Risk factors to predict the incidence of surgical adverse events following open or laparoscopic surgery for apparent early stage endometrial cancer: results from a randomised controlled trial

Aims: To identify risk factors for major Adverse Events (AEs) and to develop a nomogram to predict the probability of such AEs in individual patients who have surgery for apparent early stage endometrial cancer. Methods: We used data from 753 patients who were randomized to either total laparoscopic hysterectomy or total abdominal hysterectomy in the LACE trial. Serious adverse events that prolonged hospital stay or postoperative adverse events (using common terminology criteria 3+, CTCAE V3) were considered major AEs. We analyzed pre-surgical characteristics that were associated with the risk of developing major AEs by multivariate logistic regression. We identified a parsimonious model by backward stepwise logistic regression. The six most significant or clinically important variables were included in the nomogram to predict the risk of major AEs within 6 weeks of surgery and the nomogram was internally validated. Results: Overall, 132 (17.5%) patients had at least one major AE. An open surgical approach (laparotomy), higher Charlson’s medical co-morbidities score, moderately differentiated tumours on curettings, higher baseline ECOG score, higher body mass index and low haemoglobin levels were associated with AE and were used in the nomogram. The bootstrap corrected concordance index of the nomogram was 0.63 and it showed good calibration. Conclusions: Six pre-surgical factors independently predicted the risk of major AEs. This research might form the basis to develop risk reduction strategies to minimize the risk of AEs among patients undergoing surgery for apparent early stage endometrial cancer.

Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer : results from a randomised controlled trial

AIM: To compare Total Laparoscopic Hysterectomy (TLH) and Total Abdominal Hysterectomy (TAH) with regard to surgical safety. METHODS: Between October 2005 and June 2010, 760 patients with apparent early stage endometrial cancer were enroled in a multicentre, randomised clinical trial (LACE) comparing outcomes following TLH or TAH. The main study end points for this analysis were surgical adverse events (AE), hospital length of stay, conversion from laparoscopy to laparotomy, including 753 patients who completed at least 6 weeks of follow-up. Postoperative AEs were graded according to Common Toxicity Criteria (V3), and those immediately life-threatening, requiring inpatient hospitalisation or prolonged hospitalisation, or resulting in persistent or significant disability/incapacity were regarded as serious AEs. RESULTS: The incidence of intra-operative AEs was comparable in either group. The incidence of post-operative AE CTC grade 3+ (18.6% in TAH, 12.9% in TLH, p 0.03) and serious AE (14.3% in TAH, 8.2% in TLH, p 0.007) was significantly higher in the TAH group compared to the TLH group. Mean operating time was 132 and 107 min, and median length of hospital stay was 2 and 5 days in the TLH and TAH group, respectively (p<0.0001). The decline of haemoglobin from baseline to day 1 postoperatively was 2g/L less in the TLH group (p 0.006). CONCLUSIONS: Compared to TAH, TLH is associated with a significantly decreased risk of major surgical AEs. A laparoscopic surgical approach to early stage endometrial cancer is safe.

The complete mitochondrial genome of the flesh fly, Sarcophaga impatiens Walker (Diptera: Sarcophagidae)

Approximately 2500 fly species comprise the Sarcophagidae family worldwide. The complete mitochondrial genome of the carrion-breeding, forensically important Sarcophaga impatiens Walker (Diptera: Sarcophagidae) from Australia was sequenced. The 15,169 bp circular genome contains the 37 genes found in a typical Metazoan genome: 13 protein-coding genes, 2 ribosomal RNA genes and 22 transfer RNA genes. It also contains one non-coding A+T-rich region. The arrangement of the genes was the same as that found in the ancestral insect. All the protein initiation codons are ATN, except for cox1 that begins with TCG (encoding S). The 22 tRNA anticodons of S. impatiens are consistent with those observed in Drosophila yakuba, and all form the typical cloverleaf structure, except for tRNA-Ser(AGN) that lacks the DHU arm. The mitochondrial genome of Sarcophaga presented will be valuable for resolving phylogenetic relationships within the family Sarcophagidae and the order Diptera, and could be used to identify favourable genetic markers for species identifications for forensic purposes.

Rejoyce Dublin 2004: Revived copyrights and public exhibitions

This article considers the impact of the copyright term extension upon public exhibitions in libraries and cultural institutions. It focuses upon the legal action taken by the Joyce Estate to prevent the staging of "Rejoyce Dublin 2004", a festival celebrating the centenary of Bloomsday. It evaluates the emergency legislation rushed through by the Irish Parliament, Copyright and Related Rights (Amendment) Act 2004 (Ireland) to safeguard the celebrations. It concludes that copyright law needs to be revised to promote the interests of libraries and other cultural institutions.

Localization of type 1 diabetes susceptibility to the MHC class I genes HLA-B and HLA-A

The major histocompatibility complex (MHC) on chromosome 6 is associated with susceptibility to more common diseases than any other region of the human genome, including almost all disorders classified as autoimmune. In type 1 diabetes the major genetic susceptibility determinants have been mapped to the MHC class II genes HLA-DQB1 and HLA-DRB1 (refs 1–3), but these genes cannot completely explain the association between type 1 diabetes and the MHC region4, 5, 6, 7, 8, 9, 10, 11. Owing to the region's extreme gene density, the multiplicity of disease-associated alleles, strong associations between alleles, limited genotyping capability, and inadequate statistical approaches and sample sizes, which, and how many, loci within the MHC determine susceptibility remains unclear. Here, in several large type 1 diabetes data sets, we analyse a combined total of 1,729 polymorphisms, and apply statistical methods—recursive partitioning and regression...

Preference and performance of Aconophora compressa Walker (Hemiptera: Membracidae) on different lantana phenotypes in Australia

The plant phenotypic preference and performance of Aconophora compressa, a biocontrol agent for Lantana camara in Australia, were assessed. Overall, there were no significant trends of A. compressa favouring any one particular phenotype. However, there was a gradual decrease in performance through subsequent generations, with populations of A. compressa dying out on two phenotypes. Females did not show preference for any particular lantana phenotype, ovipositing similarly on all five phenotypes presented in choice trials and all 16 phenotypes in no-choice trials. Nymphs developed on all 16 phenotypes tested. Percent development and time to complete development were not significant in the first generation but were significant in the second generation. There was a general decrease in performance with generation. However, this was probably due to rising temperatures with season rather than an effect of phenotype. These results suggest that A. compressa should establish on all phenotypes within its geographic range.

: Parasitoids of the painted apple moth Teia anartoides Walker (Lepidoptera: Lymantriidae) in Australia.

Painted apple moth Teia anartoides Walker (Lepidoptera: Lymantriidae), a native to Australia, was discovered in Auckland, New Zealand in late 1999 and eradicated by 2006. It was recognised in 2002 that biological control would be the most effective long-term control strategy if eradication was unsuccessful, and a search was initiated for potential biocontrol agents in Australia. In 2003, autumn and spring surveys were undertaken in Victoria, Tasmania and South Australia of the guild of parasitoid natural enemies of T. anartoides. Eggs, larvae and pupae were collected and held to rear out any parasitoids. In addition, localised searches were made in Queensland in late 2003 early 2004 and laboratory-reared juvenile stages of T. anartoides were released for recapture in both Victoria and Queensland. Acacia dealbata Link (Fabales: Fabaceae) was the main plant from which T. anartoides was recovered, followed by apple. Most T. anartoides samples were collected from Victoria and Tasmania. Eighteen species from 13 genera of egg, larval and pupal parasitoids were reared and included Diptera (Tachinidae) and Hymenoptera (Braconidae, Encyrtidae, Eulophidae and Ichneumonidae). Of the seven Hymenopteran genera recovered from the larval stage, the most common in Victoria and Tasmania was a previously unidentified larval parasitoid Cotesia Cameron (Hymenoptera: Braconidae) sp. Echthromorpha intricatoria (Fabricius) (Hymenoptera: Ichneumonidae) was the dominant pupal parasitoid. The survey showed that the parasitoid complex associated with T anartoides is structurally very similar to that on other pest Lymantriidae in the northern hemisphere such as gypsy moth (Lymantria dispar L.) (Lepidoptera: Lymantriidae). Meteorus pulchricornis (Wesmael) (Hymenoptera: Braconidae) was recorded for the first time in Australia.

Effect of temperature on the survival of Aconophora compressa Walker (Hemiptera: Membracidae): implications for weed biocontrol

Abstract In weed biocontrol, similarity of abiotic factors between the native and introduced range of a biocontrol agent is critical to its establishment and effectiveness. This is particularly the case for weeds that have a wide geographical distribution in the native range. For such weeds, the choice of a specialist insect that has narrow tolerance limits to important abiotic factors can diminish its ability to be an effective biocontrol agent. The membracid Aconophora compressa was introduced in Australia from Mexico for biocontrol of Lantana camara, a plant with a wide climatic tolerance. In this study we investigated the effect of constant and alternating temperatures on A. compressa survival. Longevity of adults and nymphs declined with increasing temperatures, and at 39°C individuals survived for less than a day. At lower temperatures, nymphs survived longer than adults. Survival at alternating temperatures was longer than at constant temperatures, but the general trend of lower survival at higher temperatures remained. Spatially and temporally, the climatic tolerance of A. compressa appears to be a subset of that of lantana, thereby limiting its potential impact.

On the importance of backbone loop and peptide flip in the Walker sequence in F-1-ATPase action

The Walker sequence, GXXXXGKT, present in all the six subunits of F-1-ATPase exists in a folded form, known as phosphate-binding loop (P-loop). Analysis of the Ramachandran angles showed only small RMS deviation between the nucleotide-bound and nucleotide-free forms. This indicated a good overlap of the backbone loops. The catalytic beta-subunits (chains D, E and F) showed significant changes in the Ramachandran angles and the side chain torsion angles, but not the structural alpha-subunits (chains A, B and C). Most striking among these are the changes associated with Val160 and Gly161 corresponding to a flip in the peptide unit between them when a nucleotide is bound (chains D or F compared to nucleotide-free chain E). The conformational analysis further revealed a hitherto unnoticed hydrogen bond between amide-N of the flipped Gly161 and terminal phosphate-O of the nucleotide. This assigns a role for this conserved amino acid, otherwise ignored, of making an unusual direct interaction between the peptide backbone of the enzyme protein and the incoming nucleotide substrate. Significance of this interaction is enhanced, as it is limited only to the catalytic subunits, and also likely to involve a mechanical rotation of bonds of the peptide unit. Hopefully this is part of the overall events that link the chemical hydrolysis of ATP with the mechanical rotation of this molecule, now famous as tiny molecular motor.

Physical constraints, fundamental limits, and optimal locus of operating points for an inverted pendulum based actuated dynamic walker

The inverted pendulum is a popular model for describing bipedal dynamic walking. The operating point of the walker can be specified by the combination of initial mid-stance velocity (v(0)) and step angle (phi(m)) chosen for a given walk. In this paper, using basic mechanics, a framework of physical constraints that limit the choice of operating points is proposed. The constraint lines thus obtained delimit the allowable region of operation of the walker in the v(0)-phi(m) plane. A given average forward velocity v(x,) (avg) can be achieved by several combinations of v(0) and phi(m). Only one of these combinations results in the minimum mechanical power consumption and can be considered the optimum operating point for the given v(x, avg). This paper proposes a method for obtaining this optimal operating point based on tangency of the power and velocity contours. Putting together all such operating points for various v(x, avg,) a family of optimum operating points, called the optimal locus, is obtained. For the energy loss and internal energy models chosen, the optimal locus obtained has a largely constant step angle with increasing speed but tapers off at non-dimensional speeds close to unity.

“Deborah Numbers”, Coupling Multiple Space and Time Scales and Governing Damage Evolution to Failure

Two different spatial levels are involved concerning damage accumulation to eventual failure. nucleation and growth rates of microdamage nN* and V*. It is found that the trans-scale length ratio c*/L does not directly affect the process. Instead, two independent dimensionless numbers: the trans-scale one * * ( V*)including the * **5 * N c V including mesoscopic parameters only, play the key role in the process of damage accumulation to failure. The above implies that there are three time scales involved in the process: the macroscopic imposed time scale tim = /a and two meso-scopic time scales, nucleation and growth of damage, (* *4) N N t =1 n c and tV=c*/V*. Clearly, the dimensionless number De*=tV/tim refers to the ratio of microdamage growth time scale over the macroscopically imposed time scale. So, analogous to the definition of Deborah number as the ratio of relaxation time over external one in rheology. Let De be the imposed Deborah number while De represents the competition and coupling between the microdamage growth and the macroscopically imposed wave loading. In stress-wave induced tensile failure (spallation) De* < 1, this means that microdamage has enough time to grow during the macroscopic wave loading. Thus, the microdamage growth appears to be the predominate mechanism governing the failure. Moreover, the dimensionless number D* = tV/tN characterizes the ratio of two intrinsic mesoscopic time scales: growth over nucleation. Similarly let D be the “intrinsic Deborah number”. Both time scales are relevant to intrinsic relaxation rather than imposed one. Furthermore, the intrinsic Deborah number D* implies a certain characteristic damage. In particular, it is derived that D* is a proper indicator of macroscopic critical damage to damage localization, like D* ∼ (10–3~10–2) in spallation. More importantly, we found that this small intrinsic Deborah number D* indicates the energy partition of microdamage dissipation over bulk plastic work. This explains why spallation can not be formulated by macroscopic energy criterion and must be treated by multi-scale analysis.