St. Luke's General Hospital

BACKGROUND: In general, academic but not community endoscopists have demonstrated adequate endoscopic differentiation accuracy to make the 'resect and discard' paradigm for diminutive colorectal polyps workable. Computer analysis of video could potentially eliminate the obstacle of interobserver variability in endoscopic polyp interpretation and enable widespread acceptance of 'resect and discard'. STUDY DESIGN AND METHODS: We developed an artificial intelligence (AI) model for real-time assessment of endoscopic video images of colorectal polyps. A deep convolutional neural network model was used. Only narrow band imaging video frames were used, split equally between relevant multiclasses. Unaltered videos from routine exams not specifically designed or adapted for AI classification were used to train and validate the model. The model was tested on a separate series of 125 videos of consecutively encountered diminutive polyps that were proven to be adenomas or hyperplastic polyps. RESULTS: The AI model works with a confidence mechanism and did not generate sufficient confidence to predict the histology of 19 polyps in the test set, representing 15% of the polyps. For the remaining 106 diminutive polyps, the accuracy of the model was 94% (95% CI 86% to 97%), the sensitivity for identification of adenomas was 98% (95% CI 92% to 100%), specificity was 83% (95% CI 67% to 93%), negative predictive value 97% and positive predictive value 90%. CONCLUSIONS: An AI model trained on endoscopic video can differentiate diminutive adenomas from hyperplastic polyps with high accuracy. Additional study of this programme in a live patient clinical trial setting to address resect and discard is planned.

BACKGROUND: The standard approach to generalized peritonitis due to perforated diverticulitis involves open surgery and diversion of faecal content. This study assessed the feasibility of laparoscopic peritoneal lavage. METHODS: A prospective multi-institutional study of 100 patients was undertaken. All consenting patients with perforated diverticulitis causing generalized peritonitis underwent attempted laparoscopic peritoneal lavage. The degree of peritonitis, according to the Hinchey grading system, was recorded. Primary endpoints were operative success and resolution of symptoms. RESULTS: Patients had a median age of 62.5 (range 39-94) years, a male : female ratio of 2 : 1 and a median American Society of Anesthesiologists grade of III (range II-V). Eight patients with grade 4 diverticulitis had conversion to an open Hartmann's procedure. The remaining 92 patients were managed by laparoscopic lavage, with morbidity and mortality rates of 4 and 3 per cent respectively. Two patients required postoperative intervention for a pelvic abscess. Only two patients re-presented with diverticulitis at a median follow up of 36 (range 12-84) months. CONCLUSION: Laparoscopic management of perforated diverticulitis with generalized peritonitis is feasible, with a low recurrence risk in the short term.

CONTEXT: Treatment for patients with congenital adrenal hyperplasia (CAH) may affect the final height of these patients. OBJECTIVE: Our objective was to determine the distribution of achieved height in patients with classic CAH diagnosed at infancy or early childhood and treated with glucocorticoids. DATA SOURCES: We searched MEDLINE, EMBASE, Cochrane Library, ISI Web of Science, and Scopus through September 2008; the reference sections of included studies; and expert files. STUDY SELECTION: Eligible studies included patients diagnosed with CAH before age 5 and followed to final height. DATA EXTRACTION: Reviewers working in duplicate independently extracted data on study characteristics and outcomes and determined each study's risk of bias. DATA SYNTHESIS: The sd score (SDS) for final height and corrected height (defined as final height SDS - midparental height SDS) were estimated from each study and pooled using random-effects metaanalysis. The I(2) statistic was used to assess inconsistency in results across studies. RESULTS: We found 35 eligible studies, most of which were retrospective single-cohort studies. The final height SDS achieved by CAH patients was -1.38 (-1.56 to -1.20; I(2) = 90.2%), and the corrected height SDS was -1.03 (-1.20 to -0.86; I(2) = 63.1%). This was not significantly associated with age at diagnosis, gender, type and dose of steroid, and age of onset of puberty. Mineralocorticoid users had a better height outcome in comparison with the nonusers (P = 0.02). CONCLUSION: Evidence derived from observational studies suggests that the final height of CAH patients treated with glucocorticoids is lower than the population norm and is lower than expected given parental height.

OBJECTIVES: To gather the current evidence and to offer recommendations for follow-up and management. METHODS: The Special Interest Group on Celiac Diseases of the European Society of Paediatric Gastroenterology Hepatology and Nutrition formulated ten questions considered to be essential for follow-up care. A literature search (January 2010-March 2020) was performed in PubMed or Medline. Relevant publications were identified and potentially eligible studies were assessed. Statements and recommendations were developed and discussed by all coauthors. Recommendations were voted upon: joint agreement was set as at least 85%. RESULTS: Publications (n = 2775) were identified and 164 were included. Using evidence or expert opinion, 37 recommendations were formulated on: The need to perform follow-up, its frequency and what should be assessed, how to assess adherence to the gluten-free diet, when to expect catch-up growth, how to treat anemia, how to approach persistent high serum levels of antibodies against tissue-transglutaminase, the indication to perform biopsies, assessment of quality of life, management of children with unclear diagnosis for which a gluten-challenge is indicated, children with associated type 1 diabetes or IgA deficiency, cases of potential celiac disease, which professionals should perform follow-up, how to improve the communication to patients and their parents/caregivers and transition from pediatric to adult health care. CONCLUSIONS: We offer recommendations to improve follow-up of children and adolescents with celiac disease and highlight gaps that should be investigated to further improve management.

BACKGROUND: The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all-cause 30-day readmissions and complications in a prospective population-based cohort. METHODS: Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all-cause 30-day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2). RESULTS: Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. CONCLUSION: Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics.

BACKGROUND: Early warning scores (EWS) are used to identify physiological deterioration in patients. Studies to date have primarily focused on the correlation between trends in serially recorded EWS of inpatients and clinical outcomes. This study examined the predictive value of an EWS calculated immediately on presentation to hospital for acute medical patients. METHOD: A prospective study of 225 consecutive medical admissions. Pulse, systolic blood pressure, respiratory rate, oxygen saturation and neurological status were used to calculate an EWS. Patients were divided into four score categories based on their EWS. The primary endpoints examined were intensive care unit (ICU)/coronary care unit (CCU) admission, death, cardiac arrest and length of hospital stay. RESULTS: For each rise in score category there was an increased risk of admission to ICU (odds ratio (OR) 3.35, CI 1.52 to 7.40, p = 0.003), admission to CCU (OR 1.82, CI 1.07 to 3.09, p = 0.027), death (OR 2.19, CI 1.41 to 3.39, p = 0.000) and reaching the combined endpoint of CCU/ICU admission or death (OR 2.19, CI 1.41 to 3.39, p = 0.000). The higher the score the longer the length of hospital admission (p = 0.04). A decrease in EWS between first presentation to hospital and transfer to the ward was associated with a decreased risk of reaching the combined endpoint of CCU or ICU admission or death (OR 2.56, CI 1.11 to 5.89, p = 0.028). DISCUSSION: Higher admission EWS correlate with increased risk of CCU/ICU admission, death and longer hospital stays independent of patient age. An improvement in serial EWS within 4 h of presentation to hospital predicts improved clinical outcomes. The EWS is a potential triage tool in the emergency department for acute medical patients.

BACKGROUND: Body image refers to a person's sense of their physical appearance and body function. A negative body image self-evaluation may result in psychosocial dysfunction. Crohn's disease and ulcerative colitis are associated with disabling features, and body image dissatisfaction is a concern for many patients with inflammatory bowel disease (IBD). However, no study has assessed body image and its comorbidities in patients with IBD using validated instruments. Our aim was to explore body image dissatisfaction in patients with IBD and assess its relationship with biological and psychosocial variables. METHODS: We studied 330 patients (median age, 36 yr; range, 18-83; 169 men) using quantitative and qualitative methods. Patients completed a self-administered questionnaire that included a modified Hopwood Body Image Scale, the Cash Body Image Disturbance Questionnaire, and other validated instruments. Clinical and disease activity data were also collected. RESULTS: Body image dissatisfaction was associated with disease activity (P < 0.001) and steroid treatment (P = 0.03) but not with immunotherapy (P = 0.57) or biological (P = 0.55) therapy. Body image dissatisfaction was also associated with low levels of general (P < 0.001) and IBD-specific (P < 0.001) quality of life, self-esteem (P < 0.001), and sexual satisfaction (P < 0.001), and with high levels of anxiety (P < 0.001) and depression (P < 0.001). Qualitative analysis indicated that patients were concerned about both physical and psychosocial consequences of body image dissatisfaction, including steroid side effects and impaired work and social activities. CONCLUSIONS: Body image dissatisfaction is common in patients with IBD, relates to specific clinical variables and is associated with significant psychological dysfunction. Its measurement is warranted as part of a comprehensive patient-centered IBD assessment.

Abstract Objective Despite the high prevalence of hospitalization for left iliac fossa tenderness, there is a striking lack of randomized data available to guide therapy. The authors hypothesize that an oral antibiotic and fluids are not inferior to intravenous (IV) antibiotics and ‘bowel rest’ in clinically diagnosed acute uncomplicated diverticulitis. Method A randomized controlled trial was constructed in two District General Hospitals. All clinically diagnosed patients presenting with acute uncomplicated diverticulitis were eligible for the study. Oral and IV regimens utilizing ciprofloxacin and metronidazole were compared. The primary outcomes studied were surrogates for resolution of symptoms (including tenderness on day 3 and length of stay) and failure of oral therapy. Secondary endpoints studied were serial constitutional and biomarker trends. Results There were 41 patients in the oral arm and 38 in the IV arm ( n = 79). No patient had to be converted to IV antibiotics from the oral group. There was a complete resolution of symptoms in both groups. Tenderness was equivalent in both groups on day 3. Among secondary endpoints, a serial decrease in C reactive protein was the best serological predictor of resolution for both groups. Conclusion Oral antibiotics are not inferior to intravenous antibiotics in achieving resolution of clinically diagnosed diverticulitis.

CONTEXT: Prenatal treatment with dexamethasone to prevent virilization in pregnancies at risk for classical congenital adrenal hyperplasia (CAH) remains controversial. OBJECTIVE: To conduct a systematic review and meta-analyses of studies that evaluated the effects of dexamethasone administration during pregnancies at risk for classical CAH because of 21-hydroxylase deficiency (CYP21A2). DATA SOURCES: We searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception through August 2009. Review of reference lists and contact with CAH experts further identified candidate studies. STUDY SELECTION: Reviewers working independently and in duplicate determined trial eligibility. Eligible studies reported the effects on either foetal or maternal outcomes of dexamethasone administered during pregnancy compared to a control group that did not receive any treatment. DATA EXTRACTION: Reviewers working independently and in duplicate determined the methodological quality of studies and collected data on patient characteristics, interventions, and outcomes. DATA SYNTHESIS: We identified only four eligible observational studies (325 pregnancies treated with dexamethasone). The methodological quality of the included studies was overall low. Meta-analysis demonstrates a reduction in foetus virilization measured by Prader score in female foetuses treated with dexamethasone initiated early during pregnancy (weighted mean difference, -2.33, 95% CI, -3.38, -1.27). No deleterious effects of dexamethasone on stillbirths, spontaneous abortions, foetal malformations, neuropsychological or developmental outcomes were found although these data are quite sparse. There was increased oedema and striae in the mothers treated with dexamethasone. There were no data on long-term follow-up of physical and metabolic outcomes in children exposed to dexamethasone. CONCLUSIONS: The observational nature of the available evidence and the overall small sample size of the whole body of the literature significantly weaken inferences about the benefits and harms of dexamethasone in this setting. Dexamethasone seems to be associated with reduction in foetus virilization without significant maternal or foetal adverse effects. However, this review underscores the current uncertainty and further investigation is clearly needed. The decision about initiating treatment should be based on patients' values and preferences and requires fully informed and consenting parents.

BACKGROUND: Laparoscopic inguinal hernia repair has emerged as a viable alternative to the open procedure. To date, few studies have included validated measures of quality of life as end points. We compared quality-of-life outcomes following laparoscopic versus open repair of inguinal hernia. METHODS: All laparoscopic repairs were performed via the totally extraperitoneal route (TEP). All open procedures were Lichtenstein repairs (LR). Hernia repairs performed between January 1999 and December 2006 were included in the study. Data was recorded prospectively and each TEP repair was matched with a LR for analysis. The SF-36 form was used to assess quality of life. Statistical significance was determined using the two-sample Wilcoxon rank-sum (Mann-Whitney) test. RESULTS: Three hundred fourteen procedures were performed during the study period, 164 (52%) had a TEP repair and 150 (48%) had a LR. Ninety TEP repairs were matched with 90 LR. Recurrence rates were 3% following TEP repair and 2% following LR. There was a significant difference between the laparoscopic and open groups in terms of physical function (p = 0.0001), physical role (p < 0.0001), bodily pain (p = 0.0029), general health (p = 0.0025), and emotional role (p < 0.0001). There was no significant difference between the groups in terms of vitality (p = 0.2501), mental health (p = 0.08), or social functioning (p = 0.1677). CONCLUSIONS: These data suggest that the TEP repair results in less postoperative pain, a quicker return to normal functional status, and improved quality-of-life outcomes with equivalent recurrence rates when compared to the LR.

Les relations de parenté de deux crocodiles nains de Mauritanie ont été déduites de l&#39;analyse de séquences mitochondriales 12S. Des spécimens de 13 populations différentes de Crocodylus niloticus (d&#39;Afrique de l&#39;Est, de l&#39;Ouest et de Madagascar) ont été comparés. Des spécimens supplémentaires du genre Crocodylus (un d&#39;Afrique et un d&#39;Australie), du genre africain Osteolamus et de l&#39;alligatoridé Paleosuchus palpebrosus (comme extra-groupe) ont été inclus dans l&#39;analyse. La probabilité maximale et les analyses bayésiennes ont livré des relations de parenté qui sont remarquablement différentes des hypothèses phylogénétiques classiques. Les deux analyses ont révélé logiquement deux groupes : l&#39;un comprenant les populations monophylétiques d&#39;Afrique de l&#39;Ouest et centrale et l&#39;autre un groupe paraphylétique comprenant des populations d&#39;Afrique de l&#39;Est et de Madagascar. Une forte divergence génétique entre ces groupes indique une séparation au niveau spécifique. En outre, il est clair que &laquo; C &raquo;. cataphractus n&#39;appartient pas au genre Crocodylus. Les changements de nomenclature qui en résultent sont discutés.

Achondroplasia is a rare genetic disorder resulting in short-limb skeletal dysplasia. We present the largest European population-based epidemiological study to date using data provided by the European Surveillance of Congenital Anomalies (EUROCAT) network. All cases of achondroplasia notified to 28 EUROCAT registries (1991-2015) were included in the study. Prevalence, birth outcomes, prenatal diagnosis, associated anomalies, and the impact of paternal and maternal age on de novo achondroplasia were presented. The study population consisted of 434 achondroplasia cases with a prevalence of 3.72 per 100,000 births (95%CIs: 3.14-4.39). There were 350 live births, 82 terminations of pregnancy after prenatal diagnosis, and two fetal deaths. The prenatal detection rate was significantly higher in recent years (71% in 2011-2015 vs. 36% in 1991-1995). Major associated congenital anomalies were present in 10% of cases. About 20% of cases were familial. After adjusting for maternal age, fathers >34 years had a significantly higher risk of having infants with de novo achondroplasia than younger fathers. Prevalence was stable over time, but regional differences were observed. All pregnancy outcomes were included in the prevalence estimate with 80.6% being live born. The study confirmed the increased risk for older fathers of having infants with de novo achondroplasia.

BACKGROUND: Opportunities to improve emergency surgery outcomes exist through guided better practice and reduced variability. Few attempts have been made to define optimal care in emergency surgery, and few clinically derived key performance indicators (KPIs) have been published. A summit was therefore convened to look at resources for optimal care of emergency surgery. The aim of the Donegal Summit was to set a platform in place to develop guidelines and KPIs in emergency surgery. METHODS: The project had multidisciplinary global involvement in producing consensus statements regarding emergency surgery care in key areas, and to assess feasibility of producing KPIs that could be used to monitor process and outcome of care in the future. RESULTS: Forty-four key opinion leaders in emergency surgery, across 7 disciplines from 17 countries, composed evidence-based position papers on 14 key areas of emergency surgery and 112 KPIs in 20 acute conditions or emergency systems. CONCLUSIONS: The summit was successful in achieving position papers and KPIs in emergency surgery. While position papers were limited by non-graded evidence and non-validated KPIs, the process set a foundation for the future advancement of emergency surgery.

Objective Our study aims to understand the psychological impact of the COVID-19 pandemic among healthcare workers (HCWs) at acute hospital settings in the South-East of Ireland, as a crucial step in guiding policies and interventions to maintain their psychological well-being. Design Observational cohort study. Participants and setting 472 HCWs participated from two distinct acute hospital settings, A and B, in the South-East of Ireland. Primary and secondary outcome measures Measures of psychological distress—depression, anxiety, acute and post-traumatic stress disorder (PTSD)—as dictated by the Depression, Anxiety and Stress Scale (DASS-21) and Impact of Event Scale-Revised (IES-R). An independent sample t-test and a Mann-Whitney U test was used to determine significance of difference in continuous variables between groups. Categorical variables were assessed for significance with a χ 2 test for independence. Results The DASS-21 provided independent measures of depression (mean 4.57, IQR 2–7), anxiety (mean 3.87, IQR 1–6) and stress (mean 7.41, IQR 4–10). Positive scores were reflected in 201 workers (42.6%) for depression and 213 (45.1%) for both anxiety and stress. The IES-R measured subjective distress on three subscales: intrusion (mean 1.085, IQR 0.375–1.72), avoidance (mean 1.008, IQR 0.375–1.5) and hyperarousal (mean 1.084, IQR 0.5–1.667). Overall, 195 cases (41.3%) were concerning for PTSD. Site B scored significantly higher across all parameters of depression (5.24 vs 4.08, p&lt;0.01), anxiety (4.66 vs 3.3, p&lt;0.01), stress (8.91 vs 6.33, p&lt;0.01) and PTSD (0.058 vs 0.043, p&lt;0.01). Worse outcomes were also noted in HCWs with underlying medical ailments. Conclusion Psychological distress is prevalent among HCWs during the COVID-19 pandemic; screening for adverse mental and emotional outcomes and developing timely tailored preventative measures with effective feedback are vital to protect their psychological well-being, both in the immediate and long-term.

This study aimed at (1) deriving Bayesian methods to predict breeding values for ratio (i.e. feed conversion ratio; FCR) or linear (i.e. residual feed intake; RFI) traits; (2) estimating genetic parameters for average daily feed consumption (ADFI), average daily weight gain (ADG), lean meat percentage (LMP) along with the derived traits of RFI and FCR; and (3) deriving Bayesian estimates of direct and correlated responses to selection on RFI, FCR, ADG, ADFI, and LMP. Response to selection was defined as the difference in additive genetic mean of the selected top individuals, expected to be parents of the next generation, and the total population after integrating genetic trends out of the posterior distribution of selection responses. Inferences were based on marginal posterior distributions obtained from the Bayesian method for integration over unknown population parameters and “fixed” environmental effects and for appropriate handling of ratio traits. Terminal line pigs (n = 3724) were used for a multi-variate model for ADFI, ADG, and LMP. RFI was estimated from the conditional distribution of ADFI given ADG and LMP, using either genetic (RFIG) or phenotypic (RFIP) partial regression coefficients. The posterior distribution of the FCR’s breeding values was derived from the posterior distribution of “fixed” environmental effects and additive genetic effects on ADFI and ADG. Posterior means of heritability were 0.32, 0.26, 0.56, 0.20, and 0.15 for ADFI, ADG, LMP, RFIP, and RFIG, respectively. Selection against RFIG showed a direct response of − 0.16 kg/d and correlated responses of − 0.16 kg/kg for FCR and − 0.15 kg/d for ADFI, with no effect on other production traits. Selection against FCR resulted in a direct response of − 0.17 kg/kg and correlated responses of − 0.14 kg/d for RFIG, − 0.18 kg/d for ADFI, and 0.98% for LMP. The Bayesian methodology developed here enables prediction of breeding values for FCR and RFI from a single multi-variate model. In addition, we derived posterior distributions of direct and correlated responses to selection. Genetic parameter estimates indicated a genetic basis for the studied traits and that genetic improvement through selection was possible. Direct selection against FCR or RFIP resulted in unexpected responses in production traits.

OBJECTIVE: The purpose of our study was to evaluate the usefulness of MR cholangiopancreatography in the diagnosis and further treatment of patients with failed or inadequate ERCP. SUBJECTS AND METHODS: Fifty-eight patients with failed or inadequate ERCP underwent MR cholangiopancreatography using a two-dimensional heavily T2-weighted multislice fast spin-echo technique. The final diagnosis was made on the basis of a second ERCP (n = 4), percutaneous transhepatic cholangiopancreatography (n = 19), intraoperative cholangiography (n = 6), percutaneous biopsy (n = 3), surgical findings (n = 5), or clinical follow-up (n = 21) for a mean period of 22 months (range, 7-31 months). RESULTS: MR cholangiopancreatography was technically successful in 57 patients and resulted in a sensitivity, specificity, and diagnostic accuracy of 97.1%, 100%, and 98.2%, respectively. Overall, MR cholangiopancreatography gave clinically useful information that contributed to patient management in 56 (96.6%) of the 58 patients. On the basis of the MR cholangiopancreatography findings, patients were managed using a second ERCP (n = 4), combined percutaneous and endoscopic procedure (n = 2), percutaneous biliary stent insertion (n = 13), surgery (n = 12), chemotherapy (n = 1), or conservative treatment (n = 24). CONCLUSION: MR cholangiopancreatography was found to have a unique and valuable role in the investigation of patients in whom ERCP failed or was inadequate. MR cholangiopancreatography helped us avoid using invasive procedures such as percutaneous transhepatic cholangiography in the diagnosis of bile duct disease after failed ERCP.

Rubinstein-Taybi syndrome (RSTS) is a heterogeneous disorder with approximately 45-55% of patients showing mutations in the CREB binding protein and a further 3% of patients having mutations in EP300. We report a male child with a deletion of exons 3-8 of the EP300 gene who has RSTS. He has a milder skeletal phenotype, a finding that has been described in other cases with EP300 mutations. The mother suffered from pre-eclampsia and HELLP syndrome in the pregnancy. She subsequently developed a mullerian tumor of her cervix 6 years after the birth of her son.

BACKGROUND: Body image refers to a persons' sense of their own physical appearance. This can be negatively influenced by a number of factors including disease states and treatments. Inflammatory bowel disease (IBD) carries a distinct psychosocial and a physical burden, but body image has not been formally assessed in patients with IBD, nor is there a validated body image questionnaire. Our aim was to assess and validate a body image questionnaire for patients with IBD. METHODS: Three hundred thirty-eight ambulatory patients (median age, 36; 174 male) completed a questionnaire that included the Hopwood body image scale adapted from the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Study Group. Data from another scale, the Cash Body Image Disturbance Questionnaire, were also collected in addition to demographic and clinical data. RESULTS: Factor analysis resulted in a single factor solution explaining 65% of the variance. Internal consistency of the body image scale was demonstrated with a Cronbach alpha of 0.93. Convergent validity was established with a correlation coefficient of 0.64 (P < 0.001) with the Cash Body Image Disturbance Questionnaire. Females (P < 0.001) and those who had undergone either stoma or nonstoma forming surgery experienced more body image dissatisfaction (P = 0.002), indicating predictive validity. Reliability was confirmed with a test-retest correlation of 0.82 (P < 0.001). CONCLUSIONS: The modified body image scale is a valid tool for assessing body image in patients with IBD.

Feed conversion efficiency is a measure of how well an animal converts feed into live weight and it is typically expressed as feed conversion ratio (FCR). FCR and related traits like growth rate (e.g. days to 110 kg-D110) are of high interest for animal breeders, farmers and society due to implications on animal performance, feeding costs and environmental sustainability. The objective of this study was to identify genomic regions associated with FCR and D110 in pigs. A total of 952 terminal line boars, showing an individual variation in FCR, were genotyped using 60K SNP-Chips. Markers were tested for associations with estimated breeding values (EBV) for FCR and D110. For FCR, the largest number of associated SNPs was located on chromosomes 4 (30 SNPs), 1 (25 SNPs), X (15 SNPs) and 6 (12 SNPs). The most prominent genomic regions for D110 were identified on chromosomes 15 (10 SNPs), 1 and 4 (both 9 SNPs). The most significantly associated SNPs for FCR and D110 mapped 129.8 Kb from METTL11B (chromosome 4) and 32Kb from MBD5 (chromosome 15), respectively. A list of positional genes, closest to significantly associated SNPs, was used to identify enriched pathways and biological functions related to the QTL for both traits. A number of candidate genes were significantly overrepresented in pathways of immune cell trafficking, lymphoid tissue structure, organ morphology, endocrine system function, lipid metabolism, and energy production. After resequencing the coding region of selected positional and functional candidate genes, six SNPs were genotyped in a subset of boars. SNPs in PRKDC, SELL, NR2E1 and AKRIC3 showed significant associations with EBVs for FCR/D110. The study revealed a number of chromosomal regions and candidate genes affecting FCR/D110 and pointed to corresponding biological pathways related to lipid metabolism, olfactory reception, and also immunological status.

INTRODUCTION: The aim of this study is to determine if simulated 3D vision improves the speed and accuracy of laparoscopic phantom tasks in laparoscopically naïve subjects. METHODS: Thirty laparoscopically naïve subjects were divided into matched groups according to age, sex, hand dominance and initial scores on a standardised visio-spatial test. Laprotrain(©) laparoscopic simulators were used, one attached to the standard 2D monitor and the other to a simulated 3D monitor and 3D glasses were worn by the subjects in this group. Five standardised laparoscopic tasks were developed and the subjects underwent testing on four separate occasions with more than 24 h between sessions. The subjects were timed for each task and errors were recorded by two independent observers. In the second part of the study, subjects switched to the opposite group and task times and errors were again recorded. Statistical differences between groups were calculated using student t-test and Fisher's exact test. RESULTS: There were fifteen subjects in each group with no significant difference in demographic or psychometric variables. The mean time to complete the tasks was faster in the 3D group compared with the 2D group. There was a lower rate of errors noted in the 3D group compared with the 2D group but this only reached statistical significance in two of the five laparoscopic tasks. In the crossover study, subjects who had trained on simulated 3D had better task times and fewer errors compared to those who had trained on 2D simulators. DISCUSSION & CONCLUSION: Training on a simulated 3D model (compared to standard 2D) allows trainees to reach proficiency sooner.