Does social-norm messaging influence expected satiety and ideal portion-size selection?

A person's perception of how long a food will stave off hunger (expected satiety) and the ideal amount to consume (ideal portion size) are both influenced by food-to-mealtime norms. Here, we examine whether social norms can modulate this effect, in three experimental studies. In study 1 (n = 235) participants were exposed to a social norm suggesting most people enjoyed consuming pasta for breakfast. There was a main effect of food-to-mealtime congruence for expected satiety and ideal portion size (p < 0.001) - participants selected a smaller portion of pasta for breakfast (vs. lunch) - but there were no other main effects/interactions (p ≥ 0.15). Study 2 (n = 200) followed the same approach as study 1, but sought to examine whether the typical volume of food consumed at breakfast and lunch needed to be controlled. Again, there was a main effect of congruence (the same pattern) (p ≤ 0.02) but no other main effects/interactions (p ≥ 0.73). Study 3 (n = 208) followed the same approach as study 2, but the social-norm message was changed to suggest that most people who eat pasta for breakfast found it effectively reduced their hunger. Again, there was a main effect of congruence (the same pattern) (p < 0.001) but no other main effects/interaction (p ≥ 0.26). These studies provide further evidence for the food-to-mealtime effect, but do not provide any evidence that a single, simple social-norm statement can modulate expected satiety or ideal portion size, or interact with the food-to-mealtime effect.

Online prediction tools for melanoma survival: A comparison

BACKGROUND

Breslow thickness, patient age and ulceration are the three most valuable clinical and pathological predictors of melanoma survival. A readily available reliable online tool that accurately considers these and other predictors could be valuable for clinicians managing melanoma patients.

OBJECTIVE

To compare online melanoma survival prediction tools that request user input on clinical and pathological features.

METHODS

Search engines were used to identify available predictive nomograms. For each, clinical and pathological predictors were compared.

RESULTS

Three tools were identified. The American Joint Committee on Cancer tool inappropriately rated thin tumours as higher risk than intermediate tumours. The University of Louisville tool was found to have six shortcomings: a requirement for sentinel node biopsy, unavailable input of thin melanoma or patients over 70 years of age and less reliable hazard ratio calculations for age, ulceration and tumour thickness. The LifeMath.net tool was found to appropriately consider tumour thickness, ulceration, age, sex, site and tumour subtype in predicting survival.

LIMITATIONS

The authors did not have access to the base data used to compile various prediction tools.

CONCLUSION

The LifeMath.net prediction tool is the most reliable for clinicians in counselling patients with newly diagnosed primary cutaneous melanoma regarding their survival prospects.

Placental pathologic lesions associated with stroke in term neonates

OBJECTIVE

To determine the birth prevalence of perinatal stroke in term born infants at our high-volume delivery center and assess the frequency of both gross and histologic placental pathologies associated with perinatal stroke using the Amsterdam Placental Workshop Group Consensus Statement guidelines and definitions.

STUDY DESIGN

A single-center retrospective cohort study spanning 2010-2020.

RESULTS

There were 129,759 live births at Parkland Hospital during the study period and a total of 18 term born infants leading to a birth prevalence of 1 in 6,829 infants. Perinatal risk factors were found in all but one patient, and 74% presented with seizures. Pathologic placental examination was available in 56% of the cohort and only one patient had normal placental examination. Acute histologic chorioamnionitis was described in five placentas (50%) and an additional two had isolated umbilical and/or chorionic plate vasculitis with or without funisitis compared to a rate of 28% with acute inflammation in a Control group. Chronic inflammation in the form of villitis of unknown etiology was described in three of the acutely inflamed placentas and was high-grade in each of those while none of the placentas from our Control group showed evidence of any chronic lesion.

CONCLUSION

Both acute and chronic placental inflammation are common in perinatal stroke; placental examination should be considered an essential component to the diagnostic workup.

A neonatal neuroNICU collaborative approach to neuromonitoring of posthemorrhagic ventricular dilation in preterm infants

Morbidity and mortality in prematurely born infants have significantly improved due to advancement in perinatal care, development of NeuroNICU collaborative multidisciplinary approaches, and evidence-based management protocols that have resulted from a better understanding of perinatal risk factors and neuroprotective treatments. In premature infants with intraventricular hemorrhage (IVH), the detrimental secondary effect of posthemorrhagic ventricular dilation (PHVD) on the neurodevelopmental outcome can be mitigated by surgical intervention, though management varies considerably across institutions. Any benefit derived from the use of neuromonitoring to optimize surgical timing and technique stands to improve neurodevelopmental outcome. In this review, we summarize (1) the approaches to surgical management of PHVD in preterm infants and outcome data; (2) neuromonitoring modalities and the effect of neurosurgical intervention on this data; (3) our resultant protocol for the monitoring and management of PHVD. In particular, our protocol incorporates cerebral near-infrared spectroscopy (NIRS) and transcranial doppler ultrasound (TCD) to better understand cerebral physiology and to enable the hypothesis-driven study of the management of PHVD. IMPACT: Review of the published literature concerning the use of near-infrared spectroscopy (NIRS) and a cerebral Doppler ultrasound to study the effect of cerebrospinal fluid drainage on infants with posthemorrhagic ventricular dilation. Presentation of our institution's evidence-based protocol for the use of NIRS and cerebral Doppler ultrasound to study the optimal neurosurgical treatment of posthemorrhagic ventricular dilation, an as yet inadequately studied area.

Accuracy of magnetic resonance imaging in predicting anterior cruciate ligament tear location and tear degree

Purpose

The purpose of this study is to evaluate the reliability of magnetic resonance imaging (MRI) in predicting the location of ACL tears in preoperative planning for anterior cruciate ligament (ACL) repair.

Methods

Thirty-four patients who underwent ACL repair were retrospectively analyzed to compare intraoperative arthroscopic findings with preoperative MRIs.

Results

For identifying type I tears, the sensitivity of MRI was 9.0% and the accuracy of MRI was 8.8%. There was moderate interrater agreement between MRI findings for tear location and tear degree.

Conclusion

MRI alone may not necessarily be accurate in identifying which ACL tears are amenable to repair.

Study design

Retrospective case series; Level of Evidence: IV.

Complications and survival after hybrid and fully minimally invasive oesophagectomy

Background

Minimally invasive oesophagectomy (MIO) is reported to produce fewer respiratory complications than open oesophagectomy. This study assessed differences in postoperative complications between MIO and hybrid MIO (HMIO) employing thoracoscopy and laparotomy, along with the influence of co-morbidities on postoperative outcomes.

Methods

Patients with oesophageal cancer undergoing three-stage MIO or three-stage HMIO between 1999 and 2018 were identified from a prospectively developed database, which included patient demographics, co-morbidities, preoperative therapies, and cancer stage. The primary outcome was postoperative complications in the two groups. Secondary outcomes included duration of operation, blood transfusion requirement, duration of hospital stay, and overall survival.

Results

There were 828 patients, of whom 722 had HMIO and 106 MIO, without significant baseline differences. Median duration of operation was longer for MIO (325 versus 289 min; P < 0.001), but with less blood loss (median 250 versus 300 ml; P < 0.001) and a shorter hospital stay (median 12 versus 13 days; P = 0.006). Respiratory complications were not associated with operative approach (31.1 versus 35.2 per cent for MIO and HMIO respectively; P = 0.426). Anastomotic leak rates (10.4 versus 10.2 per cent) and 90-day mortality (1.0 versus 1.7 per cent) did not differ. Cardiac co-morbidity was associated with more medical and surgical complications. Overall survival was associated with AJCC stage and co-morbidities, but not operative approach.

Conclusion

MIO had a small benefit in terms of blood loss and hospital stay, but not in operating time. Oncological outcomes were similar in the two groups. Postoperative complications were associated with pre-existing cardiorespiratory co-morbidities rather than operative approach.

Evaluation of later timepoints for split-time artificial insemination when using sex-sorted semen among beef heifers following the 14-d CIDR®-PG protocol

An experiment was designed to evaluate later timepoints for Split-Time AI (STAI), with the hypothesis that delaying AI may improve estrous response and pregnancy per AI when using sex-sorted semen. Timing of estrus was synchronized among 794 heifers using the 14-d CIDR®-PG protocol (1.38 g progesterone intravaginal insert from Day 0-14, followed by 25 mg dinoprost tromethamine on Day 30) with STAI performed based on estrous status. Heifers were blocked based on breed, source, sire, reproductive tract score (RTS), and BW and assigned within block to one of two approaches. In Approach 66, heifers that were estrual by 66 h after PG administration were inseminated at 66 h, and remaining heifers were inseminated 24 h later (90 h). In Approach 72, heifers that were estrual by 72 h were inseminated at 72 h, and remaining heifers were inseminated 24 h later (96 h). With both approaches, heifers that were non-estrual by the final timepoint were administered 100 μg gonadorelin acetate (GnRH). Within approach, heifers were pre-assigned to receive SexedULTRA 4M™ sex-sorted or conventional semen. The proportion of heifers estrual by the first timepoint was greater (P < 0.0001) with Approach 72 (76 %; 302/395) compared to Approach 66 (61 %; 242/399). The proportion of heifers pregnant as a result of AI differed (P = 0.0005) by semen type (59 % [240/404] for conventional compared with 48 % [187/390] for sex-sorted) but was not affected by approach or approach × semen type. In summary, pregnancy per AI of heifers receiving sex-sorted or conventional semen following the 14-d CIDR®-PG protocol did not differ when STAI was delayed 6 h. The proportion of estrual heifers prior to the first timepoint, however, was greater with later STAI.

Comparison of the 7 & 7 Synch protocol and the 7-day CO-Synch + CIDR protocol among recipient beef cows in an embryo transfer program

An experiment was designed to evaluate the effectiveness of the recently developed 7 & 7 Synch protocol to synchronize estrus among recipients prior to embryo transfer (ET). Postpartum beef cows (n = 1358) across thirteen locations were assigned to either the 7-d CO-Synch + CIDR protocol or the 7 & 7 Synch protocol prior to ET. Cows were preassigned to balanced treatments within location based on age and days postpartum, with body condition score recorded at ET. Cows assigned to the 7-d CO-Synch + CIDR protocol were administered gonadotropin-releasing hormone (GnRH; 100 μg gonadorelin acetate) on Day 7, an intravaginal controlled internal drug release (CIDR; 1.38 g progesterone) from Day 7 to Day 14, and prostaglandin F_2α (PGF_2α; 25 mg dinoprost tromethamine) coincident with CIDR removal on Day 14. Cows assigned to the 7 & 7 Synch protocol were administered PGF_2α (25 mg dinoprost tromethamine) coincident with CIDR insertion on Day 0, GnRH (100 μg gonadorelin acetate) on Day 7, and PGF_2α (25 mg dinoprost tromethamine) coincident with CIDR removal on Day 14. Cows were observed for visible signs of estrus, with GnRH (100 μg gonadorelin acetate) administered to cows failing to express estrus during the detection period. Embryo transfer was performed approximately seven days after estrus or GnRH administration. Presence of corpora lutea (CL) was determined via transrectal palpation by a single veterinarian blinded to treatment, and embryos were transferred only to cows with palpable CL. Embryo transfer was performed using either fresh or frozen embryos, with embryo stage and grade recorded for each recipient. The proportion of cows expressing estrus was increased (P < 0.0001) among cows assigned to the 7 & 7 Synch protocol (86% [529/615] vs 76% [488/640]). The proportion of cows expressing estrus and presenting with palpable CL at ET was greater (P < 0.0001) among cows following treatment with the 7 & 7 Synch protocol compared to the 7-d CO-Synch + CIDR protocol (76% [466/615] vs 65% [418/640]). Consequently, the proportion pregnant to ET was greater (P < 0.03) following the 7 & 7 Synch protocol (40% [263/653]) compared to the 7-d CO-Synch + CIDR protocol (34% [228/664]). In summary, the 7 & 7 Synch protocol involving administration of PGF_2α and treatment with a CIDR for 7 days prior to GnRH improved the likelihood of estrus expression in recipients, increased the proportion of cows eligible to receive an embryo, which resulted in a greater pregnancy rate to ET.

Treatment with prostaglandin F2α and an intravaginal progesterone insert promotes follicular maturity in advance of gonadotropin-releasing hormone among postpartum beef cows

An experiment was designed to evaluate treatments to promote ovarian follicular maturity in advance of administration of exogenous gonadotropin-releasing hormone (GnRH; 100 μg gonadorelin) for control of the bovine estrous cycle. We hypothesized prostaglandin F_2α (PGF_2α; 500 μg cloprostenol) followed by an intravaginal progesterone-releasing insert (CIDR; 1.38 g progesterone) would induce greater follicle size and serum estradiol at the time of GnRH administration. Postpartum cows (n = 194) in two locations were assigned to one of five treatments based on age, days postpartum, and body condition score. Cows in Treatment 1 were treated with the standard 7-d CO-Synch + CIDR protocol: administration of GnRH and CIDR insertion on Day -10, and administration of PGF_2α and CIDR removal on Day -3. Treatments 2-5 were designed in a 2 × 2 factorial arrangement, with Treatment 1 included as an additional reference. On Day -17, cows in Treatments 2-5 received a CIDR insert, either with (Treatments 2 and 3) or without (Treatments 4 and 5) administration of PGF_2α at CIDR insertion. On Day -10, all cows were administered GnRH, and CIDR inserts were either removed (Treatments 2 and 4) or remained in place until Day -3 (Treatments 3 and 5). Treatment with PGF_2α and CIDR in advance of GnRH (Treatments 2 and 3) resulted in increased diameter of the largest ovarian follicle (P < 0.001) and increased serum concentrations of estradiol (P < 0.0005) on Day -10. In addition, variation among cows in CL status (no CL vs. a single CL vs. multiple CL) on Day -3 tended to be decreased (P = 0.08), with cows more likely to have a single CL rather than no CL or multiple CL. Lastly, the proportion of cows expressing estrus prior to fixed-time artificial insemination tended (P = 0.08) to be improved. Results support the hypothesis that administration of PGF_2α and treatment with a CIDR for 7 days prior to GnRH promotes follicular maturity in advance of GnRH administration and may provide an approach by which to enhance response of postpartum beef cows to GnRH-based estrus synchronization programs.

Baseline neutrophil-lymphocyte ratio holds no prognostic value for esophageal and junctional adenocarcinoma in patients treated with neoadjuvant chemotherapy

BACKGROUND

Several studies have reported that neutrophil-lymphocyte ratio (NLR) can predict survival in esophageal and gastroesophageal junction adenocarcinoma, as it reflects systemic inflammation. Hence, we aimed to determine whether baseline NLR holds prognostic value for esophageal adenocarcinoma patients treated with neoadjuvant chemotherapy (nCT) followed by surgery.

METHODS

We studied the data of 139 patients that received nCT before undergoing esophagectomy with curative intent, all identified from a prospectively maintained database (1998-2016). Pretreatment hematology reports were used to calculate the baseline NLR. A receiver operating characteristic curve (ROC-curve) was plotted to determine an optimal cutoff value. NLR quartiles were used to display possible differences between groups in relation to overall survival (OS) and disease-free survival (DFS) using the method of Kaplan-Meier. Cox regression analysis was performed to assess the prognostic value of NLR.

RESULTS

The median OS and DFS times were 46 months (interquartile range [IQR]: 19-166) and 30 months (IQR: 13-166], respectively, for the entire cohort. The ROC-curve showed that NLR has no discriminating power for survival status (area under the curve = 0.462) and therefore no optimal cutoff value could be determined. There were no statistically significant differences in median OS times for NLR quartiles: 65 (Q1), 32 (Q2), 45 (Q3), and 46 months (Q4) (P = 0.926). Similarly, DFS showed no difference between quartile groups, with median survival times of 27 (Q1), 19 (Q2), 36 (Q3), and 20 months (Q4) (P = 0.973). Age, pN, pM, and resection margin were independent prognostic factors for both OS and DFS. On the contrary, NLR was not associated with OS or DFS in univariable and multivariable analyses.

CONCLUSION

Baseline NLR holds no prognostic value for esophageal and gastroesophageal junction adenocarcinoma patients treated with nCT in this study, in contrast to other recently published papers. This result questions the validity of NLR as a reliable prognostic indicator and its clinical usefulness in these patients.

Comparison of long-term progestin-based protocols to synchronize estrus prior to natural service or fixed-time artificial insemination in Bos indicus-influenced beef heifers

This experiment was designed to evaluate breeding strategies involving natural service or fixed-time artificial insemination (FTAI) in Bos indicus-influenced beef heifers (n = 1456) when there were field-type management conditions. Body weights and reproductive tract scores (RTS; Scale 1-5) were obtained for heifers before assignment to one of five treatments: 1) Non-synchronized control exposed for natural service (NS), n = 299; 2) melengestrol acetate + natural service (MGA + NS; 0.5 mg/heifer/d), n = 295; 3) 14-d controlled internal drug release insert + natural service (CIDR + NS), n = 289; 4) 14-d MGA-prostaglandin F_2α (PG) + FTAI, n = 295; or 5) 14-d CIDR-PG + FTAI, n = 278. Fertile bulls were placed in pastures with heifers of the three NS treatment groups for a 65-day period which began 10 days after progestin treatments (MGA or CIDR) ended. Heifers in FTAI treatment groups were administered PG (25 mg, IM) 16 days after CIDR removal or 19 days following MGA withdrawal, respectively, and FTAI was performed at 66 (CIDR-PG) or 72 h (MGA-PG) after PG. Gonadotropin-releasing hormone (GnRH; 100 μg, i.m.) was administered at FTAI. Pregnancy status was determined at the end of a 65-day breeding period. Pregnancy rates on Days 21 and 65 of the breeding period differed among treatment groups based on pre-treatment pubertal status (P ≤ 0.02) and body weight (P ≤ 0.05) but did not differ by group. These data highlight the need for continued research efforts to improve reproductive management of Bos indicus-influenced females.

Prospective cohort study of ultrasound surveillance of regional lymph nodes in patients with intermediate-risk cutaneous melanoma

Background

For patients with intermediate‐thickness melanoma, surveillance of regional lymph node basins by clinical examination alone has been reported to result in a larger number of lymph nodes involved by melanoma than if patients had initial sentinel node biopsy and completion dissection. This may result in worse regional control. A prospective study of both regular clinical examination and ultrasound surveillance was conducted to assess the effectiveness of these modalities.

Methods

Between 2010 and 2014, patients with melanoma of thickness 1·2–3·5 mm who had under‐gone wide local excision but not sentinel node biopsy were recruited to a prospective observational study of regular clinical and ultrasound nodal surveillance. The primary endpoint was nodal burden within a dissected regional lymph node basin. Secondary endpoints included locoregional or distant relapse, progression‐free and overall survival.

Results

Ninety patients were included in the study. After a median follow‐up of 52 months, ten patients had developed nodal relapse as first recurrence, four had locoregional disease outside of an anatomical nodal basin as the first site of relapse and six had relapse with distant disease. None of the patients who developed relapse within a nodal basin presented with unresectable nodal disease. The median number of involved lymph nodes in patients undergoing lymphadenectomy for nodal relapse was 1 (range 1–2; mean 1·2).

Conclusion

This study suggests that ultrasound surveillance of regional lymph node basins is safe for patients with melanoma who undergo a policy of nodal surveillance.

Evaluation of SexedULTRA 4M™ sex-sorted semen in timed artificial insemination programs for mature beef cows

An experiment was designed to compare fertility of SexedULTRA 4M™ sex-sorted semen and conventional, non-sex-sorted semen following either fixed-time artificial insemination (FTAI) or split-time artificial insemination (STAI) of mature suckled beef cows. Units of sex-sorted and conventional semen were produced using contemporaneous ejaculates from three commercially available sires. Units of conventional semen were generated with 25.0 × 10⁶ live cells per 0.25 ml straw prior to freezing, and units of sex-sorted semen were generated using the SexedULTRA^TM Genesis III sorting technology with 4.0 × 10⁶ live cells per 0.25 ml straw prior to freezing. Sex-sorted units were sorted to contain X chromosome-bearing sperm cells at an accuracy level of >90%. Cows (n = 1620) across four herds were treated with the 7-d CO-Synch + CIDR protocol [administration of gonadotropin-releasing hormone (GnRH) and insertion of a progesterone insert (CIDR) on Day -10, followed by administration of prostaglandin F_2α (PG) and removal of CIDR inserts on Day -3]. Cows were preassigned based on age, body condition score, and days postpartum to one of the following four treatments: FTAI with SexedULTRA 4M™ sex-sorted semen, FTAI with conventional semen, STAI with SexedULTRA 4M™ sex-sorted semen, or STAI with conventional semen. On Day -3, estrus detection aids (Estrotect^®) were applied. For cows in FTAI treatments, AI was performed on Day 0 at 66 h after PG administration and CIDR removal, and 100 μg GnRH was administered concurrent with AI. For cows in STAI treatments, AI was performed on either Day 0 or 1, at 66 or 90 h after PG administration and CIDR removal, based on timing of estrus expression. On Day 1 at 90 h after PG administration and CIDR removal, 100 μg GnRH was administered concurrent with AI to any STAI-treated cows that had failed to express estrus. Pregnancy rates to AI were affected (P = 0.04) by the interaction of bull and semen type. Greater pregnancy rates were obtained with conventional semen versus SexedULTRA 4M™ sex-sorted semen when using semen from Bull A (64% [176/277] versus 36% [100/278]; P < 0.0001) and Bull B (72% [200/277] versus 57% [156/276]; P < 0.01), whereas pregnancy rates to AI did not differ between conventional and SexedULTRA 4M™ sex-sorted semen when using semen from Bull C (58% [149/258] versus 52% [131/254]). Pregnancy rates did not differ significantly between cows inseminated using a STAI versus FTAI approach, regardless of whether insemination was performed with conventional semen (65% [265/409] versus 65% [260/403] or SexedULTRA 4M™ sex-sorted semen (50% [200/403] versus 48% [187/405]). However, due to the additional 24 h for potential estrus expression when performing STAI, total estrous response prior to AI was greater (P < 0.001) among cows receiving STAI (84%; 686/812) compared to FTAI (72%; 585/808), and greater pregnancy rates (P < 0.0001) were obtained among cows that expressed estrus prior to AI. In summary, the relative fertility of SexedULTRA 4M™ sex-sorted semen and conventional semen varied across bulls. Although overall pregnancy rates to timed AI did not differ between STAI and FTAI approaches, use of a STAI approach allowed for greater total estrous response prior to AI. Therefore, to achieve acceptable conception rates per unit and service the maximum number of cows with sex-sorted semen, one viable approach may be to use STAI to maximize total estrous response and restrict use of SexedULTRA 4M™ sex-sorted to only those cows expressing estrus.

The 9-d CIDR-PG protocol II: Characterization of endocrine parameters, ovarian dynamics, and pregnancy rates to fixed-time AI following use of long-term CIDR-based estrus synchronization among mature beef cows

An experiment was designed to evaluate endocrine parameters, ovarian dynamics, and pregnancy rates to fixed-time artificial insemination (FTAI) following the 9-d CIDR-PG protocol in comparison to the 14-d CIDR-PG protocol. While both are long-term protocols using CIDR treatment for presynchronization, the 9-d CIDR-PG protocol differs from the 14-d CIDR-PG protocol in that prostaglandin F_2α (PG) is administered at CIDR insertion and removal to facilitate a decreased length of progestin treatment and potentially enhance response to the presynchronization treatment. Estrus was synchronized for 393 mature beef cows across five locations. Treatments were represented in each location, and cows within each location were randomly assigned to one of the two protocols based on age, days postpartum (DPP), and body condition score (BCS). Cows assigned to the 14-d CIDR-PG treatment received a CIDR insert (1.38 g progesterone) on Day 0 with removal of CIDR on Day 14, and 25 mg PG 16 d after CIDR removal on Day 30. Cows assigned the 9-d CIDR-PG treatment received 25 mg PG and a CIDR insert (1.38 g progesterone) on Day 5; 25 mg PG and removal of CIDR on Day 14; and 25 mg PG 16 d after CIDR removal on Day 30. In both treatments, cows received FTAI on Day 33, 72 h after PG. All cows were administered 100 μg gonadotropin-releasing hormone (GnRH) concurrent with insemination. For a subset of animals in each treatment, ovarian ultrasound was performed and blood samples were collected for determination of serum estradiol concentrations at CIDR removal, PG administration, and FTAI. Protocols were compared on the basis of estrous response and pregnancy rate resulting from FTAI. Serum estradiol concentrations, follicle size, and estrous response did not differ based on treatment. However, cows assigned to the 9-d CIDR-PG protocol tended to achieve greater FTAI pregnancy rates than cows assigned to the 14-d CIDR-PG protocol (62% versus 52%; P = 0.07). Across treatments, greater pregnancy rates tended (P = 0.10) to be achieved by cows that expressed estrus prior to FTAI (69% for 9-d CIDR-PG, 58% for 14-d CIDR-PG) than by cows that failed to express estrus (55% for 9-d CIDR-PG, 47% for 14-d CIDR-PG). In summary, the 9-d CIDR-PG protocol is an effective protocol for synchronization of estrus among mature beef cows, and pregnancy rates to FTAI tended to be improved through use of the 9-d CIDR-PG compared to the 14-d CIDR-PG protocol.

Use of Allogeneic Bone Marrow Labeled with Neomycin Resistance Gene to Examine Bone Marrow-Derived Chimerism in Experimental Organ Transplantation

Posttransplant infusion of viable donor bone marrow cells (DBMC) has been shown in our previous studies to promote acceptance of incompatible kidney allografts in rhesus monkeys after treatment with polyclonal antithymocyte globulin to deplete peripheral T-lymphocytes. In this nonhuman primate model, the infusion of the DBMC is requisite for the induction of functional graft tolerance and specific MLR and CTLp unresponsiveness, although the relevant role and fate of bone marrow-derived chimeric cells is uncertain. Standard immunological and molecular techniques applied to this monkey model are unable to differentiate between chimeric cells derived from the infused DBMC and those derived from allograft-borne passenger leukocyte emigrants. To distinguish chimerism due to infused DBMC, we transduced DBMC with a functional neomycin resistance gene (Neor) using the retroviral vector pHSG-Neo. Neor-Mransduced BMC were infused into recipients approximately 2 wk after kidney transplantation and treatment with rabbit antithymocyte globulin. No maintenance immunosuppressive drugs were given. Genomic DNA isolated from peripheral blood leukocytes was used to monitor the presence of Neor-positive cells. Tissue samples obtained at necropsy also were assessed for Neor-positive chimeric cells. The presence of DBMC-derived chimerism was assessed by polymerase chain reaction using Neor sequence-specific primers (PCR-SSP). Chimerism was detectable in recipient tissues at various times for up to 6 mo after DBMC infusion. These studies using gene transduction methodology indicate that a stable genetic marker can provide capability to examine DBMC-derived chimerism for prolonged periods in a nonhuman primate model. This approach should facilitate future studies in preclinical models to study the role and type of chimeric cell lineages in relation to functional allograft tolerance.

Effective use of SexedULTRA™ sex-sorted semen for timed artificial insemination of beef heifers

An experiment was designed to evaluate the relative fertility of SexedULTRA^TM sex-sorted semen compared to conventional, non-sex-sorted semen when used among beef heifers in conjunction with split-time AI following the 14-d CIDR-PG protocol. Units of conventional semen were generated with 25.0 × 10⁶ live cells per 0.5 ml straw prior to freezing, and units of sex-sorted semen were generated using the SexedULTRA^TM Genesis III sorting technology with 4.0 × 10⁶ live cells per 0.25 ml straw prior to freezing. Sex-sorted units were sorted to contain X chromosome-bearing sperm cells at an accuracy level of >90%. Estrus was synchronized in 851 heifers at four locations using the 14-d CIDR-PG protocol: controlled internal drug release (CIDR) insert (1.38 g progesterone) on Day 0, CIDR removal on Day 14, and administration of prostaglandin F_2α (PG; 25 mg im) on Day 30. Estrus detection aids were applied at PG on Day 30 to evaluate estrous response rate, and split-time AI was performed based on estrous response. At 66 h after PG (Day 33), heifers having expressed estrus received timed AI. Heifers failing to express estrus by 66 h received timed AI 24 h later (90 h after PGF_2α on Day 34). Heifers failing to express estrus by 90 h were administered gonadotropin-releasing hormone (GnRH; 100 μg im) concurrent with AI. Heifers were preassigned to treatment (insemination with either conventional or SexedULTRA^TM sex-sorted semen), and treatments were balanced within each location based on source, reproductive tract score, and weight. Heifers were exposed for natural service beginning 14 d after AI for the remainder of a 60 d breeding season. Pregnancy rates to AI across locations tended to be higher (P = 0.09) for heifers inseminated with conventional semen (60%; 257/429) compared to sex-sorted semen (52%; 218/422). Higher pregnancy rates to AI (P < 0.0001) were obtained among heifers that expressed estrus prior to AI than among heifers that failed to express estrus prior to AI at 90 h. Total pregnancy rates at the end of the 60 d breeding season did not differ between heifers that received sex-sorted semen at AI (89%; 376/422) and heifers that received conventional semen at AI (89%; 382/429). In summary, the pregnancy rates observed suggest that SexedULTRA^TM sex-sorted semen can be used effectively for timed AI of beef heifers when split-time AI is performed following the 14-d CIDR-PG protocol.

[Specificity of communication in general practice]

Beyond its scientific and ethical competencies, a good doctor is characterized by his communication skills. The ability to listen is fundamental. During an interview, the physician must keep in mind a bio-psycho-social approach while being able to hear the unspeakable and inaudible. Knowledge of patients and their relatives, which seems to be a specific knowledge for general practitioners, offers a lot of information. Among the main sensitive topics that the clinician must identify are: intrafamily violence, domestic violence, substance abuse and anxiety-depressive disorders. In order to improve, the practitioner can use tools such as the Calgary-Cambridge guide and techniques used in Motivational Maintenance.

[Communicating with elderly patients]

As with other adults, communication with elderly patients will be based on the three pillars of the person-centered approach, on motivational interviewing and on the Calgary Cambridge guide. The particularity of communication with the elderly lies in the consideration of obstacles such as visual, auditory and cognitive deficits. In addition, caregivers who accompany the patient sometimes monopolize the discussion, which could prevent him from expressing himself or even making decisions about his health. Humanity and Validation are a set of tools for communicating more effectively with the very elderly or those suffering from dementia.

Comparing strategies to synchronize estrus before fixed-time artificial insemination in primiparous 2-year-old beef cows

Two experiments evaluated controlled internal drug release (CIDR)-based protocols to synchronize estrus in primiparous 2-year-old beef cows. In each experiment, treatments were balanced according to body condition score and days postpartum. Experiment 1 compared the 14-day CIDR-PG (14-d) and 7-day CO-Synch + CIDR (7-d) protocols on the basis of estrous response, pregnancy rates after fixed-time artificial insemination (FTAI), and final pregnancy rate. Cows assigned to 14-d (n = 355) received a CIDR insert on Day 0 with removal on Day 14. Cows assigned to 7-d (n = 349) received gonadotropin releasing hormone (GnRH) and a CIDR insert on Day 23. On Day 30, CIDRs were removed from 7-d cows, and PGF_2α was administered to all cows in each treatment. On Day 33, GnRH was administered concurrent with FTAI at 66 and 72 hours after PGF_2α for 7-d and 14-d treated cows, respectively. Estrous response before FTAI was higher for 7-d compared with 14-d cows (74% vs. 43%, respectively; P < 0.0001); however, pregnancy rates resulting from FTAI were similar (14-d 63%; 7-d 64%; P = 0.52). Ovarian follicular dynamics and serum estradiol-17β concentrations were evaluated among a subset of cows assigned to each protocol. Dominant follicle diameter was smaller at PGF_2α (P = 0.04) and FTAI (P = 0.002) among 14-d cows compared with 7-d cows; however, estradiol-17β at PGF_2α (P = 0.06) and FTAI (P = 0.001) was greater for 14-d versus 7-d treated cows. Experiment 2 compared estrous response and pregnancy rates in 2-year-old beef cows after FTAI- or split-time artificial insemination (STAI) following synchronization of estrus with the 14-day protocol. Cows assigned to FTAI (n = 266) were inseminated at a fixed time concurrent with GnRH at 72 hours after PGF_2α regardless of estrus expression, whereas cows assigned to STAI (n = 257) were inseminated based on estrus expression as determined by activation of an estrus detection aid. Cows assigned to STAI that exhibited estrus by 72 hours were inseminated; however, AI was delayed until 24 hours after GnRH (96 hours after PGF_2α) for nonestrous cows. Total estrous response was increased for STAI- versus FTAI-treated cows (STAI 64%; FTAI 42%; P < 0.0001); pregnancy rates resulting from AI were similar (STAI 55%; FTAI 56%; P = 0.60). In summary, the 14-day CIDR-PG and 7-day CO-Synch + CIDR protocols can be used effectively to synchronize estrus before FTAI in primiparous 2-year-old beef cows. Although expression of estrus was increased using STAI in conjunction with the 14-day protocol, this approach did not increase pregnancy rates compared with FTAI.

Patterns of disease relapse in primary extremity soft-tissue sarcoma

Background

Extremity soft-tissue sarcomas comprise a range of distinct histological subtypes. This study aimed to characterize the patterns of disease relapse in patients undergoing resection of primary extremity soft-tissue sarcoma.

Methods

All patients who had resection of primary extremity soft-tissue sarcoma at the Royal Marsden Hospital between January 2004 and January 2014 were identified from an institutional database.

Results

In the period examined, 556 patients underwent resection. The most common histological subtypes were undifferentiated pleomorphic sarcoma (169 patients, 30·4 per cent), well differentiated liposarcoma (63, 11·3 per cent), myxoid liposarcoma (62, 11·2 per cent), myxofibrosarcoma (54, 9·7 per cent) and leiomyosarcoma (39, 7·0 per cent). Local recurrence-free survival (LRFS) did not differ significantly between histological subtypes (P = 0·222). Distant metastasis-free survival (DMFS) and disease-specific survival (DSS) were found to differ significantly between subtypes (P &lt; 0·001 for both DMFS and DSS), with the worst outcomes in patients with undifferentiated pleomorphic sarcoma (5-year survival rate: 56·8 (95 per cent c.i. 52·5 to 61·1) per cent for DMFS; 60·1 (55·6 to 64·6) per cent for DSS). However, on multivariable analysis, histological subtype was not found to be independently prognostic for LRFS, DMFS or DSS. Metastatic disease developed in 149 patients, with the lungs being the most common site of first metastasis (120 patients, 80·5 per cent). The site of first metastasis differed between subtypes, with extrapulmonary metastases predominant in myxoid liposarcoma (11 of 13 patients; P &lt; 0·001).

Conclusion

Although histological subtype was not found to be an independent prognostic factor for oncological outcomes, the site of first metastasis differed significantly between subtypes.

Outcome following resection of retroperitoneal sarcoma

Background

Retroperitoneal sarcoma comprises a range of different histological subtypes with dissimilar behaviour and biology. This study sought to characterize the morbidity and mortality associated with multivisceral resection and oncological outcomes according to subtype.

Methods

All patients undergoing resection of primary retroperitoneal sarcoma at the Royal Marsden Hospital between January 2005 and December 2014 were identified from a database.

Results

Some 362 patients underwent resection, with 292 requiring multivisceral resection. The 30-day mortality rate was 1·4 per cent (5 patients), the 30-day morbidity rate was 15·7 per cent (57 patients), and 27 patients required a return to theatre. Age over 75 years was predictive of 30-day mortality (hazard ratio 1·37, 95 per cent c.i. 1·13 to 1·65). The overall disease-specific survival rate at 3 years was 81·2 per cent. For well differentiated liposarcoma, dedifferentiated liposarcoma and leiomyosarcoma, 3-year local recurrence-free survival rates were 98 (95 per cent c.i. 83 to 99), 56·7 (45·7 to 66·2) and 80 (67 to 89) per cent respectively. At 3 years the distant metastasis-free survival rate was 100, 85·9 (77·4 to 91·4) and 65 (49 to 77) per cent, and the disease-specific survival rate was 97 (89 to 99), 78·5 (74·6 to 82·4) and 79 (63 to 85) per cent for well differentiated liposarcoma, dedifferentiated liposarcoma and leiomyosarcoma respectively.

Conclusion

Resection of retroperitoneal sarcoma was associated with a 30-day mortality rate of less than 2 per cent and a morbidity rate of 15·7 per cent. The overall 3-year disease-specific survival rate was 81·2 per cent.