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Gearry R, Fukudo S, Barbara G, Kuhn-Sherlock B, Ansell J, Blatchford P, Eady S, Wallace A, Butts C, Cremon C, Barbaro MR, Pagano I, Okawa Y, Muratubaki T, Okamoto T, Fuda M, Endo Y, Kano M, Kanazawa M, Nakaya N, Nakaya K, Drummond L. Consumption of 2 Green Kiwifruits Daily Improves Constipation and Abdominal Comfort-Results of an International Multicenter Randomized Controlled Trial. Am J Gastroenterol 2023; 118:1058-1068. [PMID: 36537785 PMCID: PMC10226473 DOI: 10.14309/ajg.0000000000002124] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/02/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Consumption of green kiwifruit is known to relieve constipation. Previous studies have also reported improvements in gastrointestinal (GI) comfort. We investigated the effect of consuming green kiwifruit on GI function and comfort. METHODS Participants included healthy controls (n = 63), patients with functional constipation (FC, n = 60), and patients with constipation-predominant irritable bowel syndrome (IBS-C, n = 61) randomly assigned to consume 2 green kiwifruits or psyllium (7.5 g) per day for 4 weeks, followed by a 4-week washout, and then the other treatment for 4 weeks. The primary outcome was the number of complete spontaneous bowel movements (CSBM) per week. Secondary outcomes included GI comfort which was measured using the GI symptom rating scale, a validated instrument. Data (intent-to-treat) were analyzed as difference from baseline using repeated measures analysis of variance suitable for AB/BA crossover design. RESULTS Consumption of green kiwifruit was associated with a clinically relevant increase of ≥ 1.5 CSBM per week (FC; 1.53, P < 0.0001, IBS-C; 1.73, P = 0.0003) and significantly improved measures of GI comfort (GI symptom rating scale total score) in constipated participants (FC, P < 0.0001; IBS-C, P < 0.0001). No significant adverse events were observed. DISCUSSION This study provides original evidence that the consumption of a fresh whole fruit has demonstrated clinically relevant increases in CSBM and improved measures of GI comfort in constipated populations. Green kiwifruits are a suitable dietary treatment for relief of constipation and associated GI comfort.
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Affiliation(s)
- Richard Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Shin Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | | | - Sarah Eady
- The New Zealand Institute for Plant and Food Research Limited, Palmerston North and Christchurch, New Zealand
| | - Alison Wallace
- The New Zealand Institute for Plant and Food Research Limited, Palmerston North and Christchurch, New Zealand
| | - Christine Butts
- The New Zealand Institute for Plant and Food Research Limited, Palmerston North and Christchurch, New Zealand
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Isabella Pagano
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Yohei Okawa
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Muratubaki
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomoko Okamoto
- Department of Nutrition, Sapporo University of Health Sciences, Sapporo, Japan
| | - Mikiko Fuda
- Department of Clinical Nutrition, Tohoku University Hospital, Sendai, Japan
| | - Yuka Endo
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan
| | - Michiko Kano
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Motoyori Kanazawa
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan
| | - Naoki Nakaya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kumi Nakaya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Lynley Drummond
- Drummond Food Science Advisory Limited, Killinchy, Canterbury, New Zealand
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Minto T, Abdelrahman T, Jones L, Wheat J, Key T, Shivakumar N, Ansell J, Seddon O, Cronin A, Tomkinson A, Theron A, Trickett RW, Sagua N, Sultana S, Clark A, McKay E, Johnson A, Behera K, Towler J, Kynaston H. Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU): A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board. Surg Open Sci 2022; 10:168-173. [PMID: 36211629 PMCID: PMC9531361 DOI: 10.1016/j.sopen.2022.09.005] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. Methods A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Results Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39–70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P < .001). Protected Elective Surgical Unit postoperative transmission was significantly lower than non–Protected Elective Surgical Unit (0.42% vs 3.2% P < .001), with an adjusted likely in-hospital Protected Elective Surgical Unit transmission of 0.04%. The 30-day all-cause mortality was 1.7% and was 14.6% in COVID-19–positive patients. COVID-19 infection, age > 70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality. Conclusion This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.
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Affiliation(s)
- T Minto
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - T Abdelrahman
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - L Jones
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - J Wheat
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - T Key
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - N Shivakumar
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - J Ansell
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - O Seddon
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - A Cronin
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - A Tomkinson
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - A Theron
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - RW Trickett
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - N Sagua
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - S Sultana
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - A Clark
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - E McKay
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - A Johnson
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - Karishma Behera
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - J Towler
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - H Kynaston
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW,School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN,Corresponding author at: School of Medicine, Cardiff University, Cardiff, United Kingdom CF14 4XN.
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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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Minto T, Abdelrahman T, Jones L, Shivakumar N, Wheat J, Ansell J, Seddon O, Cronin A, Tomkinson A, Theron A, Trickett R, Kynaston H, Sagua N, Sultana S, Clark A, McKay E, Johnson A, Behera K, Towler J. 276 Safety of Maintaining Elective and Emergency Surgery During the COVID-19 Pandemic with the Introduction of an Innovative Protected Elective Surgical Unit (PESU): A Cross-Specialty Evaluation of 30-Day Outcomes in 9925 Patients Undergoing Surgery in a University Health Board. Br J Surg 2022. [DOI: 10.1093/bjs/znac040.022] [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: 11/14/2022]
Abstract
Abstract
Aim
High quality mobile health applications (mhealth apps) have the potential to enhance the prevention, diagnosis, and treatment of burns. The primary aim of this study was to evaluate whether the quality of mhealth apps for burns care is being adequately assessed. The secondary aim was to determine whether these apps meet UK regulatory standards.
Method
We searched AMED, BNI, CINAHL, Cochrane library, Embase, Emcare, Medline and PsychInfo to identify studies assessing mhealth app quality for burns. The PRISMA reporting guideline was adhered to. Two independent reviewers screened s to identify relevant studies. We analysed whether seven established domains of mhealth app quality were assessed: design, information/content, usability, functionality, ethical issues, security/privacy, and user-perceived value.
Results
Of the 28 included studies, none assessed all seven domains of quality. Design was assessed in 4/28 studies; information/content in 26/28 studies; usability in 12/28 studies; functionality in 10/28 studies; ethical issues were never assessed in any studies; security/privacy was not assessed; subjective assessment was made in 9/28 studies. 17/28 studies included apps that met the definition of ‘medical device’ according to MHRA guidance, yet only one app was appropriately certified with the UK Conformity Assessed (UKCA) mark.
Conclusions
The quality of mHealth apps for burns are not being adequately assessed. The majority of apps should be considered medical devices according to UK standards, but only one was appropriately certified. Regulatory bodies should support mhealth app developers, so as to improve quality control whilst simultaneously fostering innovation.
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Affiliation(s)
- T. Minto
- University Hospital Wales, Cardiff, United Kingdom
| | | | - L. Jones
- University Hospital Wales, Cardiff, United Kingdom
| | | | - J. Wheat
- University Hospital Wales, Cardiff, United Kingdom
| | - J. Ansell
- University Hospital Wales, Cardiff, United Kingdom
| | - O. Seddon
- University Hospital Wales, Cardiff, United Kingdom
| | - A. Cronin
- University Hospital Wales, Cardiff, United Kingdom
| | - A. Tomkinson
- University Hospital Wales, Cardiff, United Kingdom
| | - A. Theron
- University Hospital Wales, Cardiff, United Kingdom
| | - R. Trickett
- University Hospital Wales, Cardiff, United Kingdom
| | - H. Kynaston
- University Hospital Wales, Cardiff, United Kingdom
| | - N. Sagua
- Cardiff Medical School, Cardiff, United Kingdom
| | - S. Sultana
- Cardiff Medical School, Cardiff, United Kingdom
| | - A. Clark
- Cardiff Medical School, Cardiff, United Kingdom
| | - E. McKay
- Cardiff Medical School, Cardiff, United Kingdom
| | - A. Johnson
- Cardiff Medical School, Cardiff, United Kingdom
| | - K. Behera
- Cardiff Medical School, Cardiff, United Kingdom
| | - J. Towler
- Cardiff Medical School, Cardiff, United Kingdom
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Dent MP, Vaillancourt E, Thomas RS, Carmichael PL, Ouedraogo G, Kojima H, Barroso J, Ansell J, Barton-Maclaren TS, Bennekou SH, Boekelheide K, Ezendam J, Field J, Fitzpatrick S, Hatao M, Kreiling R, Lorencini M, Mahony C, Montemayor B, Mazaro-Costa R, Oliveira J, Rogiers V, Smegal D, Taalman R, Tokura Y, Verma R, Willett C, Yang C. Paving the way for application of next generation risk assessment to safety decision-making for cosmetic ingredients. Regul Toxicol Pharmacol 2021; 125:105026. [PMID: 34389358 PMCID: PMC8547713 DOI: 10.1016/j.yrtph.2021.105026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/22/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022]
Abstract
Next generation risk assessment (NGRA) is an exposure-led, hypothesis-driven approach that has the potential to support animal-free safety decision-making. However, significant effort is needed to develop and test the in vitro and in silico (computational) approaches that underpin NGRA to enable confident application in a regulatory context. A workshop was held in Montreal in 2019 to discuss where effort needs to be focussed and to agree on the steps needed to ensure safety decisions made on cosmetic ingredients are robust and protective. Workshop participants explored whether NGRA for cosmetic ingredients can be protective of human health, and reviewed examples of NGRA for cosmetic ingredients. From the limited examples available, it is clear that NGRA is still in its infancy, and further case studies are needed to determine whether safety decisions are sufficiently protective and not overly conservative. Seven areas were identified to help progress application of NGRA, including further investments in case studies that elaborate on scenarios frequently encountered by industry and regulators, including those where a ‘high risk’ conclusion would be expected. These will provide confidence that the tools and approaches can reliably discern differing levels of risk. Furthermore, frameworks to guide performance and reporting should be developed.
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Affiliation(s)
- M P Dent
- Unilever Safety and Environmental Assurance Centre, Sharnbrook, Bedfordshire, MK44 1LQ, UK.
| | - E Vaillancourt
- Health Canada, Healthy Environments and Consumer Safety Branch, 269 Laurier Ave. W., Ottawa, ON K1A 0K9, Canada.
| | - R S Thomas
- Center for Computational Toxicology and Exposure, U.S. Environmental Protection Agency, Research, Triangle Park, NC, 27711, USA.
| | - P L Carmichael
- Unilever Safety and Environmental Assurance Centre, Sharnbrook, Bedfordshire, MK44 1LQ, UK.
| | - G Ouedraogo
- l'Oréal, Research and Development, Paris, France.
| | - H Kojima
- National Institute of Health Sciences, 1-18-1 Kamiyoga, Setagaya-ku, 158-8501, Tokyo, Japan.
| | - J Barroso
- European Commission, Joint Research Centre (JRC), Ispra, VA, Italy.
| | - J Ansell
- US Personal Care Products Council (PCPC), 1620 L St. NW, Suite 1200, Washington, D.C, 20036, USA.
| | - T S Barton-Maclaren
- Health Canada, Healthy Environments and Consumer Safety Branch, 269 Laurier Ave. W., Ottawa, ON K1A 0K9, Canada.
| | - S H Bennekou
- National Food Institute, Technical University of Denmark (DTU), Copenhagen, Denmark.
| | - K Boekelheide
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, USA.
| | - J Ezendam
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - J Field
- Health Canada, Healthy Environments and Consumer Safety Branch, 269 Laurier Ave. W., Ottawa, ON K1A 0K9, Canada.
| | - S Fitzpatrick
- US Food and Drug Administration (US FDA), Center for Food Safety and Applied Nutrition (CFSAN), 5001 Campus Drive, College Park, MD, 20740, USA.
| | - M Hatao
- Japan Cosmetic Industry Association (JCIA), Metro City Kamiyacho 6F, 5-1-5, Toranomon, Minato-ku, Tokyo, 105-0001 Japan.
| | - R Kreiling
- Clariant Produkte (Deutschland) GmbH, Am Unisyspark 1, 65843, Sulzbach, Germany.
| | - M Lorencini
- Grupo Boticário, Research & Development, São José dos Pinhais, Brazil.
| | - C Mahony
- Procter & Gamble Technical Centres Ltd, Reading, RG2 0RX, UK.
| | - B Montemayor
- Cosmetics Alliance Canada, 420 Britannia Road East Suite 102, Mississauga, ON L4Z 3L5, Canada.
| | - R Mazaro-Costa
- Departament of Pharmacology, Universidade Federal de Goiás, Goiânia, GO, 74.690-900, Brazil.
| | - J Oliveira
- Brazilian Health Regulatory Agency (ANVISA), Gerência de Produtos de Higiene, Perfumes, Cosméticos e Saneantes, Setor de Indústria e Abastecimento (SIA), Trecho 5, Área Especial 57, CEP 71205-050, Brasília, DF, Brazil.
| | - V Rogiers
- Vrije Universiteit Brussel, Brussels, Belgium.
| | - D Smegal
- US Food and Drug Administration (US FDA), Center for Food Safety and Applied Nutrition (CFSAN), 5001 Campus Drive, College Park, MD, 20740, USA.
| | - R Taalman
- Cosmetics Europe, Avenue Herrmann-Debroux 40, 1160 Auderghem, Belgium.
| | - Y Tokura
- Allergic Disease Research Center, Chutoen General Medical Center, Kakegawa, Japan.
| | - R Verma
- US Food and Drug Administration (US FDA), Center for Food Safety and Applied Nutrition (CFSAN), 5001 Campus Drive, College Park, MD, 20740, USA.
| | - C Willett
- Humane Society International, Washington, DC, USA.
| | - C Yang
- Taiwan Cosmetic Industry Association (TWCIA), 8F No. 136, Bo'ai Rd., Zhongzheng Dist., Taipei City, 100, Taiwan, ROC.
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Straiton N, McKenzie A, Bowden J, Nichol A, Murphy R, Snelling T, Zalcberg J, Clements J, Stubbs J, Economides A, Kent D, Ansell J, Symons T. Facing the Ethical Challenges: Consumer Involvement in COVID-19 Pandemic Research. J Bioeth Inq 2020; 17:743-748. [PMID: 33169265 PMCID: PMC7651817 DOI: 10.1007/s11673-020-10060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
Consumer involvement in clinical research is an essential component of a comprehensive response during emergent health challenges. During the COVID-19 pandemic, the moderation of research policies and regulation to facilitate research may raise ethical issues. Meaningful, diverse consumer involvement can help to identify practical approaches to prioritize, design, and conduct rapidly developed clinical research amid current events. Consumer involvement might also elucidate the acceptability of flexible ethics review approaches that aim to protect participants whilst being sensitive to the challenging context in which research is taking place. This article describes the main ethical challenges arising from pandemic research and how involving consumers and the community could enable resolution of such issues.
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Affiliation(s)
- N Straiton
- Australian Clinical Trials Alliance, Suite 1, Level 2, 24 Albert Road, Melbourne, VIC, 3205, Australia.
| | - A McKenzie
- Telethon Kids Institute, Consumer Engagement, Perth, Australia
| | | | - A Nichol
- Monash University, Melbourne, Australia
- St. Vincent's University Hospital, Dublin, Ireland
| | - R Murphy
- University of Auckland, Auckland, New Zealand
| | - T Snelling
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - J Zalcberg
- Monash University, Cancer Research, Melbourne, Australia
| | - J Clements
- Australian Clinical Trials Alliance, Consumer Engagement, Melbourne, Australia
| | - J Stubbs
- Australian Clinical Trials Alliance, Consumer Engagement, Melbourne, Australia
| | - A Economides
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - D Kent
- Australian Clinical Trials Alliance, Consumer Engagement, Melbourne, Australia
| | - J Ansell
- Consumers Health Forum, Canberra, Australia
| | - T Symons
- Australian Clinical Trials Alliance, Consumer Engagement, Melbourne, Australia
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7
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Bakhru S, Jiang X, Chen L, Wang Y, Osmani D, Mootoo D, Ansell J, Zappe S. A novel whole blood coagulometer for NOAC testing. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3775] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
While use of the non-vitamin K antagonist oral anticoagulants (NOACs) does not currently require routine coagulation monitoring, this can be highly desirable in at-risk patients, including those suffering major trauma or having to undergo emergency surgery, especially when a NOAC reversal agent is used. However, a point-of-care (PoC) device for the rapid measurement of clotting times in patients on NOACs is currently not available.
Purpose
To characterize the sensitivity of a novel PoC coagulometer to NOAC-induced anticoagulation, as well as quantify instrument precision, via venous whole blood samples freshly spiked with rivaroxaban, apixaban and edoxaban.
Methods
This study was conducted using healthy volunteers with normal coagulation lab values, including PT/INR and aPTT, confirmed via laboratory testing. Whole blood samples from two volunteers per NOAC were spiked with either 0 (sham), 75, 150, or 300 ng/mL of rivaroxaban, apixaban or edoxaban, in randomized order, each day for five days of testing. Each day, each spiked sample was run on five PoC coagulometers simultaneously for replicate measurement.
Results
PoC coagulometer clotting times exhibited a high degree of linearity spanning the measuring range, with R2 values approaching 1, and high sensitivity across NOAC concentrations tested (i.e. each concentration was statistically significantly different from the others), as well as a high level of precision across the five days of testing. Furthermore, the PoC coagulometer yielded notably low %CVs at each concentration tested, for each subject and anticoagulant, ranging from approximately 3–7% (Fig. 1, rivaroxaban and apixaban data from individual subjects shown).
Conclusions
These results suggest that this PoC coagulometer could be a valuable tool to assess the pharmacodynamic effects of the NOACs in emergency and other settings. The PoC coagulometer yields results within minutes at a patient's bedside, requiring only a drop of whole blood.
Figure 1
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Perosphere Technologies Inc.
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Affiliation(s)
- S Bakhru
- Perosphere Technologies Inc., Danbury, United States of America
| | - X Jiang
- Perosphere Technologies Inc., Danbury, United States of America
| | - L Chen
- Perosphere Technologies Inc., Danbury, United States of America
| | - Y Wang
- Perosphere Technologies Inc., Danbury, United States of America
| | - D Osmani
- Perosphere Technologies Inc., Danbury, United States of America
| | - D Mootoo
- Perosphere Technologies Inc., Danbury, United States of America
| | - J Ansell
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, United States of America
| | - S Zappe
- Perosphere Technologies Inc., Danbury, United States of America
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8
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Bakhru S, Jiang X, Chen L, Wang Y, Osmani D, Mootoo D, Zappe S, Ansell J. 28 Analytical Validation of a Novel Point-of-Care Coagulometer for DOAC and Heparin Testing. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.038] [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: 11/28/2022]
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9
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Ansell J, Laulicht B, Bakhru S, Luo X, Villano S. 10 Efficacy and Safety of Ciraparantag in Reversing Apixaban and Rivaroxaban as Measured by Whole Blood Clotting Time in Healthy Adults. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.020] [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: 11/15/2022]
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10
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Caballero N, Benslaiman B, Ansell J, Serra J. The effect of green kiwifruit on gas transit and tolerance in healthy humans. Neurogastroenterol Motil 2020; 32:e13874. [PMID: 32431019 PMCID: PMC7507131 DOI: 10.1111/nmo.13874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Green kiwifruit is a fiber-rich fruit that has been shown effective for treatment of constipation. However, fermentation of fibers by colonic bacteria may worsen commonly associated gas-related abdominal symptoms. AIM To determine the effect of green kiwifruit on transit and tolerance to intestinal gas in humans. METHODS In 11 healthy individuals, two gas challenge tests were performed (a) after 2 weeks on a low-flatulogenic diet and daily intake of 2 green kiwifruits and (b) after 2 weeks on a similar diet without intake of kiwifruits. The gas challenge test consisted in continuous infusion of a mixture of gases into the jejunum at 12 mL/min for 2 hours while measuring rectal gas evacuation, abdominal symptoms, and abdominal distension. During the 2 weeks prior to each gas challenge test (on-kiwifruit and off-kiwifruit), the number and consistency of stools, and abdominal symptoms were registered. KEY RESULTS Intake of kiwifruits was associated with more bowel movements per day (1.8 ± 0.1 vs 1.5 ± 0.1 off-kiwifruit; P = .001) and somewhat looser stools (Bristol score 3.3 ± 0.2 vs 2.8 ± 0.1 off-kiwifruit; P = .072) without relevant abdominal symptoms. Gas infusion produced similar gas evacuation (1238 ± 254 mL and 1172 ± 290 mL; P = .4355), perception of symptoms (score 1.2 ± 0.2 and 1.3 ± 0.3; P = .2367), and abdominal distension (17 ± 7 mm and 17 ± 6 mm; P = .4704) while on-kiwifruit or off-kiwifruit. CONCLUSIONS AND INFERENCES In healthy subjects, green kiwifruit increases stool frequency without relevant effects on intestinal gas transit and tolerance. If confirmed in patients, these fruits may provide a natural and well-tolerated treatment alternative for constipation.
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Affiliation(s)
- Noemi Caballero
- Motility and Functional Gut Disorders UnitCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)University Hospital Germans Trias i PujolBadalonaSpain
- Department of MedicineAutonomous University of BarcelonaBadalonaSpain
| | - Bouchra Benslaiman
- Motility and Functional Gut Disorders UnitCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)University Hospital Germans Trias i PujolBadalonaSpain
- Department of MedicineAutonomous University of BarcelonaBadalonaSpain
| | | | - Jordi Serra
- Motility and Functional Gut Disorders UnitCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)University Hospital Germans Trias i PujolBadalonaSpain
- Department of MedicineAutonomous University of BarcelonaBadalonaSpain
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11
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Whewell H, Brown C, Gokani VJ, Harries RL, Aguilera ML, Ahrend H, Al Qallaf A, Ansell J, Beamish A, Borraez-Segura B, Di Candido F, Chan D, Govender T, Grass F, Gupta AK, Dae Han Y, Jensen KK, Kusters M, Wing Lam K, Machila M, Marquardt C, Moore I, Ovaere S, Park H, Premaratne C, Sarantitis I, Sethi H, Singh R, Yonkus J. Variation in training requirements within general surgery: comparison of 23 countries. BJS Open 2020; 4:714-723. [PMID: 33521506 PMCID: PMC7397354 DOI: 10.1002/bjs5.50293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/14/2020] [Accepted: 03/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Many differences exist in postgraduate surgical training programmes worldwide. The aim of this study was to provide an overview of the training requirements in general surgery across 23 different countries. Methods A collaborator affiliated with each country collected data from the country's official training body website, where possible. The information collected included: management, teaching, academic and operative competencies, mandatory courses, years of postgraduate training (inclusive of intern years), working‐hours regulations, selection process into training and formal examination. Results Countries included were Australia, Belgium, Canada, Colombia, Denmark, Germany, Greece, Guatemala, India, Ireland, Italy, Kuwait, the Netherlands, New Zealand, Russia, Saudi Arabia, South Africa, South Korea, Sweden, Switzerland, UK, USA and Zambia. Frameworks for defining the outcomes of surgical training have been defined nationally in some countries, with some similarities to those in the UK and Ireland. However, some training programmes remain heterogeneous with regional variation, including those in many European countries. Some countries outline minimum operative case requirement (range 60–1600), mandatory courses, or operative, academic or management competencies. The length of postgraduate training ranges from 4 to 10 years. The maximum hours worked per week ranges from 38 to 88 h, but with no limit in some countries. Conclusion Countries have specific and often differing requirements of their medical profession. Equivalence in training is granted on political agreements, not healthcare need or competencies acquired during training.
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Affiliation(s)
- H Whewell
- Department of General Surgery Royal Gwent Hospital Newport UK
| | - C Brown
- Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK
| | - V J Gokani
- Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK
| | - R L Harries
- Department of General Surgery Morriston Hospital Swansea UK
| | | | - M L Aguilera
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - H Ahrend
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - A Al Qallaf
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - J Ansell
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - A Beamish
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - B Borraez-Segura
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - F Di Candido
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - D Chan
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - T Govender
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - F Grass
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - A K Gupta
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - Y Dae Han
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - K K Jensen
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - M Kusters
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - K Wing Lam
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - M Machila
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - C Marquardt
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - I Moore
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - S Ovaere
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - H Park
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - C Premaratne
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - I Sarantitis
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - H Sethi
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - R Singh
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
| | - J Yonkus
- Department of General Surgery Royal Gwent Hospital Newport UK.,Postgraduate Research Degrees Office Cardiff University School of Medicine Cardiff UK.,Department of Plastic Surgery Queen Victoria Hospital East Grinstead UK.,Department of General Surgery Morriston Hospital Swansea UK
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12
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Mowbray NG, Ansell J, Horwood J, Cornish J, Rizkallah P, Parker A, Wall P, Spinelli A, Torkington J. Safe management of surgical smoke in the age of COVID-19. Br J Surg 2020; 107:1406-1413. [PMID: 32363596 PMCID: PMC7267397 DOI: 10.1002/bjs.11679] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/21/2022]
Abstract
Background The COVID-19 global pandemic has resulted in a plethora of guidance and opinion from surgical societies. A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery. Methods The limited published evidence was analysed in combination with expert opinion. A review was undertaken of the novel coronavirus with regards to its hazards within surgical smoke and the procedures that could mitigate the potential risks to healthcare staff. Results Using existing knowledge of surgical smoke, a theoretical risk of virus transmission exists. Best practice should consider the operating room set-up, patient movement and operating theatre equipment when producing a COVID-19 operating protocol. The choice of energy device can affect the smoke produced, and surgeons should manage the pneumoperitoneum meticulously during laparoscopic surgery. Devices to remove surgical smoke, including extractors, filters and non-filter devices, are discussed in detail. Conclusion There is not enough evidence to quantify the risks of COVID-19 transmission in surgical smoke. However, steps can be undertaken to manage the potential hazards. The advantages of minimally invasive surgery may not need to be sacrificed in the current crisis.
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Affiliation(s)
- N G Mowbray
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Ansell
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Horwood
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Cornish
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - P Rizkallah
- School of Medicine, Cardiff University, Cardiff, UK
| | - A Parker
- School of Medicine, Cardiff University, Cardiff, UK
| | - P Wall
- Isca Healthcare Research, Caerleon, UK
| | - A Spinelli
- Department of General and Minimally Invasive Surgery, Istituto Clinico Humanitas, Rozzano, Italy
| | - J Torkington
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
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13
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Scott KP, Grimaldi R, Cunningham M, Sarbini SR, Wijeyesekera A, Tang MLK, Lee JCY, Yau YF, Ansell J, Theis S, Yang K, Menon R, Arfsten J, Manurung S, Gourineni V, Gibson GR. Developments in understanding and applying prebiotics in research and practice-an ISAPP conference paper. J Appl Microbiol 2019; 128:934-949. [PMID: 31446668 DOI: 10.1111/jam.14424] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 12/17/2022]
Abstract
AIMS The concept of using specific dietary components to selectively modulate the gut microbiota to confer a health benefit, defined as prebiotics, originated in 1995. In 2018, a group of scientists met at the International Scientific Association for Probiotics and Prebiotics annual meeting in Singapore to discuss advances in the prebiotic field, focussing on issues affecting functionality, research methodology and geographical differences. METHODS AND RESULTS The discussion ranged from examining scientific literature supporting the efficacy of established prebiotics, to the prospects for establishing health benefits associated with novel compounds, isolated from different sources. CONCLUSIONS While many promising candidate prebiotics from across the globe have been highlighted in preliminary research, there are a limited number with both demonstrated mechanism of action and defined health benefits as required to meet the prebiotic definition. Prebiotics are part of a food industry with increasing market sales, yet there are great disparities in regulations in different countries. Identification and commercialization of new prebiotics with unique health benefits means that regulation must improve and remain up-to-date so as not to risk stifling research with potential health benefits for humans and other animals. SIGNIFICANCE AND IMPACT OF STUDY This summary of the workshop discussions indicates potential avenues for expanding the range of prebiotic substrates, delivery methods to enhance health benefits for the end consumer and guidance to better elucidate their activities in human studies.
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Affiliation(s)
- K P Scott
- Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - R Grimaldi
- Food and Nutritional Sciences, University of Reading, Reading, UK
| | - M Cunningham
- Metagenics (Aust) Pty Ltd., Virginia, Queensland, Australia
| | - S R Sarbini
- Department of Crop Science, Universiti Putra Malaysia, Bintulu Campus, Malaysia
| | - A Wijeyesekera
- Food and Nutritional Sciences, University of Reading, Reading, UK
| | - M L K Tang
- Department of Allergy and Immunology, The Royal Children's Hospital, Parkville, Melbourne, VIC, Australia
| | - J C-Y Lee
- School of Biological Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - Y F Yau
- School of Biological Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - J Ansell
- Zespri International Ltd, Mt Maunganui, New Zealand
| | - S Theis
- Beneo-Institute, Obrigheim, Germany
| | - K Yang
- Departments of Obstetrics and Gynaecology and Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - R Menon
- The Bell Institute of Health and Nutrition, General Mills Inc., Minneapolis, MN, USA
| | - J Arfsten
- Nestlé Product and Technology Center Dairy, Konolfingen, Switzerland
| | - S Manurung
- Reckitt Benckiser, Nijmegen, The Netherlands
| | - V Gourineni
- Ingredion Incorporated, Bridgewater, NJ, USA
| | - G R Gibson
- Food and Nutritional Sciences, University of Reading, Reading, UK
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14
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Eady SL, Wallace AJ, Butts CA, Hedderley D, Drummond L, Ansell J, Gearry RB. The effect of 'Zesy002' kiwifruit ( Actinidia chinensis var. chinensis) on gut health function: a randomised cross-over clinical trial. J Nutr Sci 2019; 8:e18. [PMID: 31080591 PMCID: PMC6498757 DOI: 10.1017/jns.2019.14] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 12/19/2022] Open
Abstract
Functional gastrointestinal disorders including constipation affect up to 14 % of the world's population. Treatment is difficult and challenging resulting in a need for alternative safe and effective therapies. The present study investigated whether daily consumption of three gold-fleshed kiwifruit could alleviate constipation and improve gastrointestinal discomfort in mildly constipated individuals with and without pain. A total of thirty-two participants were enrolled in a 16-week randomised, single-blind, crossover study. Participants received either three 'Zesy002' kiwifruit or 14·75 g Metamucil® (5 g dietary fibre/d (a positive control)) for 4 weeks each with a 4-week washout between treatments. A 2-week washout period was included at the beginning and end of the study. Daily bowel habit diaries were kept throughout the study. The primary outcome measure was differences in the number of complete spontaneous bowel movements (CSBM). Secondary outcome measures were bowel movement frequency and stool form as well as digestive symptoms and comfort. The number of CSBM per week was significantly greater during daily consumption of three kiwifruit compared with the baseline (6·3 v. 3·3; P < 0·05) and the Metamucil® treatment (6·3 v. 4·5; P < 0·05). Stool consistency was also improved, with kiwifruit producing softer stools and less straining (P < 0·05). Gastrointestinal discomfort was also improved compared with baseline for abdominal pain, constipation and indigestion (P < 0·05) during the kiwifruit intervention and constipation during the Metamucil® intervention (P < 0·05). This randomised controlled trial demonstrates that daily consumption of three gold-fleshed kiwifruit is associated with a significant increase of two CSBM per week and reduction in gastrointestinal discomfort in mildly constipated adults.
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Affiliation(s)
- Sarah L. Eady
- The New Zealand Institute for Plant & Food Research Limited, Lincoln, New Zealand
| | - Alison J. Wallace
- The New Zealand Institute for Plant & Food Research Limited, Lincoln, New Zealand
| | - Christine A. Butts
- The New Zealand Institute for Plant & Food Research Limited, Palmerston North, New Zealand
| | - Duncan Hedderley
- The New Zealand Institute for Plant & Food Research Limited, Palmerston North, New Zealand
| | - Lynley Drummond
- Drummond Food Science Advisory Limited, Christchurch, New Zealand
| | - Juliet Ansell
- Zespri International Ltd, Mount Maunganui, New Zealand
| | - Richard B. Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
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15
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Grass F, Lovely JK, Crippa J, Ansell J, Hübner M, Mathis KL, Larson DW. Comparison of recovery and outcome after left and right colectomy. Colorectal Dis 2019; 21:481-486. [PMID: 30585680 DOI: 10.1111/codi.14543] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/19/2018] [Indexed: 02/08/2023]
Abstract
AIM The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies. METHOD Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 and recorded in a prospectively maintained enhanced recovery database, were analysed. Demographic and surgical items, as well as functional recovery and 30-day complications, were compared between left-sided and right-sided colectomies. Multivariable analysis was performed to identify risk factors for postoperative ileus (POI). RESULTS In total, 1001 left and 1041 right colectomies were comparable regarding demographic factors; only body mass index (BMI) was higher in patients undergoing left-sided resections (> 30 kg/m2 : 33% vs 27%, P = 0.004). Malignancy (29% vs 67%, P < 0.001) and Crohn's disease (1% vs 31%, P < 0.001) were preponderant in right colectomies, whereas diverticular disease (68% vs 1%, P < 0.001) was the most common indication for left colectomy. Compliance with the enhanced recovery pathway (ERP) was comparable. While the minimally invasive approach was the preferred approach for both sides (61% vs 64%, P = 0.158), left colectomies took longer (180 ± 80 min vs 150 ± 70 min, P < 0.001), needed more perioperative fluids (3.1 ± 1.4 l vs 2.7 ± 1.5 l, P < 0.001) and resulted in greater postoperative weight gain (3.9 ± 6.5 kg vs 2.6 ± 6 kg, P = 0.025). Crohn's disease (OR = 2.64, 95% CI: 1.27-5.46) and fluid overload (OR = 2.02, 95% CI: 1.06-3.82) were independent risk factors for POI. CONCLUSION Despite equal ERP compliance, postoperative ileus was higher after right-sided colectomies. This finding was associated with Crohn's disease and fluid overload.
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Affiliation(s)
- F Grass
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - J K Lovely
- Hospital Pharmacy Services, Mayo Clinic, Rochester, MN, USA
| | - J Crippa
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - J Ansell
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - M Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - K L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - D W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
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16
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Wilkinson‐Smith V, Dellschaft N, Ansell J, Hoad C, Marciani L, Gowland P, Spiller R. Mechanisms underlying effects of kiwifruit on intestinal function shown by MRI in healthy volunteers. Aliment Pharmacol Ther 2019; 49:759-768. [PMID: 30706488 PMCID: PMC6590324 DOI: 10.1111/apt.15127] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/05/2018] [Accepted: 12/13/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Chronic constipation affects approximately 17% of the population worldwide and remains an important unmet need since patients are often dissatisfied with treatment. Kiwifruit may offer an alternative to traditional laxatives and have been shown to increase stool volume, frequency and improve consistency. AIMS Using non-invasive MRI techniques, we assessed the effect of ingestion of kiwifruit on fluid distribution in the intestines and bowel function. METHODS Two period crossover trial of kiwifruit vs control in healthy adults. INTERVENTION two kiwifruits twice daily vs isocaloric control (maltodextrin) twice daily, consumed for a total of 3 days. Subjects underwent MRI scanning fasted and at hourly intervals for 7 hours on the third day. PRIMARY OUTCOME T1 relaxation time of ascending colon (T1AC) using MRI. SECONDARY OUTCOMES Small bowel water content (SBWC), colonic volume, gut transit time, T1 of descending colon, stool frequency and form. RESULTS Fourteen volunteers completed the study. T1AC was higher after kiwifruit ingestion (P = 0.029) during the second half of the day (when meal residue would be expected to reach the AC, AUC T1 T240-420 minutes; mean (SD) 137 (39) s*minute with kiwifruit versus 108 (40) s*minute with control. SBWC (P < 0.001), colon volumes (P = 0.004), as well as stool frequency (1.46 ± 0.66 with kiwifruit vs 1.14 ± 0.46 stools per day with control; P = 0.034) and stool form score (Bristol Stool Chart score 4.1 (0.9) with kiwifruit versus 3.4 (0.7) with control; P = 0.011) were markedly increased in participants consuming kiwifruit compared to control. CONCLUSION Consumption of kiwifruit in healthy volunteers increases water retention in the small bowel and ascending colon and increases total colonic volume. The data may explain the observed increase in stool frequency and looser stool consistencies, suggesting that kiwifruit could be used as a dietary alternative to laxatives in mild constipation.
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Affiliation(s)
- Victoria Wilkinson‐Smith
- National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and University of NottinghamNottinghamUK,Nottingham Digestive Diseases CentreUniversity of NottinghamNottinghamUK
| | - Neele Dellschaft
- Sir Peter Mansfield Imaging CentreUniversity of NottinghamNottinghamUK
| | | | - Caroline Hoad
- National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and University of NottinghamNottinghamUK,Sir Peter Mansfield Imaging CentreUniversity of NottinghamNottinghamUK
| | - Luca Marciani
- National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and University of NottinghamNottinghamUK,Nottingham Digestive Diseases CentreUniversity of NottinghamNottinghamUK
| | - Penny Gowland
- National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and University of NottinghamNottinghamUK,Sir Peter Mansfield Imaging CentreUniversity of NottinghamNottinghamUK
| | - Robin Spiller
- National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and University of NottinghamNottinghamUK,Nottingham Digestive Diseases CentreUniversity of NottinghamNottinghamUK
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17
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Abstract
PURPOSE To describe the nutritional and health attributes of kiwifruit and the benefits relating to improved nutritional status, digestive, immune and metabolic health. The review includes a brief history of green and gold varieties of kiwifruit from an ornamental curiosity from China in the 19th century to a crop of international economic importance in the 21st century; comparative data on their nutritional composition, particularly the high and distinctive amount of vitamin C; and an update on the latest available scientific evidence from well-designed and executed human studies on the multiple beneficial physiological effects. Of particular interest are the digestive benefits for healthy individuals as well as for those with constipation and other gastrointestinal disorders, including symptoms of irritable bowel syndrome. The mechanisms of action behind the gastrointestinal effects, such as changes in faecal (stool) consistency, decrease in transit time and reduction of abdominal discomfort, relate to the water retention capacity of kiwifruit fibre, favourable changes in the human colonic microbial community and primary metabolites, as well as the naturally present proteolytic enzyme actinidin, which aids protein digestion both in the stomach and the small intestine. The effects of kiwifruit on metabolic markers of cardiovascular disease and diabetes are also investigated, including studies on glucose and insulin balance, bodyweight maintenance and energy homeostasis. CONCLUSIONS The increased research data and growing consumer awareness of the health benefits of kiwifruit provide logical motivation for their regular consumption as part of a balanced diet. Kiwifruit should be considered as part of a natural and effective dietary strategy to tackle some of the major health and wellness concerns around the world.
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Affiliation(s)
| | - Juliet Ansell
- Zespri International Ltd., 400 Maunganui Road, Mount Maunganui 3116, Tauranga, New Zealand
| | - Lynley N Drummond
- Drummond Food Science Advisory Ltd., 1137 Drain Road, Killinchy, 7682, New Zealand.
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18
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Parkar SG, Simmons L, Herath TD, Phipps JE, Trower TM, Hedderley DI, McGhie TK, Blatchford P, Ansell J, Sutton KH, Ingram JR. Evaluation of the prebiotic potential of five kiwifruit cultivars after simulated gastrointestinal digestion and fermentation with human faecal bacteria. Int J Food Sci Technol 2017. [DOI: 10.1111/ijfs.13697] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Shanthi G. Parkar
- The New Zealand Institute for Plant & Food Research Limited (PFR); Private Bag 11600 Palmerston North 4442 New Zealand
| | | | - Thanuja D. Herath
- The New Zealand Institute for Plant & Food Research Limited (PFR); Private Bag 11600 Palmerston North 4442 New Zealand
| | | | | | - Duncan I. Hedderley
- The New Zealand Institute for Plant & Food Research Limited (PFR); Private Bag 11600 Palmerston North 4442 New Zealand
| | - Tony K. McGhie
- The New Zealand Institute for Plant & Food Research Limited (PFR); Private Bag 11600 Palmerston North 4442 New Zealand
| | - Paul Blatchford
- The New Zealand Institute for Plant & Food Research Limited (PFR); Private Bag 11600 Palmerston North 4442 New Zealand
| | - Juliet Ansell
- The New Zealand Institute for Plant & Food Research Limited (PFR); Private Bag 11600 Palmerston North 4442 New Zealand
- ZESPRI International Limited; PO Box 4043 Mt Maunganui 3149 New Zealand
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19
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Dilaver N, Ansell J, Brown C, Egan R, Leaman C, Arunachalam S, Williamson J, Turner J. Does the use of Local Anaesthetic (LA) Spray Combined With IV Sedation for Diagnostic OGD (Oesophagogastroduodenoscopy) Affect 8-Day Re-Admission and 30-Day Mortality? Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.080] [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: 11/30/2022]
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20
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Harries RL, Ansell J, Codd RJ, Williams GL. A systematic review of Clostridium difficile infection following reversal of ileostomy. Colorectal Dis 2017; 19:881-887. [PMID: 28872758 DOI: 10.1111/codi.13873] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/14/2017] [Indexed: 02/08/2023]
Abstract
AIM The incidence of Clostridium difficile infection (CDI) has been reported to be as high as 4% following ileostomy reversal. CDI can be associated with significant morbidity. A systematic review on this subject has not been previously reported; our aim was to review the literature to establish incidence and to evaluate the factors that may contribute to an increased risk of CDI following ileostomy reversal. METHOD A systematic review of Ovid, Embase and Medline was undertaken. Search terms included C. difficile, reversal of ileostomy and ileostomy closure. Articles were included where at least one case of C. difficile-associated diarrhoea following reversal of defunctioning ileostomy was reported. Data extraction for articles was performed by two authors, using predefined data fields. The primary outcome measure was incidence of CDI amongst patients undergoing ileostomy reversal. Secondary outcomes were defunctioning time, antibiotic regime, acid suppression, time to onset of symptoms and study conclusions including colectomy and mortality rate. RESULTS Eleven articles were included (five case reports and six cohort studies). The overall incidence of CDI was 1.8% (242/13 728). The mean defunctioning time was 8.7 months (range 6-12). A variety of antibiotic regimes were described. Mean time to onset of symptoms was 6 days (range 3-14). Use of acid suppression, colectomy or mortality rate were frequently not reported. CONCLUSION CDI should be recognized as a potentially life-threatening complication of ileostomy closure. Careful consideration should be given to peri-operative antibiotic regime, acid suppression, timing of reversal and appropriate preoperative counselling of patients.
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Affiliation(s)
- R L Harries
- Department of Colorectal Surgery, Royal Gwent Hospital, Newport, UK
| | - J Ansell
- Department of Colorectal Surgery, Royal Gwent Hospital, Newport, UK
| | - R J Codd
- Department of Colorectal Surgery, Royal Gwent Hospital, Newport, UK
| | - G L Williams
- Department of Colorectal Surgery, Royal Gwent Hospital, Newport, UK
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21
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Wallace A, Eady S, Drummond L, Hedderley D, Ansell J, Gearry R. A Pilot Randomized Cross-Over Trial to Examine the Effect of Kiwifruit on Satiety and Measures of Gastric Comfort in Healthy Adult Males. Nutrients 2017. [PMID: 28640214 PMCID: PMC5537759 DOI: 10.3390/nu9070639] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
‘Hayward’ kiwifruit anecdotally are associated with improved gastrointestinal comfort following the consumption of high protein meals, possibly because of the presence of a protease enzyme, actinidin. The study aimed to use SmartPill™ technology to investigate the acute effect of kiwifruit with actinidin (Actinidia chinensis var. deliciosa ‘Hayward’) and kiwifruit without actinidin (A. chinensis var. chinensis ‘Hort16A’) on digestion of a large protein meal. Ten healthy male subjects were recruited. The participants attended the clinic three times, having fasted overnight. They consumed a test meal consisting of 400 g lean steak and two ‘Hort16A’ or two ‘Hayward kiwifruit’. Subjects completed visual analogue scales (VAS) by rating feelings of hunger, satisfaction, fullness, and comfort and swallowed a SmartPill™ before completing further VAS scales. After 5 h, participants consumed an ad libitum lunch to assess satiety. SmartPill™ transponders were worn for five days. There were no significant differences in gastric emptying time, small bowel, or colonic transit time between the two kiwifruit arms of the study measured by SmartPill™. Similarly, no significant differences were observed in VAS satiety measures or energy consumption at the ad libitum meal. However, the measurement of overall gastric comfort tended to be lower, and bloating was significantly reduced following the consumption of the steak meal with ‘Hayward’ kiwifruit (p < 0.028). Conclusions: The SmartPill™ is marketed as a diagnostic tool for patients presenting with gastrointestinal disorders and is usually used with a standard ‘SmartBar’. This small pilot study suggests that it is less likely to measure gastric emptying effectively following a high protein meal, as it may be delayed because of the meal’s physical consistency. However, green kiwifruit, containing actinidin, may reduce bloating and other measures of gastric discomfort in healthy males. Possible future studies could use repeated measures with more readily digested protein and larger numbers of participants.
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Affiliation(s)
- Alison Wallace
- The New Zealand Institute for Plant & Food Research Limited, Lincoln 7608, New Zealand.
| | - Sarah Eady
- The New Zealand Institute for Plant & Food Research Limited, Lincoln 7608, New Zealand.
| | - Lynley Drummond
- Drummond Food Science Advisory Limited, Christchurch 7682, New Zealand.
| | - Duncan Hedderley
- The New Zealand Institute for Plant & Food Research Limited, Palmerston North 4474, New Zealand.
| | - Juliet Ansell
- Zespri International Limited, Mount Manganui 3149, New Zealand.
| | - Richard Gearry
- Department of Medicine, University of Otago, Christchurch 8140, New Zealand.
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22
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Malhotra A, Maughan D, Ansell J, Lehman R, Henderson A, Gray M, Stephenson T, Bailey S. Choosing Wisely in the UK: reducing the harms of too much medicine. Br J Sports Med 2017; 50:826-8. [PMID: 27313236 DOI: 10.1136/bjsports-2016-h2308rep] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A Malhotra
- Consultant clinical associate, Academy of Medical Royal Colleges, London, UK
| | - D Maughan
- Royal College of Psychiatrists sustainability fellow, Centre For Sustainable Healthcare, Oxford, UK
| | - J Ansell
- Advanced trainee in general surgery, Welsh Institute for Minimal Access Therapy, Cardiff Medicentre, Cardiff, UK
| | - R Lehman
- Senior research fellow, Department of Primary Health Care, University Of Oxford, Oxford, UK
| | - A Henderson
- Chief executive, Academy of Medical Royal Colleges, London, UK
| | - M Gray
- Director, Better Value Healthcare, Oxford, UK
| | - T Stephenson
- Former chair, Academy of Medical Royal Colleges, London, UK and Institute of Child Health, London, UK
| | - S Bailey
- Chair, Academy of Medical Royal Colleges, London, UK
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23
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Rosendale D, Butts CA, de Guzman CE, Maddox IS, Martell S, McIntyre L, Skinner MA, Dinnan H, Ansell J. Consumption of antimicrobial manuka honey does not significantly perturb the microbiota in the hind gut of mice. PeerJ 2016; 4:e2787. [PMID: 28028466 PMCID: PMC5178337 DOI: 10.7717/peerj.2787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/11/2016] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to test the hypothesis that consuming manuka honey, which contains antimicrobial methylglyoxal, may affect the gut microbiota. We undertook a mouse feeding study to investigate whether dietary manuka honey supplementation altered microbial numbers and their production of organic acid products from carbohydrate fermentation, which are markers of gut microbiota function. The caecum of C57BL/6 mice fed a diet supplemented with antimicrobial UMF® 20+ manuka honey at 2.2 g/kg animal did not show any significantly changed concentrations of microbial short chain fatty acids as measured by gas chromatography, except for increased formate and lowered succinate organic acid concentrations, compared to mice fed a control diet. There was no change in succinate-producing Bacteroidetes numbers, or honey-utilising Bifidobacteria, nor any other microbes measured by real time quantitative PCR. These results suggest that, despite the antimicrobial activity of the original honey, consumption of manuka honey only mildly affects substrate metabolism by the gut microbiota.
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Affiliation(s)
- Doug Rosendale
- Food, Nutrition & Health Group, The New Zealand Institute for Plant & Food Research Limited , Palmerston North , New Zealand
| | - Christine A Butts
- Food, Nutrition & Health Group, The New Zealand Institute for Plant & Food Research Limited , Palmerston North , New Zealand
| | - Cloe Erika de Guzman
- Translational Genomics Group, Institute of Health and Biomedical Innovation , Brisbane , Queensland , Australia
| | - Ian S Maddox
- Massey University, College of Sciences , Auckland , New Zealand
| | - Sheridan Martell
- Food, Nutrition & Health Group, The New Zealand Institute for Plant & Food Research Limited , Palmerston North , New Zealand
| | - Lynn McIntyre
- Massey University, College of Sciences, Auckland, New Zealand; Department of Food Science and Agri-Food Supply Chain Management, Harper Adams University, Newport, Shropshire, United Kingdom
| | - Margot A Skinner
- Food Science, School of Chemical Science, The University of Auckland , Auckland , New Zealand
| | - Hannah Dinnan
- Food, Nutrition & Health Group, The New Zealand Institute for Plant & Food Research Limited , Palmerston North , New Zealand
| | - Juliet Ansell
- Food, Nutrition & Health Group, The New Zealand Institute for Plant & Food Research Limited, Palmerston North, New Zealand; Zespri International Limited, Mt Maunganui, New Zealand
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24
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Cornish J, Harries RL, Bosanquet D, Rees B, Ansell J, Frewer N, Dhruva Rao PK, Parry C, Ellis-Owen R, Phillips SM, Morris C, Horwood J, Davies ML, Davies MM, Hargest R, Davies Z, Hilton J, Harris D, Ben-Sassi A, Rajagopal R, Hanratty D, Islam S, Watkins A, Bashir N, Jones S, Russell IR, Torkington J. Hughes Abdominal Repair Trial (HART) - Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial. Trials 2016; 17:454. [PMID: 27634489 PMCID: PMC5025615 DOI: 10.1186/s13063-016-1573-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/14/2016] [Indexed: 01/05/2023] Open
Abstract
Background Incisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs. The ‘Hughes Repair’ combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision. Methods/design This is a 1:1 randomised controlled trial comparing two suture techniques for the closure of the midline abdominal wound following surgery for colorectal cancer. Full ethical approval has been gained (Wales REC 3, MREC 12/WA/0374). Eight hundred patients will be randomised from approximately 20 general surgical units within the United Kingdom. Patients undergoing open or laparoscopic (more than a 5-cm midline incision) surgery for colorectal cancer, elective or emergency, are eligible. Patients under the age of 18 years, those having mesh inserted or undergoing musculofascial flap closure of the perineal defect in abdominoperineal wound closure, and those unable to give informed consent will be excluded. Patients will be randomised intraoperatively to either the Hughes Repair or standard mass closure. The primary outcome measure is the incidence of incisional hernias at 1 year as assessed by standardised clinical examination. The secondary outcomes include quality of life patient-reported outcome measures, cost-utility analysis, incidence of complete abdominal wound dehiscence and C-POSSUM scores. The incidence of incisional hernia at 1 year, assessed by computerised tomography, will form a tertiary outcome. Discussion A feasibility phase has been completed. The results of the study will be used to inform current and future practice and potentially reduce the risk of incisional hernia formation following midline incisions. Trial registration Trial Registration Number: ISRCTN 25616490. Registered on 1 January 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1573-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Cornish
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - R L Harries
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - D Bosanquet
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - B Rees
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - J Ansell
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - N Frewer
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - P K Dhruva Rao
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - C Parry
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - R Ellis-Owen
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - S M Phillips
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - C Morris
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - J Horwood
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - M L Davies
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - M M Davies
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - R Hargest
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Z Davies
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - J Hilton
- Princess of Wales Hospital, Bridgend, UK
| | | | | | | | - D Hanratty
- Royal Glamorgan Hospital, Llantrisant, UK
| | - S Islam
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - A Watkins
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - N Bashir
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - S Jones
- Involving People, Health and Care Research Wales, Cardiff, UK
| | - I R Russell
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - J Torkington
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
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25
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Egan RJ, Abdelrahman T, Tate S, Ansell J, Harries R, Davies L, Clark G, Lewis WG. Modular emergency general surgery training: A pilot study of a novel programme. Ann R Coll Surg Engl 2016; 98:475-8. [PMID: 27269241 PMCID: PMC5210010 DOI: 10.1308/rcsann.2016.0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Pan-speciality consensus guidance advocates mandatory emergency general surgery (EGS) training modules for specialist registrars (StRs). This pilot study evaluated the impact of EGS modules aimed at StRs over 1 year. Methods Eleven StRs were allocated a focused 4-week EGS module, in addition to the standard 1:12 on-call duty rota, in a tertiary surgical centre. Primary outcome measures included the number of indicative emergency operations and validated Procedure Based Assessments (PBAs) performed, both during the EGS module and over the training year. Results StRs performed a median of 11 (range 5-15) laparotomies during the EGS module versus 31 (range 9-49) over the whole training year. StRs attended 43.7% of available laparotomies during the module (range 24.1-63.7%). EGS modules provided more than one-third of the total emergency laparotomy experience, and a quarter of the emergency colectomy, appendicectomy and Hartmann's procedure experience. There were no differences in EGS module-related outcomes between junior and senior StRs. Significantly more PBAs related to laparotomy and segmental colectomy were completed during EGS modules than the on-call duty rota, at 32% versus 14% (p<0.001) and 48% versus 22% (p=0.019), respectively. Performance levels were maintained following module completion. Conclusions These findings provide an important baseline when considering future modular EGS training.
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Affiliation(s)
- R J Egan
- Wales Deanery, Neuadd Meirionnydd , Cardiff , UK
| | | | - S Tate
- Wales Deanery, Neuadd Meirionnydd , Cardiff , UK
| | - J Ansell
- Wales Deanery, Neuadd Meirionnydd , Cardiff , UK
| | | | - L Davies
- University Hospital of Wales , Cardiff , UK
| | - Gwb Clark
- University Hospital of Wales , Cardiff , UK
| | - W G Lewis
- University Hospital of Wales , Cardiff , UK
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26
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Abstract
A class of stochastic processes useful in the investigation of the deterioration and replacement of equipment, as well as in the study of group arrival/batch service queues, storage systems, epidemics and computer software, is introduced. These so-called nested renewal processes consist of ordinary and cumulative renewal processes sequentially nested within a hierarchy. The main properties of these processes are discussed with emphasis on the asymptotic results. An example of their application to tyre wear is considered.
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27
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Butts CA, Paturi G, Tavendale MH, Hedderley D, Stoklosinski HM, Herath TD, Rosendale D, Roy NC, Monro JA, Ansell J. The fate of (13)C-labelled and non-labelled inulin predisposed to large bowel fermentation in rats. Food Funct 2016; 7:1825-32. [PMID: 26778667 DOI: 10.1039/c5fo01056j] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The fate of stable-isotope (13)C labelled and non-labelled inulin catabolism by the gut microbiota was assessed in a healthy rat model. Sprague-Dawley male rats were randomly assigned to diets containing either cellulose or inulin, and were fed these diets for 3 days. On day (d) 4, rats allocated to the inulin diet received (13)C-labelled inulin. The rats were then fed the respective non-labelled diets (cellulose or inulin) until sampling (d4, d5, d6, d7, d10 and d11). Post feeding of (13)C-labelled substrate, breath analysis showed that (13)C-inulin cleared from the host within a period of 36 hours. Faecal (13)C demonstrated the clearance of inulin from gut with a (13)C excess reaching maximum at 24 hours (d5) and then declining gradually. There were greater variations in caecal organic acid concentrations from d4 to d6, with higher concentrations of acetic, butyric and propionic acids observed in the rats fed inulin compared to those fed cellulose. Inulin influenced caecal microbial glycosidase activity, increased colon crypt depth, and decreased the faecal output and polysaccharide content compared to the cellulose diet. In summary, the presence of inulin in the diet positively influenced large bowel microbial fermentation.
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Affiliation(s)
- Christine A Butts
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Gunaranjan Paturi
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 92169, Auckland 1142, New Zealand
| | | | - Duncan Hedderley
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Halina M Stoklosinski
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Thanuja D Herath
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Douglas Rosendale
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Nicole C Roy
- AgResearch Grasslands, Palmerston North 4442, New Zealand and Riddet Institute, Massey University, Palmerston North 4442, New Zealand and Gravida: National Centre for Growth and Development, The University of Auckland, Auckland 1142, New Zealand
| | - John A Monro
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand. and Riddet Institute, Massey University, Palmerston North 4442, New Zealand
| | - Juliet Ansell
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand. and Riddet Institute, Massey University, Palmerston North 4442, New Zealand
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28
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Rizan C, Ansell J, Tilston TW, Warren N, Torkington J. Are general surgeons able to accurately self-assess their level of technical skills? Ann R Coll Surg Engl 2015; 97:549-55. [PMID: 26425781 PMCID: PMC5096608 DOI: 10.1308/rcsann.2015.0024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Self-assessment is a way of improving technical capabilities without the need for trainer feedback. It can identify areas for improvement and promote professional medical development. The aim of this review was to identify whether self-assessment is an accurate form of technical skills appraisal in general surgery. METHODS The PubMed, MEDLINE(®), Embase(™) and Cochrane databases were searched for studies assessing the reliability of self-assessment of technical skills in general surgery. For each study, we recorded the skills assessed and the evaluation methods used. Common endpoints between studies were compared to provide recommendations based on the levels of evidence. RESULTS Twelve studies met the inclusion criteria from 22,292 initial papers. There was no level 1 evidence published. All papers compared the correlation between self-appraisal versus an expert score but differed in the technical skills assessment and the evaluation tools used. The accuracy of self-assessment improved with increasing experience (level 2 recommendation), age (level 3 recommendation) and the use of video playback (level 3 recommendation). Accuracy was reduced by stressful learning environments (level 2 recommendation), lack of familiarity with assessment tools (level 3 recommendation) and in advanced surgical procedures (level 3 recommendation). CONCLUSIONS Evidence exists to support the reliability of self-assessment of technical skills in general surgery. Several variables have been shown to affect the accuracy of self-assessment of technical skills. Future work should focus on evaluating the reliability of self-assessment during live operating procedures.
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Affiliation(s)
| | - J Ansell
- Welsh Institute for Minimal Access Therapy , UK
| | | | - N Warren
- Welsh Institute for Minimal Access Therapy , UK
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29
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Bosanquet D, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, Davies L, Glasbey J, Frewer K, Frewer N, Russell D, Russell I, Torkington J. Systematic review and meta regression of factors affecting midline incisional hernia rates: An analysis of 14,618 patients. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.307] [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: 10/22/2022]
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30
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Barnes GD, Ageno W, Ansell J, Kaatz S. Recommendation on the nomenclature for oral anticoagulants: communication from the SSC of the ISTH: reply. J Thromb Haemost 2015; 13:2132-3. [PMID: 26340598 DOI: 10.1111/jth.13136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- G D Barnes
- Frankel Cardiovascular Center and Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - W Ageno
- Division of Internal Medicine, University of Insubria, Varese, Italy
| | - J Ansell
- Department of Internal Medicine, Lenox Hill Hospital, New York City, NY, USA
| | - S Kaatz
- Hurley Medical Center, Michigan State University, Flint, MI, USA
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Affiliation(s)
- Kerry L. Bentley-Hewitt
- Institute of Food Research; Norwich Norfolk NR4 7UA UK
- The New Zealand Institute for Plant & Food Research Limited; Palmerston North 4410 New Zealand
| | - Cloe Erika De Guzman
- The New Zealand Institute for Plant & Food Research Limited; Palmerston North 4410 New Zealand
| | - Juliet Ansell
- The New Zealand Institute for Plant & Food Research Limited; Palmerston North 4410 New Zealand
- Zespri International; Mount Maunganui 3116 New Zealand
| | - Tafadzwa Mandimika
- The New Zealand Institute for Plant & Food Research Limited; Palmerston North 4410 New Zealand
| | - Arjan Narbad
- Institute of Food Research; Norwich Norfolk NR4 7UA UK
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Blatchford P, Stoklosinski H, Walton G, Swann J, Gibson G, Gearry R, Ansell J. Kiwifruit fermentation drives positive gut microbial and metabolic changes irrespective of initial microbiota composition. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.bcdf.2015.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Blatchford P, Bentley-Hewitt KL, Stoklosinski H, McGhie T, Gearry R, Gibson G, Ansell J. In vitro characterisation of the fermentation profile and prebiotic capacity of gold-fleshed kiwifruit. Benef Microbes 2015; 6:829-39. [PMID: 26123782 DOI: 10.3920/bm2015.0006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 01/22/2023]
Abstract
A new Actinidia chinensis gold-fleshed kiwifruit cultivar 'Zesy002' was tested to investigate whether it could positively modulate the composition of the human colonic microbiota. Digested Zesy002 kiwifruit was added to in vitro pH-controlled anaerobic batch fermenters that were inoculated with representative human faecal microbiota. Alterations to the gut microbial ecology were determined by 16S rRNA gene sequencing and metabolic end products were measured using gas chromatography and liquid chromatography - mass spectrometry. Results indicated a substantial shift in the composition of bacteria within the gut models caused by kiwifruit supplementation. Zesy002 supplemented microbiota had a significantly higher abundance of Bacteroides spp., Parabacteroides spp. and Bifidobacterium spp. after 48 h of fermentation compared with the start of the fermentation. Organic acids from kiwifruit were able to endure simulated gastrointestinal digestion and were detectable in the first 10 h of fermentation. The fermentable carbohydrates were converted to beneficial organic acids with a particular predilection for propionate production, corresponding with the rise in Bacteroides spp. and Parabacteroides spp. These results support the claim that Zesy002 kiwifruit non-digestible fractions can effect favourable changes to the human colonic microbial community and primary metabolites, and demonstrate a hitherto unknown effect of Zesy002 on colonic microbiota under in vitro conditions.
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Affiliation(s)
- P Blatchford
- 1 The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand.,2 Department of Food and Nutritional Sciences, The University of Reading, Reading RG6 6AP, United Kingdom
| | - K L Bentley-Hewitt
- 1 The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand
| | - H Stoklosinski
- 1 The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand
| | - T McGhie
- 1 The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North 4442, New Zealand
| | - R Gearry
- 3 Department of Gastroenterology, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand
| | - G Gibson
- 2 Department of Food and Nutritional Sciences, The University of Reading, Reading RG6 6AP, United Kingdom
| | - J Ansell
- 4 Zespri International Limited, 400 Maunganui Road, P.O. Box 4043, Mt Maunganui 3149, New Zealand
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Barnes GD, Ageno W, Ansell J, Kaatz S. Recommendation on the nomenclature for oral anticoagulants: communication from the SSC of the ISTH. J Thromb Haemost 2015; 13:1154-6. [PMID: 25880598 DOI: 10.1111/jth.12969] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 01/27/2023]
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Malhotra A, Maughan D, Ansell J, Lehman R, Henderson A, Gray M, Stephenson T, Bailey S. Choosing Wisely in the UK: the Academy of Medical Royal Colleges' initiative to reduce the harms of too much medicine. BMJ 2015; 350:h2308. [PMID: 25985331 PMCID: PMC4428277 DOI: 10.1136/bmj.h2308] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 12/02/2022]
Abstract
A Malhotra and colleagues explain how and why a US initiative to get doctors to stop using interventions with no benefit is being brought to the UK
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Affiliation(s)
- A Malhotra
- Academy of Medical Royal Colleges, London, UK
| | - D Maughan
- Centre For Sustainable Healthcare, Oxford, UK
| | - J Ansell
- Welsh Institute for Minimal Access Therapy, Cardiff Medicentre, Cardiff, UK
| | - R Lehman
- Department of Primary Health Care, University Of Oxford, Oxford, UK
| | - A Henderson
- Academy of Medical Royal Colleges, London, UK
| | - M Gray
- Better Value Healthcare, Oxford, UK
| | - T Stephenson
- Academy of Medical Royal Colleges, London, UK Institute of Child Health, London, UK
| | - S Bailey
- Academy of Medical Royal Colleges, London, UK
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Ansell J, Butts CA, Paturi G, Eady SL, Wallace AJ, Hedderley D, Gearry RB. Kiwifruit-derived supplements increase stool frequency in healthy adults: a randomized, double-blind, placebo-controlled study. Nutr Res 2015; 35:401-8. [PMID: 25931419 DOI: 10.1016/j.nutres.2015.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/02/2015] [Accepted: 04/07/2015] [Indexed: 12/19/2022]
Abstract
The worldwide growth in the incidence of gastrointestinal disorders has created an immediate need to identify safe and effective interventions. In this randomized, double-blind, placebo-controlled study, we examined the effects of Actazin and Gold, kiwifruit-derived nutritional ingredients, on stool frequency, stool form, and gastrointestinal comfort in healthy and functionally constipated (Rome III criteria for C3 functional constipation) individuals. Using a crossover design, all participants consumed all 4 dietary interventions (Placebo, Actazin low dose [Actazin-L] [600 mg/day], Actazin high dose [Actazin-H] [2400 mg/day], and Gold [2400 mg/day]). Each intervention was taken for 28 days followed by a 14-day washout period between interventions. Participants recorded their daily bowel movements and well-being parameters in daily questionnaires. In the healthy cohort (n = 19), the Actazin-H (P = .014) and Gold (P = .009) interventions significantly increased the mean daily bowel movements compared with the washout. No significant differences were observed in stool form as determined by use of the Bristol stool scale. In a subgroup analysis of responders in the healthy cohort, Actazin-L (P = .005), Actazin-H (P < .001), and Gold (P = .001) consumption significantly increased the number of daily bowel movements by greater than 1 bowel movement per week. In the functionally constipated cohort (n = 9), there were no significant differences between interventions for bowel movements and the Bristol stool scale values or in the subsequent subgroup analysis of responders. This study demonstrated that Actazin and Gold produced clinically meaningful increases in bowel movements in healthy individuals.
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Affiliation(s)
- Juliet Ansell
- The New Zealand Institute for Plant & Food Research Limited, Private Bag 11600, Palmerston North, 4442, New Zealand
| | - Christine A Butts
- The New Zealand Institute for Plant & Food Research Limited, Private Bag 11600, Palmerston North, 4442, New Zealand.
| | - Gunaranjan Paturi
- The New Zealand Institute for Plant & Food Research Limited, Private Bag 92169, Auckland, 1142, New Zealand
| | - Sarah L Eady
- The New Zealand Institute for Plant & Food Research Limited, Private Bag 4704, Christchurch, 8140, New Zealand
| | - Alison J Wallace
- The New Zealand Institute for Plant & Food Research Limited, Private Bag 4704, Christchurch, 8140, New Zealand
| | - Duncan Hedderley
- The New Zealand Institute for Plant & Food Research Limited, Private Bag 11600, Palmerston North, 4442, New Zealand
| | - Richard B Gearry
- Department of Medicine, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
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Paturi G, Butts CA, Bentley-Hewitt KL, Hedderley D, Stoklosinski H, Ansell J. Differential effects of probiotics, prebiotics, and synbiotics on gut microbiota and gene expression in rats. J Funct Foods 2015. [DOI: 10.1016/j.jff.2014.12.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Wallace AJ, Eady SL, Hunter DC, Skinner MA, Huffman L, Ansell J, Blatchford P, Wohlers M, Herath TD, Hedderley D, Rosendale D, Stoklosinski H, McGhie T, Sun-Waterhouse D, Redman C. No difference in fecal levels of bacteria or short chain fatty acids in humans, when consuming fruit juice beverages containing fruit fiber, fruit polyphenols, and their combination. Nutr Res 2015; 35:23-34. [DOI: 10.1016/j.nutres.2014.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 12/22/2022]
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Christersson C, Wallentin L, Andersson U, Alexander JH, Ansell J, De Caterina R, Gersh BJ, Granger CB, Hanna M, Horowitz JD, Huber K, Husted S, Hylek EM, Lopes RD, Siegbahn A. D-dimer and risk of thromboembolic and bleeding events in patients with atrial fibrillation--observations from the ARISTOTLE trial. J Thromb Haemost 2014; 12:1401-12. [PMID: 24942912 DOI: 10.1111/jth.12638] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/12/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND D-dimer is related to adverse outcomes in arterial and venous thromboembolic diseases. OBJECTIVES To evaluate the predictive value of D-dimer level for stroke, other cardiovascular events, and bleeds, in patients with atrial fibrillation (AF) treated with oral anticoagulation with apixaban or warfarin; and to evaluate the relationship between the D-dimer levels at baseline and the treatment effect of apixaban vs. warfarin. METHODS In the ARISTOTLE trial, 18 201 patients with AF were randomized to apixaban or warfarin. D-dimer was analyzed in 14 878 patients at randomization. The cohort was separated into two groups; not receiving vitamin K antagonist (VKA) treatment and receiving VKA treatment at randomization. RESULTS Higher D-dimer levels were associated with increased frequencies of stroke or systemic embolism (hazard ratio [HR] [Q4 vs. Q1] 1.72, 95% confidence interval [CI] 1.14-2.59, P = 0.003), death (HR [Q4 vs. Q1] 4.04, 95% CI 3.06-5.33) and major bleeding (HR [Q4 vs. Q1] 2.47, 95% CI 1.77-3.45, P < 0.0001) in the no-VKA group. Similar results were obtained in the on-VKA group. Adding D-dimer level to the CHADS2 score improved the C-index from 0.646 to 0.655 for stroke or systemic embolism, and from 0.598 to 0.662 for death, in the no-VKA group. D-dimer level improved the HAS-BLED score for prediction of major bleeds, with an increase in the C-index from 0.610 to 0.641. There were no significant interactions between efficacy and safety of study treatment and D-dimer level. CONCLUSION In anticoagulated patients with AF, the level of D-dimer is related to the risk of stroke, death, and bleeding, and adds to the predictive value of clinical risk scores. The benefits of apixaban were consistent, regardless of the baseline D-dimer level.
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Affiliation(s)
- C Christersson
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
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Paturi G, Butts CA, Bentley-Hewitt KL, Ansell J. Influence of green and gold kiwifruit on indices of large bowel function in healthy rats. J Food Sci 2014; 79:H1611-20. [PMID: 25048562 DOI: 10.1111/1750-3841.12532] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 05/23/2014] [Indexed: 01/08/2023]
Abstract
The effects of kiwifruit on large bowel health were investigated in healthy rats. Four-week old Sprague-Dawley rats were given diets containing 10% homogenized green kiwifruit, gold kiwifruit or 10% glucose solution (control) over 4 or 6 wk. Green kiwifruit increased the fecal output compared to control. Growth of certain bacterial species in cecum was influenced by both green and gold kiwifruit. A significant increase in cecal Lachnospiraceae in rats fed the green kiwifruit diet was observed at week 4. At week 6, green and gold kiwifruit diets assisted in improving colonic barrier function by upregulating the expression of mucin (MUC)-2, MUC3, Toll-like receptor (TLR)-4 or trefoil factor-3 genes. Gold kiwifruit consumption increased the colonic goblet cells per crypt at week 6. Significant negative correlations between E. coli and β-defensin 1 and TLR4 expression were observed. Consuming green and gold kiwifruit for 6 wk significantly altered the biomarkers of large bowel health; indicating that regularly consuming kiwifruit helps attain optimal digestive health.
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Affiliation(s)
- Gunaranjan Paturi
- The New Zealand Inst. for Plant and Food Research Limited, Private Bag 92169, Auckland, 1142, New Zealand
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Ansell J, Arnaoutakis K, Goddard S, Warren N, Davies MM, Torkington J. A novel simulation for transanal endoscopic operation training. Ann R Coll Surg Engl 2014; 96:171. [PMID: 24780691 DOI: 10.1308/rcsann.2014.96.2.171] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- J Ansell
- Welsh Institute for Minimal Access Therapy, UK
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Ansell J, Goddard S, Gupta V, Warren N, Williams G, Haray P, Appleton B, Phillips S, Torkington J. A new ex vivo animal simulation model for skills training in laparoscopic colorectal surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.1308/rcsbull.2014.96.4.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The opportunity for using simulation in medical training has expanded in recent years. 1–3 Laparoscopic surgery is an area that is ideally suited to the use of simulators for the acquisition of clinical skills. 4 Simulation allows educators to have control over pre-selected scenarios, without distressing patients or encountering complications. 5
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Affiliation(s)
- J Ansell
- Welsh Institute for Minimal Access Therapy
| | - S Goddard
- Welsh Institute for Minimal Access Therapy
| | - V Gupta
- Aneurin Bevan University Health Board
| | - N Warren
- Welsh Institute for Minimal Access Therapy
| | | | - P Haray
- Cwm Taf University Health Board
| | - B Appleton
- Abertawe Bro Morgannwg University Health Board
| | - S Phillips
- Cardiff and Vale University Health Board
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Bentley-Hewitt KL, De Guzman CE, Ansell J, Mandimika T, Narbad A, Lund EK. Polyunsaturated fatty acids modify expression of TGF-β in a co-culture model ultilising human colorectal cells and human peripheral blood mononuclear cells exposed to Lactobacillus gasseri, Escherichia coli and Staphylococcus aureus.. EUR J LIPID SCI TECH 2014; 116:505-513. [PMID: 25598698 PMCID: PMC4281927 DOI: 10.1002/ejlt.201300337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 01/20/2014] [Accepted: 02/24/2014] [Indexed: 12/14/2022]
Abstract
Commensal bacteria and polyunsaturated fatty acids (PUFAs) have both been shown independently to modulate immune responses. This study tested the hypothesis that the different colonic immunomodulatory responses to commensal (Lactobacillus gasseri) and pathogenic bacteria (Escherichia coli and Staphylococcus aureus) may be modified by PUFAs. Experiments used a Transwell system combining the colorectal cell line HT29, or its mucous secreting sub-clone HT29-MTX, with peripheral blood mononuclear cells to analyse immunomodulatory signalling in response to bacteria, with and without prior treatment with arachidonic acid, eicosapentaenoic acid or docosahexaenoic acid. L. gasseri increased transforming growth factor β1 (TGF-β1) mRNA and protein secretion in colonic cell lines when compared with controls, an effect that was enhanced by pre-treatment with eicosapentaenoic acid. In contrast, the Gram-negative pathogen E. coli LF82 had no significant effect on TGF-β1 protein. L. gasseri also increased IL-8 mRNA but not protein while E. coli increased both; although differences between PUFA treatments were detected, none were significantly different to controls. Colonic epithelial cells show different immunomodulatory signalling patterns in response to the commensal L. gasseri compared to E. coli and S. aureus and pre-treatment of these cells with PUFAs can modify responses. Practical applications: We have demonstrated an interaction between dietary PUFAs and epithelial cell response to both commensal and pathogenic bacteria found in the gastrointestinal tract by utilising in vitro co-culture models. The data suggest that n-3 PUFAs may provide some protection against the potentially damaging effects of pathogens. Furthermore, the beneficial effects of combining n-3 PUFAs and the commensal bacteria, and potential probiotic, L. gasseri are illustrated by the increased expression of immunoregulatory TGF-β1.
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Affiliation(s)
- Kerry L Bentley-Hewitt
- Institute of Food Research Norwich Norfolk UK ; Food and Nutrition The New Zealand Institute for Plant & Food Research Limited Palmerston North New Zealand
| | - Cloe Erika De Guzman
- Food and Nutrition The New Zealand Institute for Plant & Food Research Limited Palmerston North New Zealand
| | - Juliet Ansell
- Food and Nutrition The New Zealand Institute for Plant & Food Research Limited Palmerston North New Zealand
| | - Tafadzwa Mandimika
- Food and Nutrition The New Zealand Institute for Plant & Food Research Limited Palmerston North New Zealand
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Suthanthangjai W, Kilmartin P, Phillips A, Davies K, Ansell J. Bioconversion of Pinot noir anthocyanins into bioactive phenolic compounds by lactic acid bacteria. ACTA ACUST UNITED AC 2014. [DOI: 10.3233/nua-130021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- W. Suthanthangjai
- School of Chemical Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
- Riddet Institute, Massey University, Palmerston North, New Zealand
| | - P.A. Kilmartin
- School of Chemical Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
- Riddet Institute, Massey University, Palmerston North, New Zealand
| | - A.R.J. Phillips
- School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - K. Davies
- Riddet Institute, Massey University, Palmerston North, New Zealand
- Plant & Food Research Palmerston North, Palmerston North, New Zealand
| | - J. Ansell
- Riddet Institute, Massey University, Palmerston North, New Zealand
- Plant & Food Research Palmerston North, Palmerston North, New Zealand
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Paturi G, Bentley-Hewitt KL, Butts CA, Nyanhanda T, Monro JA, Ansell J. Dietary combination of potato resistant starch and red meat up-regulates genes involved in colonic barrier function of rats. Int J Food Sci Technol 2013. [DOI: 10.1111/ijfs.12208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Gunaranjan Paturi
- The New Zealand Institute for Plant and Food Research Limited; Private Bag 92169; Auckland; 1142; New Zealand
| | - Kerry L. Bentley-Hewitt
- The New Zealand Institute for Plant and Food Research Limited; Private Bag 11600; Palmerston North; 4442; New Zealand
| | - Christine A. Butts
- The New Zealand Institute for Plant and Food Research Limited; Private Bag 11600; Palmerston North; 4442; New Zealand
| | - Tafadzwa Nyanhanda
- The New Zealand Institute for Plant and Food Research Limited; Private Bag 3230; Hamilton; 3240; New Zealand
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Mullaney JA, Kelly WJ, McGhie TK, Ansell J, Heyes JA. Lactic acid bacteria convert glucosinolates to nitriles efficiently yet differently from enterobacteriaceae. J Agric Food Chem 2013; 61:3039-46. [PMID: 23461529 DOI: 10.1021/jf305442j] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Glucosinolates from the genus Brassica can be converted into bioactive compounds known to induce phase II enzymes, which may decrease the risk of cancers. Conversion via hydrolysis is usually by the brassica enzyme myrosinase, which can be inactivated by cooking or storage. We examined the potential of three beneficial bacteria, Lactobacillus plantarum KW30, Lactococcus lactis subsp. lactis KF147, and Escherichia coli Nissle 1917, and known myrosinase-producer Enterobacter cloacae to catalyze the conversion of glucosinolates in broccoli extract. Enterobacteriaceae consumed on average 65% glucoiberin and 78% glucoraphanin, transforming them into glucoiberverin and glucoerucin, respectively, and small amounts of iberverin nitrile and erucin nitrile. The lactic acid bacteria did not accumulate reduced glucosinolates, consuming all at 30-33% and transforming these into iberverin nitrile, erucin nitrile, sulforaphane nitrile, and further unidentified metabolites. Adding beneficial bacteria to a glucosinolate-rich diet may increase glucosinolate transformation, thereby increasing host exposure to bioactives.
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Affiliation(s)
- Jane A Mullaney
- Riddet Institute, Massey University , Private Bag 11222, Palmerston North, New Zealand
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Ansell J, Arnaoutakis K, Goddard S, Hawkes N, Leicester R, Dolwani S, Torkington J, Warren N. The WIMAT colonoscopy suitcase model: a novel porcine polypectomy trainer. Colorectal Dis 2013; 15:217-23; discussion 223. [PMID: 22672629 DOI: 10.1111/j.1463-1318.2012.03122.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Simulation allows the acquisition of complex skills within a safe environment. Endoscopic polypectomy has a long learning curve. Our novel polypectomy simulator may be a useful adjunct for training. The aim of this study was to assess its content validity. METHOD The Welsh Institute for Minimal Access Therapy (WIMAT) endoscopy suitcase was designed to simulate colonic polypectomy. Participants from regional and national courses were recruited into the study. Each undertook a standardized simulated polypectomy and completed a seven-point Likert scale questionnaire examining its realism. RESULTS In all, 17 participants completed the questionnaire: 15 (88.2%) gastroenterologists, one (5.9%) colorectal surgeon and one (5.9%) experienced endoscopic nurse specialist. Of the gastroenterologists, seven (46.7%) were consultants and eight (53.3%) were senior trainees or Post CCT (Certificate of Completion of Training) fellows. The mean number of real-life polypectomies performed by the cohort was 156 (95% CI 35-355). The highest scores were for 'mucosal realism' (median score 6.0, P=0.001), 'endoscopic snare control' (median score 6.0, P=0.001), 'handling the polyp' (median score 6.0, P=0.001) and 'raising mucosa' (median score 6.0, P<0.001). Of the 15 parameters examined only three were not statistically significant in favour of the simulator. These were 'anatomical realism of sessile polyps', 'resistance of scope movement' and 'paradoxical motion'. The overall score for the simulation was 6.0 (P < 0.001). There was no significant difference between the level of difficulty of the simulator compared with real life (median score 4.0, P = 0.559). CONCLUSION The WIMAT colonoscopy suitcase model has excellent content validity for several parameters. This may have potential applications in medical training and assessment.
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Affiliation(s)
- J Ansell
- Welsh Institute for Minimal Access Therapy (WIMAT), Heath Park, Cardiff CF14 4UJ, UK.
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Ansell J, Parkar S, Paturi G, Rosendale D, Blatchford P. Modification of the Colonic Microbiota. Nutritional Benefits of Kiwifruit 2013; 68:205-17. [DOI: 10.1016/b978-0-12-394294-4.00011-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
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