A127 ENDOSCOPIC MUCOSAL RESECTION FOR DYSPLASTIC AND NEOPLASTIC BARRETT’S ESOPHAGUS: FINDINGS FROM A FOREGUT NEOPLASIA MULTIDISCIPLINARY DATABASE

Background

Previously, Barrett’s esophagus with high grade dysplasia (HGD) or neoplasia was treated with esophagectomy, which is associated with a high postoperative morbidity and mortality rate. Recent guidelines support the use of endoscopic mucosal resection (EMR) for T1a esophageal adenocarcinoma (EAC) and potentially T1b EAC; however, data on long term outcomes of endoscopic treatment is lacking. We created a combined prospective and retrospective multidisciplinary database to monitor outcomes of patients with Barrett’s esophagus undergoing endoscopic treatment.

Aims

Our primary aim was to compare outcomes of EMR and esophagectomy in patients presenting with BE and HGD, and/or early EAC.

Methods

A collaboration of gastroenterologists, general surgeons and thoracic surgeons from the University of Alberta, Edmonton, Alberta, provided input on the development of the database. All patients referred to the Northern Alberta Endoscopic Ablation Program from 2009–2021 who received at least one endoscopic treatment were included. A sub-analysis of all patients with pathologic confirmation of HGD, and/or early EAC was conducted to compare outcomes of EMR and esophagectomy.

Results

A total of 212 patients have been entered into the database. The most common findings were HGD, low grade dysplasia (LGD), and adenocarcinoma, respectively. All patients (n=48) who had at least LGD reached complete eradication of dysplasia (CE-D) and 95.8% reached complete eradication of intestinal metaplasia (CE-IM). Of those patients that reached CE-D, 8.3% developed recurrence of dysplasia (n=4). In the sub-analysis, 74 patients (76.3%) received endoscopic therapy while 23 patients (23.7%) received endoscopic therapy then ultimately an esophagectomy. There were significantly more T1b lesions in the esophagectomy group compared to the EMR group ( p<0.0001). Of all the patients in the EMR group, only 5.4% (n=4) had treatment related complications. Of patients receiving an esophagectomy, 60.9% (n=14) experienced treatment related complications. The mean length of stay for patients in the EMR group was 1.03 +/- 0.2 days, compared to 16.5 +/- 11.8 days for esophagectomy ( p<0.0001).

Conclusions

EMR provides definitive and durable treatment for BE lesions classified as T1b or less severe, with fewer complications and a shorter length of hospital stay than esophagectomy.

Funding Agencies

Alberta Innovates Health Solutions

1609 Patient Demographics and Outcomes Following Acute Presentation with An Inguinal Hernia; A 15-Year Retrospective Cohort Study from The North of England

Aim

Although inguinal hernia repair is one of the most common elective procedures performed, emergency repair carries a far greater risk to patients. This study aimed to report on patient demographics and outcomes following emergency presentation with an inguinal hernia.

Method

Patients ≥18 years admitted acutely with an inguinal hernia across NHS trusts in the North of England between 2002-2016 were identified. Data were collected on demographics, investigations, and operative interventions. Outcomes including length of stay (LoS) and 30-day mortality were analysed.

Results

A total of 4698 patients presented over the 15-year study period. The cohort were predominantly male (n = 4133, 88.0%) with median age of 71 years (IQR: 56-81). Whilst no significant difference in age or gender were found across the study period, comorbidities, as measured by Charlson score, increased over time (p < 0.001). In those who underwent operative intervention (n = 2580), median length of stay was 3 days (IQR: 2-5) and 30-day inpatient mortality rate was 2.5%. Advanced age and comorbidity were associated with higher overall 30-day mortality and post-operative 30-day mortality (both p < 0.001).

Conclusions

This study highlights the frailty of patients presenting as emergency with complications secondary to inguinal hernia. Given the increased risk observed in this patient group, it is vital that perioperative care is optimised, and patients are counselled appropriately.

1601 Trends in Investigation, Management and Patient Outcomes Following Emergency Presentation with Groin Hernia

Aim

Groin hernias are associated with an increased morbidity and mortality following emergency presentations. This study aimed to review current practices regarding investigation and operative management of acute admissions of groin hernias in the North of England.

Method

Patients ≥18 years admitted as an emergency with femoral or inguinal hernias, between 2002-2016, across NHS trusts in the North of England were included. Data on demographics, investigations and operative interventions was collected. Outcomes of interest included rate of bowel resection, length of stay (LoS) and 30-day postoperative mortality.

Results

A total of 6165 patients were identified over 15 years: 4698 inguinal hernias and 1467 femoral hernias. 3904 (63.3%) underwent emergency surgery. Pre-operative CT scanning increased from 1.0% (2002-2006) to 12.3% (2012-2016) (p < 0.001) and was associated with a reduced rate of surgical intervention (64.0% vs. 55.3%, p < 0.001). Bowel resection was higher amongst patients who underwent CT (16.6% vs. 6.4%, p < 0.001). Of those presenting with bowel obstruction, 11.7% required resection, 95.9% of these being small bowel. Bowel resection was associated with increased LoS (p < 0.001) and 30-day postoperative mortality (16.4% vs. 2.8%, p < 0.001). Laparoscopic repair, utilised in 177 procedures (4.5%), was associated with a shorter LoS compared to open repair (4.7 vs 5.5 days, p < 0.001) but no difference in mortality.

Conclusions

Emergency hernia repair, particularly cases requiring bowel resection, have high mortality rates. Pre-operative CT scanning is associated with reduced rates of operative intervention. Further research is required to assess the impact these changes have on surgical decision-making, and subsequent patient outcomes.

469 Novel Applications of Cross-Sectional Imaging in Oncoplastic Surgical Planning for Breast Cancer Following Neoadjuvant Chemotherapy

Background

Cross-sectional imaging using MRI is most commonly used to evaluate the response to neoadjuvant chemotherapy. Furthermore, CT scan of chest, abdomen, and pelvis (CAP) is used in staging the breast cancer. This study seeks to evaluate the feasibility of using preoperative cross-sectional imaging in oncoplastic surgical planning for patients undergoing neoadjuvant chemotherapy for breast cancer.

Method

All female patients who underwent neoadjuvant chemotherapy for breast cancer between January 2019 and January 2020 and underwent breast MRI pre- and post-neoadjuvant chemotherapy and staging CTCAP were included. All images were independently reviewed and analysed by two consultant breast radiologists. Chest wall symmetry, breast volume differences, skin flap thickness, arterial supply to nipple, intercostal perforators and LD pedicle were assessed on both CT and MRI.

Results

Nineteen women were included in this study. Breast measurements were best made by MRI due to difficulty interpreting the CT images when supine. The majority of the patients had a dual arterial supply. There was substantial inter–observer agreement in visualisation of MICAP and AICAP. The inter–observer reliability reduced when the radiologists were asked to visualize the LICAP and the thoracodorsal artery with moderate inter–observer agreement, as the MRI images were difficult to interpret laterally.

Conclusions

This study shows that MRI is suitable to detect most intercostal perforators and is the first study to highlight cross-sectional modalities for assessment of intercostal perforators and may aid preoperative surgical planning and choice of perforator. We have suggested potential addition of CT angiography in cases where the surgeon plans oncoplastic surgery.

20 The Junior Doctor Changeover Effect – Does It Exist in General Surgery?

Introduction

Junior doctor changeover has been perceived as a period of increased risk to patients. However, there is a paucity of contemporary evidence into this ‘Changeover Effect’. The aim of this study was to evaluate the presence of an adverse patient effect during periods of junior doctor changeover.

Method

Data were requested on all patients aged 18 years or older admitted acutely under General Surgery in the North England between 2005-16. This included patient characteristics, diagnoses, co-morbidities, procedure codes, mortality and length of stay. Patients were included in the study if they were admitted during the ‘changeover week’; defined as the first day of the changeover followed by the six subsequent days. For junior trainees (FY1-CT2), this is the first Wednesday of August, December and April each year. For higher surgical trainees (ST3-8) the first Wednesday and October. Another week, four weeks prior, was chosen as a historical comparator.

Results

61714 patients were included in this study. Patient characteristics did not vary between the cohorts. There was no difference in 30-day mortality between changeover and non-changeover groups (2.5% vs. 2.6%, p = 0.280) or length of stay (5.3 vs 5.2, p = 0.613). Changeover week was not a predictor of increased mortality (OR 1.06, p = 0.302) following multivariate adjustment. Further analysis of the first junior and higher specialty trainee periods, August and October respectively, showed no significant difference for measured outcomes.

Conclusions

This retrospective cohort study provides contemporary evidence that the ‘changeover effect’ does not exist in acute general surgical admissions in the UK.

113 Ischaemic Bowel in The North of England: Trends in Management Approach And Patient Outcomes

Aim

Bowel ischaemia is the third most common indication for emergency laparotomy in the UK and is associated with high rates of postoperative morbidity and mortality. This study describes changes in incidence, patient characteristics, management approach and outcomes for patients with bowel ischaemia over a fifteen-year period

Method

Data for patients admitted as an emergency, with a diagnosis of bowel ischaemia, to NHS hospitals in the North of England between 2002 and 2016 were collected. This included patient demographics and co-morbidities, operations performed and outcomes. The primary outcome of interest was in-hospital death within 30 days of admission for non-operatively managed patients and 30-day post-operative mortality for those who underwent an operative intervention.

Results

The incidence of bowel ischaemia has increased as a proportion of emergency general surgery admissions by 68% over fifteen years. More patients are undergoing computerised tomography (CT) imaging has (44.0% vs. 70.3%, p<0.001) and more operations are being performed within 48 hours of admission (p<0.001). The number of patients being managed operatively has fallen from 56.7% to 38.7%. Decreased 30-day mortality rates were observed for both operatively (37.5% to 26.7%, p<0.001) and non-operatively (45.7% to 26.8%, p<0.001) managed patients. Mean length of hospital stay has remained relatively unchanged over time.

Conclusions

Ischaemic bowel is becoming increasingly common. Increased usage of CT imaging has likely resulted in decreased rates of operative management due to its ability to accurately characterise intra-abdominal pathology. Improved mortality rates were observed for both operative and non-operative management strategies.

Does amantadine maintain function in long-established brain injury? A single case experimental design

OBJECTIVE

The role of dopamine agonist (DA) in restoring consciousness and cognition in recovery phase following acquired brain injury (ABI) is established ^(1-5). The role in later recovery is less well defined. We report a single case experimental design (SCED) trial of amantadine demonstrating improvement in function, six years following ABI.

METHOD

A scoring system based on established abilities in personal care and interaction was used to identify tasks with component actions, 34 actions in total, each ranked in terms of quality of response to a request or prompt. Actions were scored on maintenance dose amantadine; on withdrawal; and after reintroduction. Daytime sleep duration was also recorded.

RESULTS

At 3^rd and 5^th weeks post withdrawal, deterioration was noted in 27 of 34 graded activities. At 3^rd and 5^th weeks following reintroduction, all but 3 grades returned to baseline or better. Afternoon sleep duration increased from 35 to 80 minutes during withdrawal period returning towards baseline on amantadine resumption.

CONCLUSION

We believe this provides evidence for benefit of amantadine in sustaining function following ABI. The SCED model used provides a template for others to use to identify comparable change in similar trials.

POS0435 CHARACTERISTICS AND 6-MONTH OUTCOMES AMONG REAL-WORLD PATIENTS WITH RHEUMATOID ARTHRITIS INITIATING UPADACITINIB: ANALYSIS FROM THE CORRONA REGISTRY

Background:

Upadacitinib (UPA) has demonstrated efficacy in randomized controlled trials1-3; however, few data are available from patients with rheumatoid arthritis (RA) who have been treated with UPA in real-world clinical practice.

Objectives:

Describe the characteristics and 6-month outcomes in patients with RA initiating UPA in a real-world setting.

Methods:

We identified adults with RA enrolled in the Corrona RA Registry through October 31, 2020 who initiated UPA during or after August 2019 and had a follow-up visit 6 (±3) months after initiation of UPA. Descriptive statistics were used to summarize characteristics in all patients initiating UPA who had a 6-month follow-up visit. Outcomes (CDAI, modified HAQ-DI, pain, and fatigue) were described at the 6-month visit for all UPA initiators regardless of UPA use at 6 months and for the subset of patients who continued UPA through the 6-month visit. Patients who discontinued UPA before the 6-month visit were considered non-responders for dichotomous variables and were assigned the value at the time of discontinuation for continuous variables. Mean change from baseline in continuous variables was analyzed with one-sample t tests or one-sample Wilcoxon rank sum tests. Minimum clinically important difference (MCID) in HAQ-DI is defined as an improvement of 0.22 units or more. MCID in CDAI is an improvement of at least 2, 7, and 13 units for patients in low, moderate and severe disease at initiation, respectively. MCID for 100-point VAS is an improvement of ≥10 points. Percentages of patients achieving MCID thresholds were calculated.

Results:

We identified 181 patients who initiated UPA and had a 6-month follow-up visit. Mean±SD age was 58.6±12.1 years, 81% were female. Patients had RA for a mean of 11.5±9.8 years. At UPA initiation, 45% of patients were on monotherapy. Prior use of one or more TNFi and JAKi was 79% and 52%, respectively. Seventy-two percent of patients (n=130) initiated UPA as the third or higher line of therapy. Mean CDAI was 18.7±11.6 and mean HAQ-DI was 1.1±0.8 at initiation. Based on CDAI (n=155), 29%, 52%, and 15% of patients had high, moderate, and low disease activity, respectively; 4.5% were in remission at initiation. At 6 months (n=158), 22%, 39%, and 28% had high, moderate, and low disease activity, respectively; 11% were in remission. Among 138 initiators with valid CDAI measures at initiation and 6 months, mean change in CDAI was –4.8±11.8, P<0.01. At 6 months, 46% (63/138) maintained and 39% (54/138) achieved improvement in any CDAI category. Improvements in other outcomes were significantly different from zero. Improvements >=MCID in CDAI, HAQ-DI, pain, and fatigue were achieved in 36–44% of UPA initiators. Improvements were similar, but larger in the subset of patients (n=122) who continued UPA through the 6-month visit (Table 1).

Conclusion:

Among patients in the Corrona RA Registry, UPA is frequently started in those who failed multiple previous therapies. UPA initiators responded to therapy in the first 6 months with improvements in several disease activity measures including CDAI and HAQ-DI, as well as patient-reported pain and fatigue.

References:

[1]Fleischmann R. Arthritis Rheumatol. 2019;71:1788–800.

[2]Smolen JS. Lancet. 2019;393:2303–11.

[3]Burmester GR. Lancet. 2018;382:2505–12.

Outcomes at 6-month follow-upAll initiators(n=181)Subset remainingon UPA (n=122)nValueanValueaRemission (CDAI <2.8)15818 (11)10512 (11)Low (CDAI >=2.8 and <10)15844 (28)10538 (36)Moderate (CDAI >=10 and <22)15862 (39)10536 (34)High (CDAI >=22)15834 (22)10519 (18)Improvement in any CDAI category13854 (39)8940 (45)Maintenance of CDAI category13863 (46)10539 (44)Mean change in CDAI138–4.8±11.8*89–7.1±12.0* HAQ-DI154–0.1±0.5*101–0.2±0.5* Pain154–9.3±25.1*101–13.5±25.8* Fatigue153–7.6±27.3*100–12.5±27.5*MCID achievement in CDAI13857 (41)8943 (48) HAQ-DI15455 (36)10139 (39) Pain15468 (44)10153 (52) Fatigue15365 (42)10049 (49)

aMean±SD or n (%).

*P<0.01 for improvement significantly different from zero.

Acknowledgements:

This study was sponsored by Corrona, LLC. Corrona has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Crescendo, Eli Lilly and Company, Genentech, Gilead, GSK, Janssen, Merck, Momenta Pharmaceuticals, Novartis, Pfizer, Regeneron, Roche, Sun, UCB, and Valeant. The design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the abstract. No honoraria or payments were made for authorship.

Medical writing services were provided by Joann Hettasch of Fishawack Facilitate Ltd., part of Fishawack Health, and funded by AbbVie.

Disclosure of Interests:

Joel M Kremer Shareholder of: Corrona, Consultant of: AbbVie, Grant/research support from: AbbVie, Employee of: Corrona, Namita Tundia Shareholder of: AbbVie, Employee of: AbbVie, Robert McLean Employee of: Corrona, Taylor Blachley Employee of: Corrona, anna maniccia Shareholder of: AbbVie, Employee of: AbbVie, Dimitrios A Pappas Shareholder of: Corrona, Consultant of: AbbVie, Genentech, Novartis, Regeneron, and Roche Hellas, Employee of: Corrona

94 An Observational Cohort Study to Evaluate Volume and Severity of Emergency General Surgery Admissions During The COVID-19 Pandemic: Is There A “Lockdown” Effect?

Introduction

The COVID-19 pandemic has led to changes in NHS surgical service provision. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. This study aimed to investigate a possible ‘lockdown’ effect on the volume and severity of surgical admissions and outcomes.

Method

Two cohorts of adult emergency general surgery admissions 30 days immediately before (16/2/2020 to 15/3/2020), and after UK government advice (16/3/2020 to 15/4/2020). Data were collected relating to patient characteristics, disease severity, clinical outcomes, and compared between these groups.

Results

Following lockdown, a significant reduction in median daily admissions from 7 to 3 (p < 0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of AKI, and more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p = 0.001), all-cause 30-day mortality (8.5% vs. 2.9%, p = 0.028), but no significant difference was observed in operative 30-day mortality.

Conclusions

There appears to be a “lockdown” effect on general surgical admissions with fewer admissions, more acutely unwell patients, and an increase in all-cause 30-day mortality. Patients should be advised to present promptly, and this should be reinforced for future lockdowns during the pandemic.

Primary livedoid vasculopathy associated with mononeuritis multiplex

A 40-year-old woman presented with painful ulcerations on the bilateral lower extremities. A biopsy confirmed the diagnosis of livedoid vasculopathy (LV). She was treated initially with aspirin and pentoxifylline, and with the addition of dipyridamole she has had no recurrence of her ulcerations to date. Despite this positive response to treatment she reported numbness and paresthesias in her legs. Nerve conduction studies confirmed a diagnosis of mononeuritis multiplex. This case highlights mononeuritis multiplex as a rarely described complication of LV, and suggests that early recognition of symptoms and a multidisciplinary approach are necessary for optimal management of this condition.

Ninety years of change on a low wooded island, Great Barrier Reef

We assess 90 years of change on a Low Wooded Island (Low Isles, Great Barrier Reef), employing drones and topographic profiling to accurately survey ramparts, mangroves, the reef flat and the sand cay. A comparison with maps from the 1928-1929 Great Barrier Reef Expedition revealed the redistribution of an outer rampart and inward movement of shingle ridges. Remarkable lateral expansion of the mangrove woodland some 400 m has occurred as carbonate sand deposition has increased reef flat elevation, obscuring coral microatolls. The sand cay has stayed relatively constant in size, moving approximately 44 m in a northeasterly direction and rotating slightly. We conclude that the existing configuration of landforms probably represents an equilibrium with local biophysical conditions, including sea level, wave dynamics, vegetation growth, storms and cyclones. The variable nature of ramparts and the presence of a trough that prevents the continuous spread of mangroves across a uniformly flat colonization surface precludes the interpretation of landform changes with respect to a geomorphic evolutionary sequence. Moreover, longer-term implications of environmental change for these landforms can only be evaluated once the specific nature of the local carbonate budget, including the relative contribution of corals, foraminifera and Halimeda has been elucidated.

Short- and long-term clinical and patient-reported outcomes following laparoscopic ventral mesh rectopexy using biological mesh for pelvic organ prolapse: a prospective cohort study of 224 consecutive patients

AIM

Laparoscopic ventral mesh rectopexy (LVMR) is potentially a safe and effective operation to correct pelvic organ prolapse and to treat obstructive defaecation and solitary rectal ulcer syndrome. This study aimed to evaluate, in a prospective, consecutive cohort of patients, the long-term clinical outcomes following LVMR, patient-reported functional and quality of life outcomes, and urinary and sexual dysfunction.

METHOD

Data on 224 patients who underwent LVMR with Permacol™ biological mesh were collected prospectively from May 2008 to October 2016. Outcome measures were complications, recurrence, mortality, patient satisfaction, patient-reported functional and quality of life outcomes, and urinary and sexual dysfunction. Scores were compared using the two-tailed Wilcoxon signed rank test. P < 0.05 was considered statistically significant.

RESULTS

There was no mortalities associated with LVMR in this series; complications occurred in 10.7% of patients (4.9% early, 5.8% late). Mesh-related morbidity was 0.45% and vaginal suture-related morbidity was 1.33%. Recurrence occurred in 25 patients (11.4%), 5% at 12 months, 10.7% at 5 years. Significant improvement in patient-reported functional outcomes were seen (P < 0.001) for both constipation and faecal incontinence symptoms. Furthermore, significant improvement in quality of life outcomes for patients with constipation, faecal incontinence and prolapse persisted through follow-up (P < 0.001). Patient satisfaction was positive for > 90% of patients during follow-up. Symptoms of stress urinary incontinence, urge incontinence and dyspareunia improved significantly postoperatively (P < 0.001).

CONCLUSION

LVMR using Permacol is associated with low morbidity and mortality, recurrence and, additionally, significantly improved constipation, faecal incontinence and prolapse functional and quality of life outcomes, with associated improvement in urogynaecological symptoms.

Noonan syndrome with loose anagen hair associated with trichorrhexis nodosa and trichoptilosis

We report a case of Noonan syndrome with loose anagen hair (NS/LAH), a rare variant of Noonan syndrome, with associated trichorrhexis nodosa and trichoptilosis. The SHOC2 mutation may be responsible for these additional hair shaft defects, revealing the importance of microscopic examination of hairs in these patients.

Menkes Disease Mimicking Child Abuse

Althouygh Menkes disease has well-recognized neurologic, developmental, and cutaneous features, the initial presentation may resemble child abuse. We describe a 5-month-old boy with multiple fractures indicative of nonaccidental trauma who was ultimately diagnosed with Menkes disease. Copper deficiency leads to connective tissue abnormalities and may result in subdural hematomas, wormian bones, cervical spine defects, rib fractures, and spurring of the long bone metaphyses. Several of these findings, including fractures and subdural hematomas, may be misinterpreted as child abuse.

Localised mitogenic activity in horses following infection with Streptococcus equi

Streptococcus equi subspecies equi (S. equi) is the causative agent of strangles, a highly contagious upper respiratory disease of equids. Streptococcus equi produces superantigens (sAgs), which are thought to contribute to strangles pathogenicity through non-specific T-cell activation and pro-inflammatory response. Streptococcus equi infection induces abscesses in the lymph nodes of the head and neck. In some individuals, some abscess material remains into the guttural pouch and inspissates over time to form chondroids which can harbour live S. equi. The aim of this study was to determine the sites of sAg production during infection and therefore improve our understanding of their role. Abscess material, chondroids and serum collected from Equidae with signs of strangles were tested in mitogenic assays. Mitogenic sAg activity was only detected in abscess material and chondroids. Our data support the localised in vivo activity of sAg during both acute and carrier phases of S. equi infection.

[Postvaccinal fatal Streptococcus zooepidemicus necrotizing fasciitis in a young dog: a case report]

A 2.5-years-old female mongrel dog was routinely subcutaneously vaccinated. A few hours later mental dullness was noticed by the owner progressing into stupor the next day and resulting in a comatose state and death within 48 hours after vaccination. At post mortem examination, which was extended with histology and bacteriology, a necrotizing fasciitis and bacteremia caused by Streptococcus equi subsp. zooepidemicus were established. In the isolated Streptococcus strain four different superantigens were demonstrated that appeared to be able to produce exotoxins in vitro. Therefore, it is concluded that the minor skin trauma caused by vaccination enabled this strain to gain access to the subcutaneous tissue and to induce a necrotizing fasciitis. This process was complicated with a bacterial septicemia leading to death of the dog within 48 hours.

Down but not out: incidence and estimated costs to society of road casualties in Strathclyde, Scotland

OBJECTIVES

To investigate the recent epidemiological patterns and costs of road traffic casualties (RTCs) in Strathclyde, Scotland.

STUDY DESIGN

Retrospective record-linkage epidemiological study using routine data sources.

METHODS

A linked police-hospital database was analysed to describe the epidemiology of RTCs from 2004 to 2009. Using UK government methodology, the costs of road casualties to the National Health Service (NHS) and society were assessed.

RESULTS

RTC rates declined over the study period. Males were at higher risk than females as were those residing in more socially deprived addresses. The estimated costs of RTCs in Strathclyde amounted to £400 million annually. Of this, around one twentieth (£20 million per year), was attributable to direct NHS costs.

CONCLUSIONS

Road casualties remain a major public health threat in Strathclyde, and contribute to health inequalities. RTC costs to society amount to almost a tenth of NHS revenue expenditure. Cost-effective road safety measures should be deployed more widely.

The use of the white cell count and haemoglobin in combination as an effective screen to predict the normality of the full blood count

INTRODUCTION

The utility of the full blood count (FBC) is vast with each parameter serving as a tool to aid diagnosis and monitor disease progression. However, the effectiveness of the test is hampered because of increased workload and lack of interpretation. In the effort to redress this issue, the combined use of the white blood cell count (WBC) and haemoglobin in predicting the normality of the FBC is evaluated.

METHOD

FBC data were collated from 2191 patients and classified into two groups depending on whether the WBC and the haemoglobin were within the reference range. Blood films were examined on the abnormal FBC samples in each group and graded on morphology.

RESULTS

The FBC was normal in 89.6% of cases in the presence of a normal WBC and haemoglobin with subtle abnormalities in the remainder; 1+ grading of abnormal morphology in 93%. However, when the WBC and/or haemoglobin was abnormal, the remaining FBC was significantly abnormal (P < 0.05) and the corresponding blood films were grossly abnormal; 2+/3+ grading in 96% of cases.

CONCLUSION

We concluded that in the presence of a normal WBC and haemoglobin, the FBC is normal in almost all cases and measuring these two parameters could be used as an effective screen to predict FBC normality.

Functional relationships of phytoene synthase 1 alleles on chromosome 7A controlling flour colour variation in selected Australian wheat genotypes

Flour colour measured as a Commission Internationale de l'Eclairage (CIE) b* value is an important wheat quality attribute for a range of end-products, with genes and enzymes of the xanthophyll biosynthesis pathway providing potential sources of trait variation. In particular, the phytoene synthase 1 (Psy1) gene has been associated with quantitative trait loci (QTL) for flour b* colour variation. Several Psy1 alleles on chromosome 7A (Psy-A1) have been described, along with proposed mechanisms for influencing flour b* colour. This study sought to identify evolutionary relationships among known Psy-A1 alleles, to establish which Psy-A1 alleles are present in selected Australian wheat genotypes and establish their role in controlling variation for flour b* colour via QTL analysis. Phylogenetic analyses showed seven of eight known Psy-A1 alleles clustered with sequences from T. urartu, indicating the majority of alleles in Australian germplasm share a common evolutionary lineage. In this regard, Psy-A1a, Psy-A1c, Psy-A1e and Psy-A1p were common in Australian genotypes with flour b* colour ranging from white to yellow. In contrast Psy-A1s was found to be related to A. speltoides, indicating a possible A-B genome translocation during wheat polyploidisation. A new allele Psy-A1t (similar to Psy-A1s) was discovered in genotypes with yellow flour, with QTL analyses indicating Psy-A1t strongly influences flour b* colour in Australian germplasm. QTL LOD value maxima did not coincide with Psy-A1 gene locus in two of three populations and, therefore, Psy-A1a and Psy-A1p may not be involved in flour colour. Instead two other QTL were identified, one proximal and one distal to Psy-A1 in Australian wheat lines. Comparison of Psy-A1t and Psy-A1p predicted protein sequences suggests differences in putative sites for post-translational modification may influence enzyme activity and subsequent xanthophyll accumulation in the wheat endosperm. Psy-A1a and Psy-A1p were not involved in flour b* colour variation, indicating other genes control variation on chromosome 7A in some wheat genotypes.

Point-of-care method for total white cell count: an evaluation of the HemoCue WBC device

Point-of-care testing (POCT) is becoming an important adjunct to haematology laboratory practice. An important component of the blood count is the total white cell count (WBC). Previously, this required laborious microscopic cell counting, but it can now be performed by means of automation; however, in many under-resourced countries, costly automated counters are only available in very few central hospitals. Moreover, neither method is practical in most POCT situations. The HemoCue WBC has been developed as a simplified alternative method, consisting of a reagent pre-loaded disposable cuvette together with basic image analysis technology. This report describes an assessment of its utility. The WBC of 500 routine blood samples from the hospital were tested in parallel by the HemoCue WBC and by a reference analyser to assess accuracy and utility of the former. The tests included precision, linearity, type of blood sample and anticoagulant and potential interfering substances in blood specimens. In the tests for accuracy, 192 of the 200 showed percentage difference from the NEQAS reference of <10% whilst the remaining eight samples differed by <12%, thus meeting the requirements of Clinical laboratory improvement amendments (CLIA)-88 regulations. Of the samples tested with potential interfering substances only those with >2% normoblasts or reticulocytosis showed significant differences from the reference measurements. The HemoCue WBC is reliable for WBC counts within the analytical range of 0.4-30.0 x 10(9)/l, except in samples where there are significant numbers of normoblasts or reticulocytes. It is simple to use and provides a valuable advance in the facilities available for POCT in haematology.

Review of wheat improvement for waterlogging tolerance in Australia and India: the importance of anaerobiosis and element toxicities associated with different soils

BACKGROUND AND AIMS

The lack of knowledge about key traits in field environments is a major constraint to germplasm improvement and crop management because waterlogging-prone environments are highly diverse and complex, and the mechanisms of tolerance to waterlogging include a large range of traits. A model is proposed that waterlogging tolerance is a product of tolerance to anaerobiosis and high microelement concentrations. This is further evaluated with the aim of prioritizing traits required for waterlogging tolerance of wheat in the field.

METHODS

Waterlogging tolerance mechanisms of wheat are evaluated in a range of diverse environments through a review of past research in Australia and India; this includes selected soils and plant data, including plant growth under waterlogged and drained conditions in different environments. Measurements focus on changes in redox potential and concentrations of diverse elements in soils and plants during waterlogging.

KEY RESULTS

(a) Waterlogging tolerance of wheat in one location often does not relate to another, and (b) element toxicities are often a major constraint in waterlogged environments. Important element toxicities in different soils during waterlogging include Mn, Fe, Na, Al and B. This is the first time that Al and B toxicities have been indicated for wheat in waterlogged soils in India. These results support and extend the well-known interactions of salinity/Na and waterlogging/hypoxia tolerance.

CONCLUSIONS

Diverse element toxicities (or deficiencies) that are exacerbated during waterlogging are proposed as a major reason why waterlogging tolerance at one site is often not replicated at another. Recommendations for germplasm improvement for waterlogging tolerance include use of inductively coupled plasma analyses of soils and plants.