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Over the last decade there have been marked changes in the surgical management of patients with complications of acute complicated diverticular disease. Resections are now frequently undertaken laparoscopically with the use of laparoscopic lavage in the emergency setting. The thresholds for elective resection after recurrent episodes of acute diverticulitis have changed with a greater focus on tailored decision making with the patient. There have been alterations to the threshold for primary anastomosis especially in the emergency setting. This review of the evidence aimed to provide information for both clinicians and patient on what were the clinically and cost effective surgical approaches to the management of acute complicated diverticular disease.Diverticular abscess represents a particular therapeutic challenge given the predominant age and frequent co-morbidities of patients presenting with the condition. There has been much interest in the use of minimally invasive techniques such as percutaneous drainage to minimise the morbidity and mortality that is associated with resectional surgery. However, no clear guidance is currently available to suggest which patients should undergo percutaneous drainage versus surgery or for the subsequent management of patients initially treated conservatively. This review of the evidence aimed to provide information for both clinicians and patient to determine the clinical and cost effectiveness of percutaneous drainage versus resectional surgery for the management of diverticular abscess.This review evaluates the evidence for any treatment options for recurrent diverticular disease. These treatment options could be non-pharmacological treatments such as dietary advice or lifestyle changes or could include pharmacological treatment such as analgesia, aminosalicylates and antibiotics. The aim of these treatments would be to reduce the symptoms of diverticular disease and to also prevent future episodes of acute diverticulitis. Patients with diverticular disease are generally given dietary advice to increase fibre intake maintain an adequate fluid intake and maybe avoid certain types of food. The aim of this question was to evaluate the evidence behind these common recommendations. There are currently no medicines routinely used to treat diverticular disease other than potentially recommending bulk forming laxatives if a high fibre diet is insufficient symptom control. Symptoms of diverticular disease often include abdominal pain and analgesia such as paracetamol may be recommended. Generally patients with diverticular disease are advised to avoid non-steroidal anti-inflammatories and opioid based pain killers. This question also aimed to determine if there is any evidence for any pharmacological treatments in the management of diverticular disease.In this chapter we give recommendations about the ways clinicians should support patients, their families and carers. At present the support seems to vary greatly from one clinician to another and there is no national standard. Patients require a prompt and reliable diagnosis, with clinicians being alert to symptoms and signs indicative of diverticular disease and possible complications. Patients and their support network will generally wish to understand the anatomy of diverticular disease and to be advised about the extent to which the patient can self-medicate and what symptoms and signs would require further advice from a clinician. Advice about a healthy diet, lifestyle and symptom control will be of great importance. When patients are scheduled for surgery, it may be important to patients and their families that they are given clear advice about the nature of the surgery and what, if any, potential changes in bowel habit and other bodily functions can be expected afterwards. Other matters for consideration will include the advice to be given to patients and their families on discharge from hospital. This might include comprehensive advice about wound care, the care of indwelling catheters (if fitted), the need to avoid strenuous exercise and the likely harm that might ensue if such advice is not followed.Over the last decade there have been marked changes in the surgical management of patients with complications of acute complicated diverticular disease. Resections are now frequently undertaken laparoscopically with the use of laparoscopic lavage in the emergency setting. The thresholds for elective resection after recurrent episodes of acute diverticulitis have changed with a greater focus on tailored decision making with the patient. There have been alterations to the threshold for primary anastomosis especially in the emergency setting. This review of the evidence aimed to provide information for both clinicians and patient on what were the clinically and cost effective surgical approaches to the management of acute complicated diverticular disease.Diverticulitis is one of the most common reasons for elective bowel resections after cancer. However, there seems to be significant differences between clinicians about how to treat acute diverticulitis. Treatment varies from ‘watch and wait’, medication and surgery. There are also great variances between clinicians about when to operate, it seems to differ on the number of recurrences, the severity of the condition and how the condition affects the patient’s quality of life. Age and comorbidities are also taken into consideration. This question is aimed to review the evidence and aid the clinician’s decision when considering surgery on these patients.Perforated diverticular disease is most commonly treated by resection of the affected segment of bowel and formation of an end stoma (Hartmann’s procedure) or primary resection and anastomosis with or without a diverting stoma. These operations are associated with a high morbidity and mortality and often leave patients with a permanent stoma. Due to the high morbidity and mortality there has been a drive to pursue less invasive surgical procedures. One such procedure is the use of laparoscopic lavage for patients presenting with purulent peritonitis secondary to diverticular perforation. This review aimed to provide evidence of the clinical and cost effectiveness of this approach compared to resectional surgery.This review evaluates the evidence for treatment options for diverticular disease. These treatment options could be non-pharmacological treatments such as dietary advice or lifestyle changes or could include pharmacological treatment such as analgesia, aminosalicylates and antibiotics. The aim of these treatments would be to reduce the symptoms of diverticular disease. Patients with diverticular disease are generally given dietary advice to increase fibre intake, maintain an adequate fluid intake and maybe avoid certain types of food. The aim of this question was to evaluate the evidence behind these common recommendations. There are currently no medicines routinely used to treat diverticular disease other than potentially recommending bulk forming laxatives if a high fibre diet is insufficient symptom control. Symptoms of diverticular disease often include abdominal pain and analgesia such as paracetamol may be recommended. Generally patients with diverticular disease are advised to avoid nonsteroidal anti-inflammatories and opioid based pain killers. This question also aimed to determine if there is any evidence for any pharmacological treatments in the management of diverticular disease.Diverticulosis, the presence of colonic diverticulae unaccompanied by inflammation or resulting symptoms is extremely common. Diverticulosis does not, in itself, constitute a pathological condition, without the progression to diverticular disease. Many, perhaps even the majority, of patients with diverticulosis will never develop diverticular disease but perforation may occur. However, knowing how to reduce the risk of developing diverticular disease is important for many patients with diverticulosis. Following an incidental finding of diverticulosis many patients will ask their clinicians for advice on how to prevent diverticular disease or its complications. This section considers the evidence that exists for the clinical and cost effectiveness of conservative measures to prevent diverticular disease in patients with diverticulosis.This guideline covers the diagnosis and management of diverticular disease in people aged 18 years and over. It aims to improve diagnosis and care and help people get timely information and advice, including advice about symptoms and when to seek help.Altered DNA methylation upon ageing may result in many age-related diseases such as osteoporosis. However, the changes in DNA methylation that occur in cortical bones, the major osteocytic areas, remain unknown. In our study, we extracted total DNA and RNA from the cortical bones of 6-month-old and 24-month-old mice and systematically analysed the differentially methylated regions (DMRs), differentially methylated promoters (DMPs) and differentially expressed genes (DEGs) between the mouse groups. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of the DMR-related genes revealed that they were mainly associated with metabolic signalling pathways, including glycolysis, fatty acid and amino acid metabolism. Other genes with DMRs were related to signalling pathways that regulate the growth and development of cells, including the PI3K-AKT, Ras and Rap1 signalling pathways. The gene expression profiles indicated that the DEGs were mainly involved in metabolic pathways and the PI3K-AKT signalling pathway, and the profiles were verified through real-time quantitative PCR (RT-qPCR). Due to the pivotal roles of the affected genes in maintaining bone homeostasis, we suspect that these changes may be key factors in age-related bone loss, either together or individually. Our study may provide a novel perspective for understanding the osteocyte and its relationship with osteoporosis during ageing. SIGNIFICANCE OF THE STUDY Our study identified age-related changes in gene expressions in osteocytic areas through whole-genome bisulfite sequencing (WGBS) and RNA-seq, providing new theoretical foundations for the targeted treatment of senile osteoporosis.Background/objectives For older adults with acute hip fracture, use of preoperative noninvasive cardiac testing may lead to delays in surgery, thereby contributing to worse outcomes. Our study objective was to evaluate the preoperative use of pharmacologic stress testing and transthoracic echocardiogram (TTE) in older adults hospitalized with hip fracture. Design Retrospective chart review. Setting Seven hospitals (three tertiary, four community) within a large health system. Participants Patients, aged 65 years and older, hospitalized with hip fracture (n = 1,079; mean age = 84.2 years; 75% female; 82% white; 36% married). Measurements Data were extracted from electronic medical records. The study evaluated associations between patient factors as well as clinical outcomes (time to surgery [TTS], length of stay [LOS], and in-hospital mortality) and the use of preoperative noninvasive cardiac testing (pharmacologic stress tests or TTE). Descriptive statistics were calculated. Cox regression was performed for both TTS and LOS (evaluated as time-dependent variable); logistic regression was used for in-hospital mortality.