Laparoscopic colorectal cancer surgery in obese patients is technically feasible and oncologically safe. Despite greater postoperative morbidity, obese patients benefit from shorter length of stay. However, a higher conversion rate, particularly for rectal cancers, should be anticipated in obese male patients.

This study provides evidence that leukocyte rolling is exclusively and nonredundantly mediated by P-selectin and that firm adhesion is supported by LFA-1 in I/R-induced leukocyte recruitment in the colon. Taken together, both P-selectin and LFA-1 may be important targets to control pathologic inflammation in I/R-induced tissue injury in the colon.

Background: Leucocyte recruitment and inflammation are key features of high dose radiation-induced tissue injury. The inflammatory response in the gut may be more pronounced following radiotherapy due to its high bacterial load in comparison to the response in other organs. We designed a model to enable us to study the effects of radiation on leucocyte-endothelium interactions and on intestinal microflora in the murine ileum. This model enables us to study specifically the local effects of radiation therapy.

Computerised decision support systems or "expert systems" are computer software systems that are designed to aid clinical decision making. Computerised decision support has been defined as provision of assessments or prompts specific to the patient and selected from a knowledge base on the basis of individual patient data.1 At its simplest this definition will include programs that suggest alternatives for treatment or diagnosis on the basis of a simple algorithm. More complex systems model the likelihood of future events and the effectiveness of proposed interventions based on individual patient data and "knowledge" of risks and the effectiveness of interventions. 2Primary care more than any other specialty is characterised by uncertainty. This is not only because it is the first point of contact and the recipient of undifferentiated problems, but also because primary care has the role of monitoring and providing optimal continuing care for many common chronic conditions. Improvement of quality by a reduction of the variation in primary care practice is a key component of UK national health policy. 3 Computerised decision support systems have potential to drive reminders, provide alerts for prescribing interactions or test results, interpret complex investigations (or electrocardiograms), predict mortality on the basis of epidemiological data, aid diagnosis, and calculate drug doses. The question examined by this review is how may computerised decision support systems contribute to improving quality in primary care?The United Kingdom has the most extensively computerised primary healthcare sector in the world and has a unique opportunity to develop and evaluate this technology. 4 As the principal purpose of computerised decision support systems is to support clinical judgment and to provide the structures underlying continuing care, it is surprising that use of computerised decision support systems is not commonplace. The principal reasons for this have been a lack of agreed national standards, a failure of systems to examine the needs of users adequately, and the profusion of different systems that do not communicate with each other.5 Recent mergers between suppliers, the development of national standards for coding and information exchange, and the latest generation of Windows based medical systems could enable the development of more sophisticated computerised decision support systems than the "electronic protocols" currently being used.3 It would seem an appropriate point to consider the scope for computerised decision support systems in supporting quality primary care.According to Buchanan and Smith 6 expert systems should • Provide a solution at the same level of performance as a human expert • Use symbolic and heuristic reasoning rather than numeric and algorithmic procedures • Store knowledge separately from inference procedures • Provide explanations of their reasoning.Shortliffe has identified barriers to the use of decision support: lack of adequate theory, failure to recognise the needs of users, la...

The aims of the present study were to determine the effects and mechanisms of angiotensin II (Ang II) on leukocyte-endothelium interactions and the role of Ang II in a novel model of ischemia/reperfusion (I/R) in the mouse colon. Ang II dose-dependently increased leukocyte rolling and adhesion in colonic venules. Importantly, Ang II-induced leukocyte rolling was completely inhibited by immunoneutralization of P-selectin, and leukocyte adhesion was abolished in lymphocyte function antigen-1 (LFA-1)-deficient mice. The P-selectin-dependent rolling was found to be a precondition for the subsequent LFA-1-dependent leukocyte adhesion. Moreover, Ang II-induced leukocyte responses involved generation of reactive oxygen species and up-regulation of CXC chemokines. Notably, CXC chemokines, but not Ang II, stimulated leukocyte chemotaxis in vitro. I/R increased gene expression of angiotensin converting enzyme (ACE) in the colon and plasma concentrations of Ang II. Inhibition of ACE and the type 1 angiotensin (AT1) receptor significantly decreased the I/R-induced leukocyte adhesion. Taken together, these novel findings demonstrate that Ang II exerts potent pro-inflammatory effects in the colonic microcirculation and that inhibition of Ang II expression or function protects against I/R-induced leukocyte responses in the colon. Thus, it is suggested that Ang II is a major target to control pathological inflammation in the colon.

BACKGROUND Pancreatic ductal adenocarcinoma is the most common pancreatic cancer. Five-year overall survival is currently 3.3-6.0%. The aim of this review was to evaluate the prognostic value of lymph node ratio, number of positive nodes and total nodes examined on overall survival rate following pancreatic resection. MATERIALS AND METHODS A literature search was conducted of MEDLINE, EMBASE, the Cochrane Library and Central Register of Controlled Trials and the Cochrane Database of Systematic Review databases, from January 1996 to January 2016. RESULTS Overall, 19 studies including 4,883 patients examined the relationship between lymph node ratio and overall survival. A high lymph node ratio was associated with decreased overall survival in 17 studies. A total of 12 studies examined the relationship between the number of positive nodes and overall survival, and 11 studies revealed that an increase in the number of positive nodes was associated with decreased overall survival. In 15 studies examining the relationship between the total nodes examined and overall survival, there was no association with overall survival in 12 studies. CONCLUSIONS Lymph node ratio and number of positive nodes are factors associated with overall survival in pancreatic ductal adenocarcinoma, but not total nodes examined.

A new method for examining I/R-induced leucocyte responses in the colonic microcirculation is described. Oxygen free radicals play an important role in triggering leucocyte rolling and adhesion in colonic venules.

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