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Assesses the ability of the American Society of Anesthesiology in stratifying the preoperative physiology and mortality to a standard procedure in Great Britain. Description on the physical condition of the patients; Analysis on the severity of the disease; Level of survival.

B Background: b Pancreatoduodenectomy for ampullary carcinoma is performed with curative intent and is associated with increased survival. 63 patients underwent major pancreatic resection for ampullary carcinoma. Post pancreatectomy haemorrhage was found in 6(9.5%) patients while 8(13%) suffered delayed gastric emptying. [Extracted from the article]

B Background: b Ampullary cancer is thought to have a better prognosis following resection compared to other cancers of the pancreatic head. 63 patients underwent major pancreatic resection for ampullary carcinoma. Factors that had a significant impact on survival were lymph node involvement and resection margin status. [Extracted from the article]

Pancreas graft failure rates remain substantial. The PDRI can be used at the time of organ offering, to predict one-year graft survival. This study aimed to validate the PDRI for a UK population. Data for 1021 pancreas transplants were retrieved from a national database for all pancreas transplants. Cases were categorized by PDRI quartile and compared for death-censored graft survival. Significant differences were observed between the UK and US cohorts. The PDRI accurately discriminated graft survival for SPK and was associated with a hazard ratio of 1.52 (P = 0.009) in this group. However, in the PTA and PAK groups, no association between PDRI quartile and graft survival was observed. This is the largest study to validate the PDRI in a European cohort and has shown for the first time that the PDRI can be used as a tool to predict graft survival in SPK transplantation, but not PTA or PAK transplantation., (© 2015 Steunstichting ESOT.)

Aim: To determine the diversity and stability of cultured vaginal lactobacilli in a multi-ethnic population of pregnant women., Methods and Results: A single-centre, prospective, cohort study was performed in a tertiary perinatal centre in East London, UK. Self-collected vaginal swabs at 13 and 20 weeks gestation were obtained from women attending for routine antenatal care and cultured for lactobacilli. In women who provided both swabs, 37 of 203 (18%) had no lactobacilli cultured at either time. Only 53 (26%) had the same species at both times. Black women were less likely to have lactobacilli cultured at 13 weeks (P = 0·014), and Black and Asian women were less likely to have lactobacilli cultured at 20 weeks (P = 0·002) compared with those in the White and Other groups., Conclusions: Significant differences exist between ethnic groups in the carriage and stability of vaginal lactobacilli., Significance and Impact of the Study: These differences have implications for the design of interventions aimed at normalizing the vaginal microbiota in pregnant women., (© 2014 The Society for Applied Microbiology.)

Background: A pancreas donor risk index (PDRI) has been derived by Axelrod et al. to inform organ acceptance and developed into a smartphone app by Marc Melcher. This paper aims to validate the app for use in a single UK transplant center through a snapshot of donors and outcomes during one calendar year., Methods: Donor details for all pancreas transplants performed in 2011 were collected from a prospectively maintained clinical database to calculate a PDRI using the Pancreas Transplant Donor Risk Index smartphone app., Results: Ninety pancreas transplants were included in the analysis (72 simultaneous pancreas kidney [SPK], 18 pancreas transplant alone [PTA]). PDRI scores were found to be positively skewed compared with donors described in the US literature. The PDRI was predictive of poorer 1-y graft outcome in the SPK group but not in the PTA group. PDRI was not predictive of time to failure or failure cause., Conclusion: Validation of the PDRI app against data from our center shows that it can be used as a tool to predict poorer graft outcome in the SPK group. However, it was not predictive in the PTA group, and differences in US and UK donor characteristics were evident. Development of a UK-specific PDRI may overcome these limitations., (Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.)

Molecular diagnostic methods are of potential value in identifying tuberculosis (TB) and drug resistance where tissue specimens have been submitted for histology but not for microbiological culture. All paraffin-embedded tissue (PET) specimens (n=60) referred to a single national centre over a 42 month study period were analysed using the INNO-LiPA Rif.TB assay; 29/60 patients had been reported to the UK Enhanced Tuberculosis Surveillance database with a diagnosis of TB based on clinical, radiological and histological evidence. Mycobacterium tuberculosis (MTB) DNA was detectable in 5 out of 29 reported TB cases (17.2 %); 12 out of 29 of the reported TB cases had a positive MTB culture from a secondary clinical specimen and MTB DNA was detectable in 2 of the 12 (16.7 %) laboratory-confirmed TB cases. Referring clinicians should be aware of the limitations of this assay on PETs, and should request molecular testing only in patients with a high clinical probability of TB and when acid-fast bacilli are seen in tissue specimens.

Objectives: Uropathogenic and invasive Escherichia coli O25:H4-ST131 isolates producing CTX-M-15 extended-spectrum beta-lactamase (ESBL) enzymes have recently been shown to be disseminated across the globe. In the UK, many CTX-M-15 ESBL-producing E. coli strains have been previously defined as belonging to the epidemic strains A-E, as determined by PFGE. The present study was carried out to define the relationship between these two groups of pathogenic E. coli., Methods: Multilocus sequence typing and PFGE were used for molecular characterization of a collection of 61 ESBL-producing E. coli isolates from across the UK., Results: Strains A to E all belonged to the ST131 clone, further underscoring the epidemiological importance of this lineage., Conclusions: The future spread of the ST131 clone, and its UK variants, should be monitored closely and the pathogenic mechanisms explaining their success should be investigated.

Objectives: To determine the distribution of acquired AmpC beta-lactamases in 173 isolates of Escherichia coli and Klebsiella spp. submitted to the UK's national reference laboratory for antibiotic resistance., Methods: MICs were determined and interpreted according to BSAC guidelines. Candidate isolates were those resistant to cefotaxime and/or ceftazidime, irrespective of addition of clavulanic acid. Genes encoding six phylogenetic groups of acquired AmpC enzymes were sought by PCR. Selected isolates were compared by pulsed-field gel electrophoresis (PFGE), and one bla(AmpC) amplicon was sequenced., Results: Genes encoding acquired AmpC enzymes were detected in 67 (49%) candidate E. coli and 21 (55%) Klebsiella spp. Sixty isolates produced CIT-type enzymes, 14 had ACC types, 11 had FOX types and 3 had DHA enzymes. The low-level cephalosporin resistance of the remaining isolates (n = 85; 49%) was inferred to result from reduced permeability or, in E. coli, from hyperexpression of chromosomal ampC. Twenty-four E. coli isolates from one hospital produced a CIT-type enzyme, with 20 of these additionally producing a group 1 CTX-M extended-spectrum beta-lactamase. PFGE indicated that these isolates belonged to UK epidemic strain A, which normally produces CTX-M-15, but no acquired AmpC. Sequencing a representative bla(AmpC) amplicon indicated that in one centre this strain had acquired a novel CMY-2 variant, designated CMY-23., Conclusions: Diverse acquired AmpC enzymes occur in E. coli and Klebsiella spp. isolates in the UK and Ireland, with CIT types the most common. Producers are geographically scattered, but with some local outbreaks. Acquisition of a CMY-2-like enzyme by E. coli epidemic strain A suggests that these enzymes may be poised to become an important public health issue.

It is hypothesized that stranger rape victim statements will reveal a scale of violation experienced by the victim, ranging from personal violation, through to physical violation, and finally, at the most extreme level, sexual violation. It is also hypothesized that offences can be differentiated in terms of one of four themes: hostile, controlling, stealing, or involving. To test these hypotheses, crime scene data from 112 rapes were analyzed by the multi-dimensional scaling procedure Smallest Space Analysis. The results provide empirical support for a composite model of rape consisting of four behavioral themes as different expressions of various intensities of violation. The results also suggest that stranger rapes may be less about power and control than about hostility and pseudo-intimacy. The proposed model has implications for the classification of rape, the investigation of sexual crimes, and the treatment of victims., (Copyright 2003 John Wiley & Sons, Ltd.)

Dietary intakes, anthropometric indices and plasma lipoprotein and alpha-tocopherol concentrations were measured in premenopausal vegetarian women of Indian descent (n = 22) and in white women of European descent consuming either mixed (n = 22) or vegetarian diets (n = 18). The Indian women were shorter in height than the white women and had a higher proportion of body fat. Energy intakes were lower in the Indian women, both in absolute terms and per kg body weight. The proportion of energy derived from saturated fatty acids was lower and that from polyunsaturated fatty acids was greater in both Indian and white vegetarians compared with the subjects on mixed diets. Intakes of dietary fibre and vitamins C and E were higher in the white vegetarians compared with the other groups. Plasma concentrations of total and LDL cholesterol and apolipoprotein B and the ratio of apolipoprotein B/apolipoprotein AI were lower and HDL and HDL2 cholesterol, alpha-tocopherol concentrations and the ratio of alpha-tocopherol/cholesterol were greater in the white vegetarian group than in the other groups. Total plasma cholesterol was associated with measures of truncal obesity, especially subscapular skinfold thickness and the percentage energy derived from saturated fatty acids. Plasma concentrations of apo(a) were higher and those of HDL and HDL2 cholesterol and sex hormone binding globulin (SHBG) were lower in the Indian vegetarian women compared with both groups of white women. No relationship could be found between apo(a), HDL and HDL2 cholesterol concentration and nutrient intake but HDL and HDL2 were negatively associated with the proportion of body fat and apo(a) weakly with subscapular skinfold thickness.(ABSTRACT TRUNCATED AT 250 WORDS)