113 research outputs found
PA-IIL as a model lectin for the structural and functional characterisation of related lectins
No full textSurgeons, insurgents and the lost Caravaggio
No full textAbstract
L.14702 Michelangelo Merisi da Caravaggio (1571–1610), The Taking of Christ, 1602. Oil on canvas 133·5 × 169·5 cm. On indefinite loan to the National Gallery of Ireland from the Jesuit Community, Leeson Street, Dublin, Ireland, who acknowledge the kind generosity of the late Dr Marie Lea-Wilson, 1992 (National Gallery of Ireland Collection, Photograph © National Gallery of Ireland)
The Taking of Christ (c. 1602), by Italian Baroque master Michelangelo Merisi da Caravaggio (1571–1610), portrays the moment when Judas Iscariot betrays Jesus in the Garden of Gethsemane. By diminishing the environs of the three-quarter-length protagonists, and eschewing any depiction of the setting, all emphasis is concentrated on the action. The painting is perhaps the finest illustration of Caravaggio's imitable style and, like many of his paintings, it demonstrates his use of chiaroscuro. At the time of its completion, it was one of the most costly and celebrated artworks of the milieu, and would later influence other artists, generating its own style, caravaggioesque.
However, just like the spectacular imagery, the provenance of the painting was for centuries shrouded in mystery, action and suspense, before a final resurrection restored its legacy. It is no surprise then that its interwoven history with the Irish medical profession and, in particular, a paediatrician, Dr Marie Lea-Wilson, is at first not obvious or well known. It was while on holiday after the assassination of her husband, a police officer, by Irish revolutionaries in the aftermath of the 1916 Easter Rising, when a number of prominent buildings around Dublin, including the Royal College of Surgeons in Ireland, were occupied, that she unknowingly bought the masterpiece. It is now on indefinite loan to the National Gallery of Ireland from the Jesuit Community of St Ignatius House of Writers, 35 Lower Leeson Street, Dublin 2, Ireland. Almost 100 years later, the story of how these events are associated with the discovery of a work of art of incalculable value has lost none of its peculiarity.
Read more about the fascinating events surrounding this incredible painting in an essay online.</jats:p
Meta-analysis of the impact of surgical approach on the grade of mesorectal excision in rectal cancer
No full textAbstract
Background
The subspecialization of colorectal surgeons, and improvements in the quality of mesorectal excision have revolutionized rectal cancer surgery. With the increasing use of minimally invasive techniques, the completeness of the mesorectal excision has been questioned. This study aimed to assess the pathological outcomes of open versus laparoscopic rectal resection.
Methods
A meta-analysis of RCTs was undertaken. The primary endpoint was the adequacy of the mesorectal excision. Secondary endpoints included circumferential resection margin and distance to resection margins.
Results
Four studies were included, reporting on 2319 patients; 972 (41·9 per cent) had open and 1347 (58·1 per cent) had laparoscopic resections. Meta-analysis of adequacy of the mesorectal excision showed a small difference in achieving an intact mesorectum in favour of open surgery (risk ratio (RR) 1·06, 95 per cent c.i. 1·02 to 1·10; P = 0·001). Superficial defects were more common in laparoscopic surgery (RR 0·70, 0·54 to 0·89; P = 0·004). Deep mesorectal defects (RR 0·78, 0·51 to 1·20; P = 0·256), circumferential margin (CRM) positivity (RR 0·85, 0·62 to 1·16; P = 0·310), and distance to radial (mean difference (MD) –0·06, 95 per cent c.i. –0·10 to 0·23; P = 0·443) and distal (MD 0·03, –0·06 to 0·12; P = 0·497) margins were all similar. A complete resection (intact mesorectum, negative CRM and distal margin) was achieved in 350 of 478 patients (73·2 per cent) in the laparoscopic group and 372 of 457 (81·4 per cent) in the open group (risk difference (RD) 8 (95 per cent c.i. 3 to 13) per cent; P = 0·003). However, an acceptable mesorectum (intact or superficial defects only) was present in 1254 of 1308 (95·9 per cent) and 916 of 949 (96·5 per cent) in the laparoscopic and open groups respectively (RD 1 (–1 to 3) per cent; P = 0·263).
Conclusion
Small differences in mesorectal quality were evident between open and laparoscopic rectal resections. This may be attributable to use of laparoscopic instruments; however, to date minor defects have not affected oncological outcomes.
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The current value of determining the mismatch repair status of colorectal cancer: A rationale for routine testing
No full textThe range of peripapillary retinal nerve fibre layer and optic disc parameters in children aged up to but not including 18 years of age, as measured by optical coherence tomography:protocol for a systematic review
No full textBackgroundThe parameters of the optic disc and peripapillary retinal nerve fibre layer (pRNFL) in children may vary with disease processes that contribute to visual impairment and blindness and so could be useful as an objective measure in at-risk children. There is no standardised reference for the normal parameters of the optic disc and pRNFL in children; however, there are a large number of small individual studies that have been undertaken to look at these measures.MethodsA systematic review of current literature on the range of pRNFL and optic disc parameters in children aged less than 18 years will be performed. Studies will be considered for review if they report numerical data on optic disc and pRNFL parameters, measured using optical coherence tomography. Outcome measures will include mean pRNFL thickness and cup-disc ratio. The bibliographic databases Medline, CINAHL, EMBASE, Scopus and Web of Science will be systematically searched from 1991. Screening of search results will be conducted by two authors working independently, as will extraction of primary and secondary outcome data. Ten per cent of all other data extraction will be checked by a second author. Results will be compiled and presented in evidence tables. Where possible and appropriate, study-specific estimates will be combined to obtain an overall summary estimate of pRNFL thickness and cup-disc ratio across studies and results will be presented by age of population. Subgroup analyses will be undertaken for children of different ethnicities.DiscussionThis review aims to provide an overview of the parameters of the optic disc and pRNFL in children of different ages in order to identify gaps in knowledge and to improve understanding of what might be considered within/outside the range of normality. The findings will be presented in peer-reviewed journals and will be presented at conferences.Systematic review registrationPROSPERO CRD4201603306
Common visual problems in children with disability
No full textChildren with disability are at a substantially higher risk of visual impairment (VI) (10.5% compared with 0.16%) but also of ocular disorders of all types, including refractive errors and strabismus. The aetiology of VI in children with disability reflects that of the general population and includes cerebral VI, optic atrophy, as well as primary visual disorders such as retinal dystrophies and structural eye anomalies. VI and other potentially correctable ocular disorders may not be recognised without careful assessment and are frequently unidentified in children with complex needs. Although assessment may be more challenging than in other children, identifying these potential additional barriers to learning and development may be critical. There is a need to develop clearer guidelines, referral pathways and closer working between all professionals involved in the care of children with disability and visual disorders to improve our focus on the assessment of vision and outcomes for children with disability
Long‐term functional results and quality of life after redo rectal surgery: delayed versus immediate colo‐anal anastomosis
No full textOncological outcomes of laparoscopic versus open rectal cancer resections: meta-analysis of randomized clinical trials
No full textDetermining minimal important differences for patient-reported outcome measures in shoulder, lateral elbow, patellar and Achilles tendinopathies using distribution-based methods
No full textBackground:
Minimal important difference (MID) is a concept used inconsistently and arbitrarily in tendinopathy research. Our aim was to determine the MIDs for the most commonly used tendinopathy outcome measures using data-driven approaches.
Methods:
Recently published systematic reviews of randomised controlled trials (RCTs) on tendinopathy management were identified and used for extraction of eligible studies through a literature search. Each eligible RCT was used to obtain information on MID where this was used and it also contributed data for the calculation of the baseline pooled standard deviation (SD) for each tendinopathy (shoulder, lateral elbow, patellar and Achilles). The rule of “half SD” was used for the computation of MIDs for patient-reported pain (visual analogue scale, VAS 0–10, single-item questionnaire) and function (multi-item questionnaires) and the rule of “one standard error of measurement (SEM)” was additionally used for the multi-item functional outcome measures.
Results:
A total of 119 RCTs were included for the 4 tendinopathies. MID was defined and used by 58 studies (49%) and there were significant inconsistencies amongst studies where the same outcome measure was used as MID. From our data-driven methods the following suggested MIDs were obtained: a) Shoulder tendinopathy, pain VAS (combined) 1.3 points, Constant-Murley score 6.9 (half SD) and 7.0 (one SEM) points; b) lateral elbow tendinopathy, pain VAS (combined) 1.0 point, Disabilities of Arm, Shoulder and Hand questionnaire 8.9 (half SD) and 4.1 (one SEM) points; c) Patellar tendinopathy, pain VAS (combined) 1.2 points, Victorian Institute of Sport Assessment – Patella (VISA-P) 7.3 (half SD) and 6.6 points (one SEM); d) Achilles tendinopathy, pain VAS (combined) 1.1 points, VISA-Achilles (VISA-A) 8.2 (half SD) and 7.8 points (one SEM). The rules of half SD and one SEM produced very similar MIDs except for DASH due to its very high internal consistency. MIDs were also calculated for different pain settings for each tendinopathy.
Conclusions:
Our computed MIDs can be used in tendinopathy research to increase consistency. Clearly defined MIDs should be used with consistency in tendinopathy management studies in the future
Informant accuracy of IQCODE, AD8 and GPCOGi for diagnosis of dementia: does your friend know best?
No full textIncreasing numbers of people require evaluation for possible dementia. However, research on the accuracy of informant questionnaires in primary care remains limited. This study assessed the diagnostic accuracy of IQCODE, AD8, and GPCOGi based on the informant's relationship to the patient. We recruited 240 participants from 21 general practices in South West England. The reference standard for a diagnosis of dementia was made by a specialist clinician using ICD-10 criteria. A threshold of greater than 3.3 on IQCODE, greater or equal to 2 on AD8 and less than 5 on the informant component of GPCOG was used to indicate an abnormal test. Of 238 participants with informant data, 131 had dementia, 60 had CIND, and 47 had normal cognition. Median informant age was 70 years (IQR 60 years to 78 years). 71% of informants were female and 56% were spouses. On all three questionnaires, compared to spouses, adult descendants tended to score participants more cognitively impaired, whereas friends scored participants less cognitively impaired. However, there was little evidence of difference by informant type once fully adjusted. Sensitivity by informant type ranged from 91 to 100% for IQCODE, 94-100% for AD8 and 99% to100% for GPCOGi. There was no significant difference in sensitivity by informant type. Specificity by informant type ranged from 25 to 79% for IQCODE, 13-75% for AD8 and 17-38% for GPCOGi. Adult descendants tended to have the lowest specificity at 25% (95% CI 10-47%) for IQCODE, 13% (95% CI 3-32%) for AD8 and 17% (95% CI 5-37%) for GPCOGi. Friends tended to have the highest specificity at 79% (95% CI 49-95%) for IQCODE, 75% (95% CI 48-93%) for AD8 and 38% (95% CI 15-64%) for GPCOGi. An informant of any relationship type, using IQCODE, AD8 or GPCOGi may be useful for ruling out dementia but not for ruling it in. We found no evidence of difference between spouse or adult descendants but friends performed significantly better overall on IQCODE and AD8. [Abstract copyright: © 2025. The Author(s).
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