
- S Hallam
- University Hospitals Bristol NHS Foundation Trust , UK
| | - F Rickard
- University Hospitals Bristol NHS Foundation Trust , UK
| | - N Reeves
- University Hospitals Bristol NHS Foundation Trust , UK
| | - D Messenger
- University Hospitals Bristol NHS Foundation Trust , UK
| | - J Shabbir
- University Hospitals Bristol NHS Foundation Trust , UK
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9
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Jones H, Lang S, Reeves N, Lim J, Streets C. An Audit of Correct Urgency Categorisation in Patients Who Undergo an Emergency Laparotomy. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Reeves N, Hughes D, Pathak S. Response to Samuelsson et al.: Inappropriate drug use in elderly patients is associated with prolonged hospital stay and increased postoperative mortality after colorectal cancer surgery: a population-based study. Colorectal Dis 2016; 18:725-6. [PMID: 27149096 DOI: 10.1111/codi.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/28/2016] [Indexed: 02/08/2023]
Affiliation(s)
- N Reeves
- Department of General Surgery, Bristol Royal Infirmary, Bristol, UK.
| | - D Hughes
- Department of General Surgery, Bristol Royal Infirmary, Bristol, UK
| | - S Pathak
- Department of General Surgery, Bristol Royal Infirmary, Bristol, UK
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11
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Horner D, Wells S, Bonnici K, Reeves N, Parris RJ. RAISING THE BAR FOR EXCLUSION OF ACUTE VENOUS THROMBOEMBOLISM IN THE EMERGENCY DEPARTMENT: Table 1. Arch Emerg Med 2015. [DOI: 10.1136/emermed-2015-205372.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rittweger J, Gerrits K, Altenburg T, Reeves N, Maganaris CN, de Haan A. Bone adaptation to altered loading after spinal cord injury: a study of bone and muscle strength. J Musculoskelet Neuronal Interact 2006; 6:269-76. [PMID: 17142949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Bone loss from the paralysed limbs after spinal cord injury (SCI) is well documented. Under physiological conditions, bones are adapted to forces which mainly emerge from muscle pull. After spinal cord injury (SCI), muscles can no longer contract voluntarily and are merely activated during spasms. Based on the Ashworth scale, previous research has suggested that these spasms may mitigate bone losses. We therefore wished to assess muscle forces after SCI with a more direct measure and compare it to measures of bone strength. We hypothesized that the bones in SCI patients would be in relation to the loss of muscle forces. Six male patients with SCI 6.4 (SD 4.3) years earlier and 6 age-matched, able-bodied control subjects were investigated. Bone scans from the right knee were obtained by pQCT. The knee extensor muscles were electrically stimulated via the femoral nerve, isometric knee extension torque was measured and patellar tendon force was estimated. Tendon force upon electrical stimulation in the SCI group was 75% lower than in the control subjects (p<0.01). Volumetric bone mineral density of the patella and of the proximal tibia epiphysis were 50% lower in the SCI group than in the control subjects (p<0.01). Cortical area was lower by 43% in the SCI patients at the proximal tibia metaphysis, and by 33% at the distal femur metaphysis. No group differences were found in volumetric cortical density. Close curvilinear relationships were found between stress and volumetric density for the tibia epiphysis (r(2)=0.90) and for the patella (r(2)=0.91). A weaker correlation with the tendon force was found for the cortical area of the proximal tibia metaphysis (r(2)=0.63), and none for the distal femur metaphysis. These data suggest that, under steady state conditions after SCI, epiphyseal bones are well adapted to the muscular forces. For the metaphysis of the long bones, such an adaptation appears to be less evident. The reason for this remains unclear.
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Affiliation(s)
- J Rittweger
- Institute for Biophysical and Clinical Research into Human Movement, Manchester Metropolitan University, Cheshire, UK.
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15
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Abstract
The loss of muscle mass associated with ageing only partly explains the observed decline in muscle strength. This paper provides evidence of the contribution of muscular, tendinous and neural alterations to muscle weakness in old age and discusses the complex interplay between the changes of the contractile tissue with those of the tendinous tissue in relation to the mechanical behavior of the muscle as a whole. Despite the considerable structural and functional alterations, the elderly musculoskeletal system displays remarkable adaptability to training in old age and many of these adverse effects may be substantially mitigated, if not reversed, by resistive loading. The interplay between these muscular and tendinous adaptations has an impact both on the length-force and force-velocity relationships of the muscle and is likely to affect the range of motion, rate of force development, maximum force development and speed of movement of the older individual.
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Affiliation(s)
- M V Narici
- Institute for Biophysical and Clinical Research into Human Movement (IRM), Manchester Metropolitan University, MMU Cheshire, Alsager Campus, Alsager, UK.
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Chia F, Zheng Y, Liu J, Reeves N, Ungar G, Wright PV. Thick lamellar textures and high ambient conductivity in de-blended mixtures of low-dimensional systems of two polymers and Li salts. Electrochim Acta 2003. [DOI: 10.1016/s0013-4686(03)00171-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Narici MV, Maganaris CN, Reeves N. Muscle and tendon adaptations to ageing and spaceflight. J Gravit Physiol 2002; 9:P137-8. [PMID: 15002518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- M V Narici
- Centre for Biophysical and Clinical Research into Human Movement, Manchester Metropolitan University, Alsager Campus, United Kingdom
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Abstract
A real-time PCR assay was developed to detect and quantify Chlamydophila felis infection of cats. The assay uses a molecular beacon to specifically identify the major outer membrane protein gene, is highly reproducible, and is able to detect fewer than 10 genomic copies.
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Affiliation(s)
- C Helps
- Division of Molecular and Cellular Biology, Department of Clinical Veterinary Science, University of Bristol, Langford, Bristol, BS40 5DU, United Kingdom.
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Sansom JM, Sutton B, Reeves N, Bradley JK, Wood PJ, Bremner JC, Adams GE, Stratford IJ. Combination of photodynamic therapy (PDT) and melphalan in experimental tumors. Int J Radiat Oncol Biol Phys 1994; 29:463-6. [PMID: 8005800 DOI: 10.1016/0360-3016(94)90439-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To investigate whether application of "early" photodynamic therapy (PDT) using a disulphonated aluminium phthallocyanine photosensitizer can potentiate the action of melphalan in experimental RIF-1 tumors in vivo. METHODS AND MATERIALS Tumors were irradiated with laser light of wavelength 675 nm 60 min after treatment with the photosensitizer and 15 min after melphalan. Melphalan pharmacokinetics were measured using high performance liquid chromatography with optical detection. RESULTS Melphalan and PDT when given alone, caused a significant delay in tumor growth. This was increased for the combined treatment. Pharmacokinetic analyses showed that levels of free, unreacted melphalan in freely circulating blood are unaffected by combined treatment. However, significant differences in tumor levels were observed between treatment with melphalan alone or in combination. Whereas in the former, melphalan is still present in tumors after 2 h, it was not detectable even at the earliest time of 15-23 min for the combined treatment. CONCLUSION The antitumor effects were additive with no evidence of significant potentiation.
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Abstract
The experience of fatigue in early pregnancy was studied, using a general model of fatigue as the conceptual framework. A convenience sample of 30 women, age 20-35 years, who were at less than 20 weeks' gestation and without health problems were included in the study. Physiologic, psychological, and environmental factors were measured and related to the occurrence and intensity of fatigue. Pearson correlations and content analysis were used to analyze the data. Results showed that a large portion of the sample (90%) experienced fatigue and that this fatigue had a significant impact on their ability to maintain personal and social activities. Significant correlations were observed between fatigue and the physiologic variables of nausea and feeling tired upon awakening from sleep. There was no significant relationship between fatigue and environmental variables such as number of hours worked or the number of children living in the home. In addition, significant correlations were observed between fatigue and psychological variables that included depression, anger, anxiety, and confusion. These data suggest that fatigue is a significant problem for pregnant women and is not relieved by rest. These data further suggest that the fatigue may be related to other physiologic changes, perhaps hormonal, that mediate physiologic and psychological variables, including fatigue.
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Affiliation(s)
- N Reeves
- Department of Maternal-Child Nursing, University of Illinois, College of Nursing, Chicago 60612
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Smith SP, Reeves N. Returning to school? Energy management could help. RNABC News 1984; 16:14-5. [PMID: 6568765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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