The association between TMAO, CMPF, and clinical outcomes in advanced chronic kidney disease: results from the European QUALity (EQUAL) Study

BACKGROUND

Trimethylamine N-oxide (TMAO), a metabolite from red meat and fish consumption, plays a role in promoting cardiovascular events. However, data regarding TMAO and its impact on clinical outcomes are inconclusive, possibly due to its undetermined dietary source.

OBJECTIVES

We hypothesized that circulating TMAO derived from fish intake might cause less harm compared with red meat sources by examining the concomitant level of 3-carboxy-4-methyl-5-propyl-2-furanpropionate (CMPF), a known biomarker of fish intake, and investigated the association between TMAO, CMPF, and outcomes.

METHODS

Patients were recruited from the European QUALity (EQUAL) Study on treatment in advanced chronic kidney disease among individuals aged ≥65 y whose estimated glomerular filtration rate (eGFR) had dropped for the first time to ≤20 mL/min per 1.73 m2 during the last 6 mo. The association between TMAO, CMPF, and outcomes including all-cause mortality and kidney replacement therapy (KRT) was assessed among 737 patients. Patients were further stratified by median cutoffs of TMAO and CMPF, suggesting high/low red meat and fish intake.

RESULTS

During a median of 39 mo of follow-up, 232 patients died. Higher TMAO was independently associated with an increased risk of all-cause mortality (multivariable HR: 1.46; 95% CI: 1.17, 1.83). Higher CMPF was associated with a reduced risk of both all-cause mortality (HR: 0.79; 95% CI: 0.71, 0.89) and KRT (HR: 0.80; 95% CI: 0.71, 0.90), independently of TMAO and other clinically relevant confounders. In comparison to patients with low TMAO and CMPF, patients with low TMAO and high CMPF had reduced risk of all-cause mortality (adjusted HR: 0.49; 95% CI: 0.31, 0.73), whereas those with high TMAO and high CMPF showed no association across adjusted models.

CONCLUSIONS

High CMPF conferred an independent role in health benefits and might even counteract the unfavorable association between TMAO and outcomes. Whether higher circulating CMPF concentrations are due to fish consumption, and/or if CMPF is a protective factor, remains to be verified.

ASAS-NANP SYMPOSIUM: MATHEMATICAL MODELING IN ANIMAL NUTRITION: Opportunities and Challenges of Confined and Extensive Precision Livestock Production

Modern animal scientists, industry, and managers have never faced a more complex world. Precision livestock technologies have altered management in confined operations to meet production, environmental, and consumer goals. Applications of precision technologies have been limited in extensive systems such as rangelands due to lack of infrastructure, electrical power, communication, and durability. However, advancements in technology have helped to overcome many of these challenges. Investment in precision technologies is growing within the livestock sector, requiring the need to assess opportunities and challenges associated with implementation to enhance livestock production systems. In this review, precision livestock farming and digital livestock farming are explained in the context of a logical and iterative five-step process to successfully integrate precision livestock measurement and management tools, emphasizing the need for precision system models (PSMs). This five-step process acts as a guide to realize anticipated benefits from precision technologies and avoid unintended consequences. Consequently, the synthesis of precision livestock and modeling examples and key case studies help highlight past challenges and current opportunities within confined and extensive systems. Successfully developing PSM requires appropriate model(s) selection that aligns with desired management goals and precision technology capabilities. Therefore, it is imperative to consider the entire system to ensure that precision technology integration achieves desired goals while remaining economically and managerially sustainable. Achieving long-term success using precision technology requires the next generation of animal scientists to obtain additional skills to keep up with the rapid pace of technology innovation. Building workforce capacity and synergistic relationships between research, industry, and managers will be critical. As the process of precision technology adoption continues in more challenging and harsh, extensive systems, it is likely that confined operations will benefit from required advances in precision technology and PSMs, ultimately strengthening the benefits from precision technology to achieve short- and long-term goals.

Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study

Background

Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex.

Methods

CKD patients (≥65 years; estimated glomerular filtration rate ≤20 mL/min/1.73 m²) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off ≤70; 0–100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders.

Results

Overall kidney function decline in 1326 patients was –0.12 mL/min/1.73 m²/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03–1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality).

Conclusions

There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men.

TORSAFUF - Surgical exploration for torsion of spermatic cord suspicion and risk factors for unnecessary surgery: Results of a French nationwide retrospective study on 2940 patients

BACKGROUNDS

Spermatic cord torsion is a frequent urological emergency that mostly concerns teenagers and young adults. This study aimed to determine the clinical and surgical characteristics of young adults who had scrotal exploration for suspected spermatic cord torsion and to identify clinical risk factors associated with needless scrotal exploration.

METHODS

We retrospectively collected national data from patients aged 12years and older who underwent a surgical exploration for suspicion of torsion of the spermatic cord between 2005 and 2019 in 17 hospitals. We analyzed demographics, surgical and postoperative characteristics in our population. We compared the cohort according to the intraoperative diagnosis of torsion or not.

RESULTS

In total, 2940 had surgical exploration: 1802 (61.3%) patients had torsion of the spermatic cord and 1138 (38.7%) had another diagnosis. In multivariate analysis, age (OR: 1.04; 95% CI: 1.01-1.06; P=0.005), medical history of cryptorchism (OR: 4.14; 95% CI: 1.05-16.31; P=0.042) and VAS pain score (OR: 0.91; 95% CI: 0.83-0.98; P=0.018) were risk factors significantly associated with unnecessary surgical exploration. The rate of complications in the 90days after surgery was 11% in the "torsion" group, and 9.7% in the "non-torsion" group (P=0.28).

CONCLUSION

Scrotal exploration without intraoperative diagnosis of torsion was performed in 40% of our cohort. VAS pain score and cryptorchism history can help for the diagnosis but scrotal exploration remains the way to diagnose spermatic cord torsion and should be performed on the slightest suspicion, even after 24hours of symptoms, as the chances for testicular salvage remains around 50%.

The relationship between uremic toxins and symptoms in older men and women with advanced chronic kidney disease

Background

Patients with stage 4/5 chronic kidney disease (CKD) suffer from various symptoms. The retention of uremic solutes is thought to be associated with those symptoms. However, there are relatively few rigorous studies on the potential links between uremic toxins and symptoms in patients with CKD.

Methods

The EQUAL study is an ongoing observational cohort study of non-dialyzed patients with stage 4/5 CKD. EQUAL patients from Germany, Poland, Sweden and the UK were included in the present study (n = 795). Data and symptom self-report questionnaires were collected between April 2012 and September 2020. Baseline uric acid and parathyroid hormone and 10 uremic toxins were quantified. We tested the association between uremic toxins and symptoms and adjusted P-values for multiple testing.

Results

Symptoms were more frequent in women than in men with stage 4/5 CKD, while levels of various uremic toxins were higher in men. Only trimethylamine N-oxide (TMAO; positive association with fatigue), p-cresyl sulfate (PCS) with constipation and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (negative association with shortness of breath) demonstrated moderately strong associations with symptoms in adjusted analyses. The association of phenylacetylglutamine with shortness of breath was consistent in both sexes, although it only reached statistical significance in the full population. In contrast, TMAO (fatigue) and PCS and phenylacetylglutamine (constipation) were only associated with symptoms in men, who presented higher serum levels than women.

Conclusion

Only a limited number of toxins were associated with symptoms in persons with stage 4/5 CKD. Other uremic toxins, uremia-related factors or psychosocial factors not yet explored might contribute to symptom burden.

Methylphenidate modulates interactions of anxiety with cognition

While a large body of literature documents the impairing effect of anxiety on cognition, performing a demanding task was shown to be effective in reducing anxiety. Here we explored the mechanisms of this anxiolytic effect by examining how a pharmacological challenge designed to improve attentional processes influences the interplay between the neural networks engaged during anxiety and cognition. Using a double-blind between-subject design, we pharmacologically manipulated working memory (WM) using a single oral dose of 20 mg methylphenidate (MPH, cognitive enhancer) or placebo. Fifty healthy adults (25/drug group) performed two runs of a WM N-back task in a 3 T magnetic resonance imaging scanner. This task comprised a low (1-Back) and high (3-Back) WM load, which were performed in two contexts, safety or threat of shocks (induced-anxiety). Analyses revealed that (1) WM accuracy was overall improved by MPH and (2) MPH (vs. placebo) strengthened the engagement of regions within the fronto-parietal control network (FPCN) and reduced the default mode network (DMN) deactivation. These MPH effects predominated in the most difficult context, i.e., threat condition, first run (novelty of the task), and 3-Back task. The facilitation of neural activation can be interpreted as an expansion of cognitive resources, which could foster both the representation and integration of anxiety-provoking stimuli as well as the top-down regulatory processes to protect against the detrimental effect of anxiety. This mechanism might establish an optimal balance between FPCN (cognitive processing) and DMN (emotion regulation) recruitment.

No efficacy of biofield therapy in the treatment of warts of the hands and feet in adults: a randomized controlled trial

Although biofield therapy is unexplained by scientific evidence, it has been practised for many years in numerous cultures for a variety of medical conditions. This study aimed to determine whether one session of biofield therapy with an experienced practitioner could treat warts on the hands and feet in adults. A single-blind, assessor-blind, placebo-controlled, randomized trial was performed between April 2016 and November 2018. The enrolled participants had at least one wart on the hand or foot that had been present for at least 90 days and they were not using any other therapy for the wart. The primary outcome of this trial was the disappearance of the original wart 3 weeks after session of proximal nontouch biofield therapy vs. a sham session. No original wart had disappeared 3 weeks after intervention (0/64), which made the study impossible to conclude on the primary objective. There were no significant differences between the two groups concerning wart disappearance 3 weeks (P = 0.49) or 6 weeks (P = 0.40) after the intervention. Reduction in wart size at Week 3 tended towards a better result for biofield therapy but this was not significant (P = 0.27). No related adverse effects were observed. The major limitation of this trial was the short follow-up time for measurement of clinical outcome, which did not allow verification of the hypothesis. However, this study shows that 3 weeks after a session of proximal nontouch biofield therapy is an insufficient length of time to assess biofield therapy in comparison with a sham session. Based on this study, biofield therapy cannot be recommended to treat warts within 3 weeks.

Behavioral validation of novel high resolution attention decoding method from multi-units & local field potentials

The ability to access brain information in real-time is crucial both for a better understanding of cognitive functions and for the development of therapeutic applications based on brain-machine interfaces. Great success has been achieved in the field of neural motor prosthesis. Progress is still needed in the real-time decoding of higher-order cognitive processes such as covert attention. Recently, we showed that we can track the location of the attentional spotlight using classification methods applied to prefrontal multi-unit activity (MUA) in the non-human primates. Importantly, we demonstrated that the decoded (x,y) attentional spotlight parametrically correlates with the behavior of the monkeys thus validating our decoding of attention. We also demonstrate that this spotlight is extremely dynamic. Here, in order to get closer to non-invasive decoding applications, we extend our previous work to local field potential signals (LFP). Specifically, we achieve, for the first time, high decoding accuracy of the (x,y) location of the attentional spotlight from prefrontal LFP signals, to a degree comparable to that achieved from MUA signals, and we show that this LFP content is predictive of behavior. This LFP attention-related information is maximal in the gamma band (30-250 Hz), peaking between 60 to 120 Hz. In addition, we introduce a novel two-step decoding procedure based on the labelling of maximally attention-informative trials during the decoding procedure. This procedure strongly improves the correlation between our real-time MUA and LFP based decoding and behavioral performance, thus further refining the functional relevance of this real-time decoding of the (x,y) locus of attention. This improvement is more marked for LFP signals than for MUA signals. Overall, this study demonstrates that the attentional spotlight can be accessed from LFP frequency content, in real-time, and can be used to drive high-information content cognitive brain-machine interfaces for the development of new therapeutic strategies.

Use of an Oral Antiseptic Bioadhesive Tablet in Dogs

V3703 (Stomadhex®*) is a tablet with bioadhesive properties enabling it to remain in place for several hours after it has been placed on the oral mucosa. It continuously releases chlorhexidine and niacinamide. In a study conducted in 15 dogs, the tablets were well tolerated by the animals. The product significantly reduced (p < 0.05): dental plaque; quantitative periodontopathogen and total anaerobic bacterial counts; spirochetes; and halitosis when used daily over a 14 day period. Gingivitis was also reduced, though not significantly (p=0.07). Stomadhex® treatment can provide a carry-over effect following dental scaling by reducing oral microflora and retarding the reappearance of dental plaque.

Effect of the Oxygen Potential on the Mo Migration and Speciation in UO2 and UO2+ x

Molybdenum is an abundant element produced by fission in the nuclear fuel UO₂ in a pressurized water reactor. Although its radiotoxicity is low, this element has a key role on the fuel oxidation and other fission products migration, in particular in the case of an accidental scenario. This study aims to characterize the behavior of molybdenum in uranium dioxide as a function of environmental conditions (oxygen partial pressure, high temperature, UO₂ oxidation) typical of an accidental scenario. To do so, molybdenum was introduced in UO₂ or UO_{2+ x} pellets by ion implantation, a technique that allows us to mimic the production of Mo in the nuclear fuel by fission. Then, thermal treatments at high temperature and different oxygen partial pressures were carried out. The mobility of Mo in UO_X samples was followed by secondary ion mass spectrometry (SIMS), while the Mo chemical speciation was investigated by spectroscopic techniques (XANES, Raman). In parallel, ab initio calculations were performed showing the effect of interstitial oxygen atoms on the Mo incorporation sites in UO₂. We show that the Mo mobility is directly connected to its chemical state, which in turn, is linked to the redox conditions. Indeed, under reducing atmosphere, Mo is present in UO₂ or UO_{2+ x} samples under a metallic state Mo(0). Its mobility, being quite low, is driven by a diffusion mechanism. An increase of pO₂ entails the UO₂ and Mo oxidation and, as a consequence, a strong release of this element. We show an increase of the Mo release rate with the increase of the UO_{2+ x} hyper-stoichiometry x. After thermal treatment, Mo remaining in the samples is located in the grains under the MoO₂ form. Our experimental results are assessed by ab initio calculations showing that in the presence of oxygen Mo atoms adopt in UO₂ a local structure close to the octahedral local geometry of Mo oxides.

FIVHeMA: Intraventricular fibrinolysis versus external ventricular drainage alone in aneurysmal subarachnoid hemorrhage: A randomized controlled trial

INTRODUCTION

Aneurysmal subarachnoid hemorrhage (SAH) is a devastating form of stroke, which often causes acute hydrocephalus requiring the insertion of an external ventricular drain (EVD). A major complication of aneurysmal SAH is delayed cerebral ischemia (DCI). As DCI is linked to the presence of blood within the subarachnoid space, it has been hypothesized that removing this blood may decrease the risk of DCI. This could be achieved by injecting a fibrinolytic agent through the EVD, a strategy called intraventricular fibrinolysis (IVF). Here, we propose to conduct a phase III trial to directly evaluate the impact of IVF after aneurysmal SAH.

MATERIALS AND METHODS

We will perform an open-label randomized controlled trial comparing the standard of care, i.e. EVD alone, to the experimental treatment, i.e. IVF. We plan to include 440 patients to be able to show a 10% increase in the rate of good functional outcomes in the EVD+IVF group compared to the EVD alone group (α=0.05 and β=0.8). To obtain such sample, a multicenter trial is required, and to date 17 research sites in France have agreed to participate.

PERSPECTIVE

FIVHeMA would be the first phase III trial evaluating the relevance of IVF in aneurysmal SAH. If IVF is shown to be beneficial, then a new therapeutic tool will be available to improve the outcomes of aneurysmal SAH patients.

Myopathie der Labrador Retriever: neuromuskuläre Veränderungen bei kranken und klinisch gesunden Hunden

Gegenstand und Ziel: Die erbliche Myopathie der Labrador Retriever (LM) ist eine autosomal rezessive Krankheit, die bei schwarzen und gelben Tieren beiderlei Geschlechts und unterschiedlichen Alters vorkommt. Um der Frage nachzugehen, welche Rolle die LM in der hiesigen Labradorpopulation spielt, wurden seit 1998 am Institut für Neuropathologie der Universität Düsseldorf Muskel-und Nervenbiopsien von 121 Labrador Retrievern untersucht. Hunde: Die Tiere gehörten zu zwei Untersuchungsgruppen. Gruppe I (Einsendungen) umfasste 63 Labrador Retriever unterschiedlicher Herkunft aus Deutschland, Schweiz, Italien und Portugal mit Symptomen einer Myopathie. Gruppe II (Zuchttiere): Im Rahmen einer genetischen Studie wurden 58 miteinander verwandte Labrador Retriever aus einer Zucht in der Schweiz untersucht, nachdem dort bei zwei Welpen LM nachgewiesen worden war. Ergebnisse: Gruppe I: 17/63 (27%) hatten eine degenerative Myopathie vom Typ der Labrador-Myopathie, 8/63 (13%) metabolisch-mitochondriale Veränderungen, 33/63 (52%) andere (überwiegend neurogene oder entzündliche) Myopathien und bei 5/63 (8%) wurden keine pathologischen Veränderungen in Muskel und/oder Nerv nachgewiesen. Gruppe II: Zwar hatten nur sieben Tiere der Zucht klinische Symptome, doch wies die Mehrzahl morphologisch und histochemisch nachweisbare neuromuskuläre Veränderungen auf, nämlich 37/58 (64%) solche vom Typ der LM, darunter auch die Eltern und die sieben Geschwister der beiden Welpen, und 11/58 (19%) vorherrschend metabolisch-mitochondriale Veränderungen. Schlußfolgerungen: Die vorliegende Untersuchung zeigt, dass (a) die Verbreitung der erblichen Myopathie und deren Erfassung ein ernst zu nehmendes Problem beim Labrador Retriever darstellt und (b) neben der »klassischen« erblichen Typ-2-Myopathie der Labrador Retriever möglicherweise noch eine zweite, metabolisch-mitochondriale Form der Myopathie besteht, die Ähnlichkeiten mit einer anstrengungsabhängigen Myopathie bei Labrador Retrievern in den USA aufweist.

Effect of substituting soybean meal and canola cake with dried distillers grains with solubles at 2 dietary crude protein levels on feed intake, milk production, and milk quality in dairy cows

Dried distillers grain with solubles (DDGS) is an alternative source of feed protein for dairy cows. Previous studies found that DDGS, based on grains other than corn, can substitute for soybean meal and canola cake as a dietary protein source without reducing milk production or quality. As societal concerns exist, and in many areas strict regulation, regarding nitrogen excretion from dairy cows, the dairy industry has focused on reducing dietary protein level and nitrogen excretion. In the present study, we investigated the use of DDGS as a protein source, at a marginally low dietary crude protein (CP) levels, in a grass-clover and corn silage-based ration. The experiment involved 24 Holstein cows and 2 protein sources (DDGS or soybean-canola mixture) fed at 2 levels of CP (14 or 16%) in a 4 × 4 Latin square design. The aim of this study was to evaluate the effect of both protein source and protein level on feed intake, milk yield, and milk quality. The results indicated that feed intake, milk yield, and protein in milk increased when the protein level in the ration was 16% CP compared with 14%. We found no effect of substituting the soybean-canola mixture with DDGS. Moreover, no sensory problems were observed when comparing fresh milk with stored milk, and milk taste was unaffected by DDGS. Milk from cows fed DDGS had a slightly higher content of linoleic acid and conjugated linoleic acid (CLA 9-11), and lower content of C11 to C17 fatty acids than cows fed diets with the soybean-canola mixture. Cows fed the diets with 16% CP produced milk with higher oleic acids and lower palmitic acid content than cows fed 14% CP diets. To conclude, DDGS can substitute for a soybean-canola mixture without affecting feed intake, milk yield and quality, or sensory quality. Under the conditions of this experiment, feeding 16% CP compared with 14% CP in the ration can increase feed intake and milk production.

Effect of substituting soybean meal and canola cake with grain-based dried distillers grains with solubles as a protein source on feed intake, milk production, and milk quality in dairy cows

The growth of the bioethanol industry is leading to an increase in the production of coproducts such as dried distillers grains with solubles (DDGS). Both corn-based DDGS and grain-based DDGS (gDDGS; defined as originating from grain sources such as barley, wheat, triticale, or a mix, excluding corn) appear to be relevant sources of feed and protein for dairy cows. To date, most of the studies investigating DDGS have been performed with corn-based DDGS. The objectives of this study were to determine the effects of the proportion of gDDGS in the diet on feed intake, milk production, and milk quality. The present experiment involved 48 Holstein cows in a replicated 3 × 3 Latin square design with 3 grass-based dietary treatments consisting of 4, 13.5, and 23% gDDGS on a dry matter (DM) basis (L, M, and H, respectively) as a replacement for a concentrate mix. The concentrate mix consisted of soybean meal, canola cake, and beet pulp. Dry matter intake and energy-corrected milk yield were not affected by the proportion of gDDGS in the diet. Daily milk yield decreased with the H diet compared with the L and M diets. The percentage of fat in milk was higher when cows were fed the H diet compared with the L and M diets, whereas milk fat yield was not affected by dietary treatment. The M diet had a higher percentage of protein in milk compared with the L and H diets. Milk protein yield was similar for the L and M diets; however, it decreased for the H diet. Milk taste was not affected by the proportion of gDDGS in the diet or when milk was stored for 7 d. Linoleic acid and conjugated linoleic acid cis-9,trans-11 in milk increased with increasing proportion of gDDGS. To conclude, gDDGS can replace soybean meal and canola cake as a protein source in the diet of dairy cows. Up to 13.5% of the diet may consist of gDDGS without negatively affecting milk production, milk quality, or milk taste. When gDDGS represents 23% of dietary DM, milk production is reduced by 1.6 kg/d, whereas energy-corrected milk production is numerically reduced by 1 kg.

Structure and elasticity of composite nanoparticle/polymer nanoshells (hybridosomes®)

Our group recently introduced a new process to synthesize nanoparticle shells of about 100 nm, named "hybridosomes®". Here, the structure and mechanical properties of hybridosomes® made from iron oxide nanoparticles and poly(acrylic acid) are characterized using TEM, AFM and an osmotic compression technique. For the latter, the size distribution of the hybridosomes is monitored by nanoparticle tracking analysis (NTA) in the presence of poly(ethylene glycol)s of different molecular weights. It is found that the size of the hybridosomes® can be tuned from ca. 80 nm to over 110 nm by adjusting the amount of nanoparticles and that their shell consists of a single layer of nanoparticles, with a porous structure. The size of the pores is estimated from osmotic compression experiments at ca. 4000 g mol^-1. The mechanical properties are measured both at the ensemble level using size measurements under osmotic pressure and at the single nanoparticle level by atomic force microscopy nanoindentation. Both osmotic and AFM experiments are analyzed in the framework of the continuum elastic theory of thin shells and yield a value of Young's modulus of the order of MPa.