North Tyneside General Hospital Research Articles

Effects of obesity and weight loss on microRNA expression in the human colorectal mucosa

AbstractIntroductionColorectal cancer (CRC) is the 3rd most common cancer worldwide. Obesity, and its lifestyle determinants, physical inactivity and poor diet, increase CRC risk. However, the effects of weight loss by bariatric surgery on CRC risk are unclear. Epigenetic mechanisms involving microRNAs that lead to dysregulated gene expression may mediate the effects of obesity and weight loss on CRC risk. We hypothesised that microRNAs are i) aberrantly expressed in obese individuals compared with healthy non-obese individuals and ii) modulated by significant weight loss following bariatric surgery.MethodsWe used data and samples from the Biomarkers of Colorectal Cancer after Bariatric Surgery (BOCABS) Study. Obese patients listed for bariatric surgery and age- and sex-matched healthy non-obese adults (Controls) were recruited at North Tyneside General Hospital. Rectal mucosal biopsies were collected at baseline and six months post-surgery from obese participants and at baseline only from Controls. Using Next Generation Sequencing and bioinformatics analysis, a panel of 8 microRNAs was selected and validated by quantitative PCR in colorectal mucosal biopsies.Results and discussionData were available for 20 control participants and for 22 obese participants with matched pre- and post-surgery samples. Next Generation Sequencing revealed that compared with non-obese individuals, obese individuals showed differential expression of 112 microRNAs (p < 0.05). Roux-en-Y gastric bypass, resulted in differential expression of 60 microRNAs, when compared with expression levels at baseline (p < 0.05). A total of 36 microRNAs differed significantly in both i) the obese with non-obese and ii) the pre- and post-surgery comparisons. Validation by quantitative PCR demonstrated that expression of miR-31, miR-215, miR-3196 and miR-4516 was significantly (P < 0.05) higher in obese than in non-obese individuals. Weight loss, (mean 28.5kg) following Roux-en-Y gastric bypass, reduced expression of miR-31, miR-215 and miR-3196 significantly (P < 0.05) to expression levels that were comparable with those in Controls. These differentially expressed microRNAs are implicated in pathways linked with inflammation, obesity and cancer.ConclusionThe pattern of microRNA expression in macroscopically-normal human colorectal mucosa differed substantially between obese and non-obese individuals. However, six months after Roux-en-Y gastric bypass, the pattern of microRNA expression was similar to that in non-obese Controls. This suggests that surgically-induced weight loss may normalise microRNA expression in the human colorectal mucosa and so reduce CRC risk.

Design and baseline characteristics of the Biomarkers Of Risk In Colorectal Cancer (BORICC) Follow-Up study: A 12+ years follow-up.

Colorectal cancer (CRC) is the third most common cancer worldwide. Age is the strongest non-modifiable risk factor but it is estimated that over half of CRC cases are linked with lifestyle factors such as diet. The Biomarkers Of RIsk of Colorectal Cancer (BORICC) Study recruited 363 participants in 2005 to investigate the effects of lifestyle factors on biomarkers of CRC risk. In the present BORICC Follow-Up (BFU) Study, we are using a longitudinal study design to investigate the effects of ageing (12+ years) and lifestyle factors on biomarkers of CRC risk and on healthy ageing. BFU Study participants attended a study visit at North Tyneside General Hospital (UK) for collection of biological samples, including blood and rectal biopsies, and information collected included anthropometric measurements, a Health & Medications Questionnaire, physical activity and sedentary behaviour, and habitual diet. Furthermore, musculoskeletal function was assessed by heel bone densitometry, timed up and go and hand grip strength as markers of healthy ageing. The BFU Study outcomes will be similar to those measured at baseline in the BORICC Study, such as DNA methylation and mitochondrial function, with additional measurements including the gut microbiome, faecal short-chain fatty acid concentrations and expression of genes associated with CRC. Participants' recruitment to BFU Study and all sample and data collection have been completed. Forty-seven of the original BORICC participants were re-recruited to the BFU Study (mean age 67 years, 51% female). The recruits included 37 initially healthy participants and 10 participants who had adenomatous polyps at baseline. Approximately 70% of participants were over-weight or obese. Ultimately, identifying lifestyle factors that can reduce CRC risk, and understanding the underlying mechanisms for the effects of lifestyle and ageing on CRC risk, could lead to early prevention strategies.

Remarkably Few Sputum Cultures from People with Parkinson's Disease during Hospital In-Patient Admission.

Although respiratory tract infections can be a common complication in people with Parkinson's disease (PD), there is little published data on the nature of such infections in this patient group. We wished to investigate whether sputum samples were being taken from PD patients in order to establish whether an infection was present and if so which bacteria were responsible for the infection. We recorded the number of positive sputum samples taken from admission to North Tyneside General Hospital in North-East England across a ten-year period from June 2001 to June 2011. Of 643 in-patient episodes involving people with PD, positive sputum samples were recorded for only 12 episodes (1.9%) in eight patients. All patients were in early stage disease. In all admissions to the NHS Trust running the hospital, there were 23,069 sputum cultures from 1,056,693 in-patient episodes (2.2%). Our findings may reflect the difficultly of expectorating in many people with PD, particularly in late-stage disease. Since people with PD are especially vulnerable to respiratory tract infections, clinicians need to ensure that, where possible, a sputum sample is obtained from people with PD when clinically indicated.

Ectopic Pregnancy and Tubal Abortion

AbstractDOI: http://dx.doi.org/10.3126/njog.v9i2.11773

Case-based discussion from North Tyneside General Hospital: somatostatin analogues in yellow nail syndrome associated with recurrent pleural effusions

Kristian Brooks (KB): A 77-year-old man presented to accident and emergency with a 1-month history of progressive breathlessness and reduced exercise tolerance. He had no chest pain, cough or wheeze,...

MRI for the pre-operative workup of invasive lobular breast cancer: Change in diagnosis

MRI for the pre-operative workup of invasive lobular breast cancer: Change in diagnosis

47 Audit of medical thoracoscopy at North Tyneside General Hospital

47 Audit of medical thoracoscopy at North Tyneside General Hospital

Gender differences in 1-year survival rates after weight loss in people with idiopathic Parkinson's disease

Under-nutrition is a recognized non-motor symptom of Parkinson's disease (PD). The aim of this retrospective study was to conduct an audit of recorded weight loss prior to death in people with PD and to identify whether weight loss was a predictor of death. An audit of the medical records of people with PD was conducted. Patients were included if they were under the care of the North Tyneside General Hospital PD team, had a diagnosis of idiopathic PD, and died between 1 January 2008 and 31 December 2010. To assess whether there was a significant association between clinically significant weight loss and mortality, values of 5% and 10% weight loss from earliest available post-diagnosis baseline assessment were chosen as cut-offs. Data were available on 55 patients. Although females were more likely to have 10% weight loss than men, the difference was not significant. The odds of a female with weight loss surviving beyond 1 year were 23.4 (95% confidence interval (CI) 3.9-139.9) times better than those of a male for 5% weight loss and 10.0 (95% CI 1.8-55.6) times better than those of a male for 10% weight loss. These results were significant. Outcomes for males with PD who have clinically important weight loss are poorer than for females. Nurses and other health workers should be aware of the need to monitor weight in people with PD.

P02-159 Completed audit cycle on lithium monitoring on older adults in northumbria healthcare NHS trust, UK

Aims:The aim of this study was to audit the practise of Lithium monitoring on all patients over the age of 65 years, over a one-year period in North Tyneside General Hospital, against the recommended standards, and re-auditing the following year.Methods:During the audit; data was collected from the medical notes of all patients prescribed Lithium, over 65 years in North Tyneside General Hospital. This was from January 2004 - January 2005. The standards used were the recommendations of The British National Formulary. The monitoring of urea, electrolytes, TSH and Lithium were recorded. The presence of an ECG, documentation of side effects, information leaflets’ distribution and patients lost to follow up were noted. Following the audit, recommendations were made and prescribing Consultants were informed. A re-audit was conducted on all patients on Lithium the next year from January 2006 - June 2006, using the same designed tool.Results:22 patient's notes were audited and 29 notes re-audited. 41% were males and 59% females in the audit, with similar distribution in the re-audit. 54% were between 65-75 years and 45% over the age of 75years in the audit. 41% and 59% respectively in the re-audit. Blood monitoring followed the standards in 86% in the audit and 95% in the re-audit. 32% had documentation of side effects in the audit, increasing to 72% in the re-audit. While 23% patients were lost to follow up in the audit, all were followed up in the re-audit.Conclusions:The re-audit encouragingly showed significant improvement in practise.

Dysferlinopathy: From Gene to Protein

From the Department of Paediatrics, North Tyneside General Hospital, Rake Lane, North Shields, UK. Reprints: Eugen-Matthias Strehle, MD, MSc, MPhil, Department of Paediatrics, North Tyneside General Hospital, Rake Lane, North Shields NE29 8NH, UK (e-mail: [email protected]).

News

Tanzania to Tyneside: A&E nurse Robert Shuguru last month picked up some ideas on how to develop his emergency department at the Kilimanjaro Christian Medical Centre by visiting North Tyneside General Hospital. Pictured here with staff nurse Kerry Watts, Mr Shuguru wants to set up a triage system. 'Nurses must be responsible for safe assessment of patients before they are seen by doctors,' he said. Ms Watts travelled to Kilimanjaro in February with fellow staff nurse Ann Taylor to help establish an emergency resuscitation service there.

Flexible Needs led Community COPDOutreach Service

Introduction:Four hundred admissions annually to North Tyneside General Hospital with COPD, high rate of Social Service input, high rate of consultations and house calls to GPs, high rate of elderly patients.Rationale:Patients with COPD require care, encompassing physical, medical, social, psychological and social needs. The limitations of the current service provision highlighted a vulnerable client group that was receiving fragmented care. Social Services and the Respiratory Team at NTGH identified the unmet needs in patients with COPD. The COPD Service was therefore initiated to provide a flexible, needs led, proactive and health-promoting service. The Service comprises of a Respiratory Nurse Specialist who leads a team of six generic outreach workers. Since commencement of referrals in July 2000 to the end of March 2001 the service had received 115 referrals. Fity-five of these patients were provided with Outreach support. Fourty-five patients were assessed and appropriate needs addressed solely by the Respiratory Nurse Specialist. Fifteen were inappropriate referrals to the service.Evaluation:The service was reviewed at the end of March in conjunction with the University of Northumbria. Postal questionnaires were sent to all patients with an 82% response rate. Telephone interviews with 6 patients, interviews with all staff. At that time the active caseload was 33 patients.Mean age was 75 years58% Male, 42% FemaleMRC Scale 5–76%66% on Oxygen therapy, 45% LTOT, 21% p.r.n.The caseload can be divided into four main bands, palliative care, exercise and breathing training, social isolation and carer relief.

Abstracts of literature

Abstracts of literature

7226 Push enteroscopy in a medium-sized uk hospital.

Introduction: Push enteroscopy is a comparatively new endoscopy technique not routinely available in the UK.We have offered push enteroscopy to patients attending our hospital for 2 years. North Tyneside General Hospital serves a mixed urban population of approximately 200,000 people. In general it does not receive tertiary referrals, although the enteroscopy service has attracted some referrals from other hospitals outside our catchement area. Aims: To determine during a two year period the number of patients referred for enteroscopy from our own population and from further afield, the indication for referral, the diagnoses made and alterations to patient management. Methods: The medical notes of all 52 patients referred for enteroscopy during this period were reviewed. All except one underwent enteroscopy. 26 patients were referred from within the hospital and 26 from outside. Results: 26 referrals were made from our 200,000 population over a 2 year period. This suggests that there is a need for approximately 6-7 push enteroscopies per 100,000 people per year in our population. The indications for enteroscopy were: Obscure GI haemorrhage (n=32 with 19 acute and 13 chronic cases) Arteriovenous malformations (AVM's) on initial endoscopy (n=7) Unexplained clinical deterioration in known coeliac disease (n=4) Abnormal small bowel follow through (n=5) Other; weight loss, diarrhoea +/- abdominal pain (n=4). Of the 51 patients undergoing enteroscopy, less than half (49%) were normal. Of the 26 abnormal enteroscopies, 7 had pathology in the stomach or first part of the duodenum (D1) that had not been diagnosed on initial OGD. Three had known AVM's in the stomach or D1 only but none distally. There were 9 patients with small bowel AVM's distal to D1 sufficient to explain their presentation and all were treated at enteroscopy. Important and unexpected diagnoses made were three cases of T cell lymphoma, two cases of coeliac disease, one of collagenous enteritis and one of jejunal adenocarcinoma. Conclusions: As in previous series, obscure GI bleeding, both acute and chronic, was the main indication for push enteroscopy and small bowel AVM's were the most frequent finding. Push enteroscopy led to alterations in management in 51% of the cases and, as previously reported, missed abnormal findings within reach of OGD were frequent (14%). Although the need for push enteroscopy appears to be small, it would only take small changes in referral practice to increase this need significantly.

Using radiology records to improve epidemiological information in paediatric fractures: a feasibility study

Objectives: To assess the feasibility of using routine computerised radiology records for community injury surveillance data using fractures in the child population as an example. Design: Radiology and in-patient computerised files were accessed to extract information concerning type of fracture, age, sex, and home address. Diagnostic coding of radiological reports was carried out using the ICD-9 classification. Children were assigned to local authority wards using home postcodes derived from home addresses. Ward fracture rates were calculated using 1991 census data. The association between ward fracture rates and deprivation was explored using Townsend scores. Setting: North Tyneside General Hospital. Subjects: Children aged 10–14 y receiving care as in-patients or out-patients for long-bone fractures. Results: Between April 1991 and March 1996 a total of 497 long-bone fractures were identified. Fractures in boys exceeded those in girls by a ratio of 2:1. The most common fracture identified was of the radius and ulna. There was no evidence of an ecological association between long-bone fracture rates in children aged 10–14 y and social deprivation. Conclusions: Computerised radiological records may be used to improve epidemiological information concerning fractures. However, at present, considerable time and effort is required to access the information, to identify and to classify, long-bone fractures. Such data could be used to assist in the audit of clinical care and long-term outcomes, and to inform effective local planning and evaluation of injury prevention initiatives.