Early detection of polyps or colorectal carcinoma can reduce colorectal carcinoma-associated deaths. Previous studies have demonstrated raised serum levels of matrix metalloproteinase 9 (sMMP-9) in a ...range of cancers. The aim of this study was to investigate the role of sMMP-9 levels in identifying colorectal neoplasia. Consenting patients donated a blood sample and were assessed by proforma-led history and physical examination. Samples were analysed for sMMP-9 concentration (enzyme-linked immuno-sorbant assay) and compared to final diagnoses. Logistic regression modelling determined independent factors associated with neoplasia. A total of 365 patients were recruited of whom 300 were analysed, including 46 normal controls. A total of 27 significant adenomas and 63 malignancies were identified. The median sMMP-9 concentration was 443 ng ml(-1) (IQR: 219-782; mean: 546). Patients with neoplasia had significantly elevated sMMP-9 levels (P<0.001). Logistic regression modelling identified elevated log(sMMP-9) as the most significant predictor of neoplasia (chi(2)=38.33, P<0.001). Other significant factors were age, sex, smoking history, abdominal pain and weight loss. The model accurately predicted neoplasia in 77.3% of cases. Sensitivity and specificity were 77.9 and 77.1%. sMMP-9 estimation can accurately stratify patient to low- or high-risk cohorts. Serum sampling is a potential means of avoiding unnecessary colonoscopy and reducing patient anxiety, iatrogenic morbidity and mortality, and cost.
A background in minimally invasive colorectal surgery (MICS) has been thought to be essential prior to robotic-assisted colorectal surgery (RACS). Our aim was to determine whether MICS is essential ...prior to starting RACS training based on results from our initial experience with RACS. Two surgeons from our centre received robotic training through the European Academy of Robotic Colorectal Surgery (EARCS). One surgeon had no prior formal MICS training. We reviewed the first 30 consecutive robotic colorectal procedures from a prospectively maintained database between November 2014 and January 2016 at our institution. Fourteen patients were male. Median age was 64.5 years (range 36–82) and BMI was 27.5 (range 20–32.5). Twelve procedures (40%) were performed by the non-MICS-trained surgeon: ten high anterior resections (one conversion), one low anterior resection and one abdomino-perineal resection of rectum (APER). The MICS-trained surgeon performed nine high and four low anterior resections, one APER and in addition three right hemicolectomies and one abdominal suture rectopexy. There were no intra-operative complications and two patients required re-operation. Median post-operative stay was five days (range 1–26). There were two 30-day re-admissions. All oncological resections had clear margins and median node harvest was 18 (range 9–39). Our case series demonstrates that a background in MICS is not essential prior to starting RACS training. Not having prior MICS training should not discourage surgeons from considering applying for a robotic training programme. Safe and successful robotic colorectal services can be established after completing a formal structured robotic training programme.
The behaviour of animals, particularly ectotherms, occurs in the context of daily and seasonal fluctuations in temperature and year-on-year increases in temperature associated with global climate ...change. Despite the importance of mating rate as a determinant of the intensity of male/female conflict over reproduction, the effects of ecological factors such as thermal environment on this process are poorly understood. We examined how temperature affects female remating rate in Drosophila melanogaster. The mating behaviour of D. melanogaster shows a circadian rhythm, and we partitioned thermal environment effects into those experienced at the point of courtship and those experienced outside courtship bouts. Temperature during and outside courtship both affected female remating rate, and did so in an approximately additive fashion. We found that female remating rate was more sensitive to thermal environment at the point of courtship than that encountered outside courtship periods. Elevation of temperature during courtship increased male courtship intensity, and we hypothesize that this directly increased a female's likelihood of remating. Our results highlight the importance of thermal conditions during and after courtship in determining mating rate in Drosophila and we discuss its implication for rates of polyandry in natural populations in terms of daily, seasonal and spatial variation, and changes that may be associated with climate change.
► We tested how temperature impacts on remating rate in a fruit fly. ► Female mating rate was largely determined by temperature at point of courtship. ► Mating rate was also sensitive to temperature outside of courtship. ► Daily, seasonal & spatial thermal variation will thus alter ectotherm mating rate. ► Global change in temperature is also likely to impact on ectotherm mating rate.
Purpose: To investigate the evidence for domain-specific deficits in self-awareness on the Patient Competency Rating Scale (PCRS) and the relationship to psychosocial outcomes after severe traumatic ...brain injury (TBI).
Methods: Fifty-six adults with severe TBI (75% males, M age =36.96, SD = 12.96), and 50 age- and gender-matched controls (72% male, M age =34.12, SD = 11.43) were administered the PCRS self-report form, and the Depression, Anxiety, Stress Scales. Relatives of TBI and control participants completed the PCRS informant version. Relatives of the TBI group also completed the Sydney Psychosocial Rating Scale.
Results: A within-group analysis indicated that self-awareness varied according to PCRS domain (p <.01). Relative to their own profile, TBI participants displayed significantly poorer self-awareness on the activities of daily living (ADLs) domain than on the interpersonal and emotional domains (p < 0.01). Further, TBI participants displayed significantly poorer self-awareness of ADLs than controls (p < 0.001), but there were no significant between-group differences in other domains. Hierarchical regression analyses revealed that poorer self-awareness of cognitive difficulties was related to lower occupational functioning (p = 0.01), whereas poorer self-awareness of difficulties with ADLs was related to lower independent living skills (p < 0.001).
Conclusions: The results provide only limited support for domain-specific deficits in self-awareness after severe TBI, with impairment most evident for ADLs. Poorer self-awareness in the ADLs and cognitive domains were associated with lower independence and occupational functioning, respectively. The findings highlight the potential benefits of targeting self-awareness related to difficulties with ADLs in the rehabilitation of people with severe TBI.
Implications for rehabilitation
People with severe traumatic brain injury had poorest self-awareness of difficulties regarding activities of daily living, which was related to less independence
Difficulties with complex activities of daily living were more likely to be under-reported than difficulties with basic self-care
It may be beneficial to target self-awareness of difficulties relating to complex activities of daily living in rehabilitation
Many insects carry maternally inherited bacteria which kill male offspring. Such bacteria will spread if male death benefits the female siblings who transmit the bacterium, and they are therefore ...expected in insects with antagonistic sibling interactions. We report that the butterfly Danaus chrysippus is host to a maternally inherited male-killing bacterium. Using diagnostic PCR and rDNA sequence, the bacterium was identified as a Spiroplasma closely related to 2 ladybird beetle male-killers and the tick symbiont Spiroplasma ixodetis. The male-killer was found to have a geographically restricted distribution, with up to 40% of females being infected in East Africa, but no detectable infection in small samples from other populations. Danaus chrysippus is a surprising host for a male-killer as its eggs are laid singly. This suggests that the ecological conditions permitting male-killers to invade may be more widespread than previously realized.
The past three decades have seen an increase in research on the attitudes of juveniles toward the police. This research suggests that juveniles are generally less positive in their attitudes toward ...the police than are adults. However, most research on juvenile attitudes has focused on youth residing in metropolitan areas, ignoring the role of geographical location in explaining perceptions. Using survey data, the present study examined the attitudes of rural youth toward the police. The findings suggest that although the level of support among rural teenagers did not mirror the levels found within the adult literature, rural teenagers may be more supportive of the police than their metropolitan counterparts. Furthermore, whereas White teenagers were generally more positive in their perception of the police than were Black teenagers, race was not a significant predictor of attitudes toward the police. Still, many of the variables identified as theoretically relevant in the existing literature were significant predictors of the attitudes of juveniles residing in rural areas.
Whilst many invertebrate taxa are haplodiploid, the factors underlying the evolution of haplodiploidy remain unresolved. We investigate theoretically whether haplodiploidy might evolve as an outcome ...of the co‐evolution between maternally inherited endosymbionts and their hosts. First, we substantially extend a recently developed model that involves maternally inherited endosymbionts that kill male offspring by eliminating the paternal genome. We also put forward a new hypothesis and develop a model that involves bacteria that induce cytoplasmic incompatibility (CI). Based on these models, we explore the co‐evolutionary events that might occur between hosts and symbionts. We find that both with male‐killers and CI‐inducing endosymbionts, the hosts are likely to develop increased viability of haploid males, which can be considered a preadaptation to haplodiploidy. In addition, populations with haploidizing male‐killers can in some cases evolve directly towards a genetic system of paternal genome elimination, a special form of haplodiploidy. These results are combined with consideration of mechanism and ecology to appraise the likelihood of male‐killers and CI inducing bacteria being involved in the evolution of haplodiploidy.
Inherited bacterial symbionts from the genus Wolbachia have attracted much attention by virtue of their ability to manipulate the reproduction of their arthropod hosts. The potential importance of ...these bacteria has been underlined by surveys, which have estimated that 17% of insect species are infected. We examined whether these surveys have systematically underestimated the proportion of infected species through failing to detect the low-prevalence infections that are expected when Wolbachia distorts the sex ratio. We estimated the proportion of species infected with Wolbachia within Acraea butterflies by testing large collections of each species for infection. Seven out of 24 species of Acraea were infected with Wolbachia. Four of these were infected with Wolbachia at high prevalence, a figure compatible with previous broad-scale surveys, whilst three carried low-prevalence infections that would have had a very low likelihood of being detected by previous sampling methods. This led us to conclude that sex-ratio-distorting Wolbachia may be common in insects that have an ecology and/or genetics that permit the invasion of these parasites and that previous surveys may have seriously underestimated the proportion of species that are infected.
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