Olive mill wastewater-evaporation ponds long term stored: Integrated assessment of in situ bioremediation strategies based on composting and vermicomposting

During the last two decades, the method most widely used to manage olive mill wastewater (OMW) derived from olive oil production has been its disposal in evaporation ponds. Long-term storage of OMW leads to the accumulation of toxic sediments (OMWS) rich in recalcitrant compounds with phytotoxic and antimicrobial properties, which limit their use for agronomic purpose. The aim of this study was to compare the effect of two in situ bioremediation strategies (composting and a combination of composting followed by vermicomposting) to remove the potential toxicity of the sediments derived from long-term stored OMW. The results obtained showed that the composting method assisted with the earthworms enhanced the depletion of phenolic compounds and OMWS ecotoxicity more than composting, especially during the maturation stage. Moreover, vermicomposting was more effective in the reduction of the OMWS salinity. However, a pre-composting process to the OMWS is necessary prior to vermicomposting to provide the suitable conditions for earthworms survival and activity. Furthermore, the final compost showed a phytostimulating effect. Therefore, these in situ bioremediation strategies can be considered potential tools for decontamination and recovery of long-term stored OMWS in evaporation ponds, which currently poses an unsolved environmental problem.

Arterial Wall Stiffening in Caveolin-1 Deficiency-Induced Pulmonary Artery Hypertension in Mice

BACKGROUND

Pulmonary artery hypertension (PAH) is a complex disorder that can lead to right heart failure. The generation of caveolin-1 deficient mice (CAV-1-/-) has provided an alternative genetic model to study the mechanisms of pulmonary hypertension. However, the vascular adaptations in these mice have not been characterized.

OBJECTIVE

To determine the histological and functional changes in the pulmonary and carotid arteries in CAV-1-/- induced PAH.

METHODS

Pulmonary and carotid arteries of young (4-6 months old) and mature (9-12 months old) CAV-1-/- mice were tested and compared to normal wild type mice.

RESULTS

Artery stiffness increases in CAV-1-/- mice, especially the circumferential stiffness of the pulmonary arteries. Increases in stiffness were quantified by a decrease in circumferential stretch and transition strain, increases in elastic moduli, and an increase in total strain energy at physiologic strains. Changes in mechanical properties for the pulmonary artery correlated with increased collagen content while carotid artery mechanical properties correlated with decreased elastin content.

CONCLUSIONS

We demonstrated that an increase in artery stiffness is associated with CAV-1 deficiency-induced pulmonary hypertension. These results improve our understanding of artery remodeling in PAH.

MAPping with fragmentation analysis in patients with atypical atrial FLUtter using the RHYthmia navigation system (MAP-FLURHY study)

Background

Atypical atrial flutter (AAFL) circuits use areas of slow conduction which can be visualized as fragmented electrograms (fEGMs).

Purpose

To test an ablation strategy based on the identification and ablation of spots with fEGMs in AAFL.

Methods

The MAP-FLURHY study prospectively included all AAFL ablations with Rhythmia in our Center from June 2016 to June 2019. Patients with non-mappable AAFL, frequent conversion to atrial fibrillation, or cavotricuspid isthmus-dependent flutters were excluded from analysis. The IntellaMap ORION catheter was used to detect fragmentation areas, arbitrarily defined as fEGMs >70ms. Entrainment was used to check if these areas belonged to the AAFL circuit. Ablation targeted the longest fEGM within the circuit (return cycle <30ms): focal ablation for microreentries, and lines including the fEGMs for macroreentries. Ablation success was defined as conversion to sinus rhythm or another flutter. Procedural success was defined as successful ablation of all inducible flutters. Follow-up included visits with 24h Holter ECG at 3–6-12 months.

Results

50 Patients received ablation (Figure). 27 Patients (70.6±13.1 years; 10 females; LVEF 57%±13%) with 44 mappable AAFLs were included in the analysis (Table). All AAFLs showed areas with fEGMs (106 areas; 2.4 areas per flutter). 42/44 AAFLs had fEGMs within the circuit, which were target of ablation. Ablation success: 34/36 AAFLs (94%); success could not be assessed in 6 circuits, due to mechanical conversion to sinus rhythm onto the target fEGM. Fragmented areas within the AAFL circuits (n=51) were longer (110±30 vs 90±15 ms, p<0.001) but had similar voltage (0.34±0.25 vs 0.36±0.26 mV) than areas outside the circuits (n=45). A fEGM duration >100ms/>40% of the cycle length predicted to be a successful site for ablation with 72.3%/73.8% specificity. Procedural success was achieved in 24/27 patients (89%). Excluding a 2-month blanking period, mean survival free from atrial arrhythmias was 19 (95% CI: 12.6–25.5) months. 57% of the patients were free from atrial arrhythmias at 1 year.

Conclusions

Most AAFLs had detectable fEGMs which could be target of ablation with high efficacy.

Figure 1

Funding Acknowledgement

Type of funding source: None

Uncovering new indicators to predict stability, maturity and biodiversity of compost on an industrial scale

Currently, the metagenomic study of the composting process has gained great importance since it has allowed the identification of the existence of microorganisms that, until now, had not been isolated during the process by traditional techniques. However, it is still complex to determine which bioindicators could reveal the degree of maturity and stability of a particular compost. Thereby, the main objective of this work was to demonstrate the possible correlation between traditional parameters of maturity and stability of compost, with other indicators of biodiversity in products highly heterogeneous from composting processes on an industrial scale. The results demonstrated the enormous influence of the raw materials in characterizing the products obtained. Even so, important relationships were established between the Chao1 and Shannon indexes, and certain parameters related to the maturity, stability and toxicity of the samples, such as nitrification index, humification rate, phenolic content, germination index or oxygen consumption.

Bromine biogeodynamics in the NE Atlantic: A perspective from natural wetlands of western Portugal

Bromine (Br) cycling in natural wetlands is highly complex, including abiotic/biotic processes and multiphase inorganic/organic Br-species. Wetland ecosystems receive Br primarily from the ocean, functioning as either sinks or sources of Br, with the overall imbalance largely decided by the prevailing climate. Aiming to trace the present-day transport of oceanogenic Br (i.e., derived from salt-water spray-droplets) and its uptake and storage in brackish and freshwater wetlands, we surveyed waters, autochthonous plants, and soils/sediments from coastal marshes and mountain peatlands in the westernmost fringe of northern Portugal. The calculated enrichment factors of bromide (Br^-) relative to chloride in rainfall (EF_sea = 16.8-75.3), rivers (EF_sea = 1.3-13.9) and wetland waters, superficial (EF_sea = 5.8-13.1) and interstitial (EF_sea = 2.1-8.9), increased towards the inland highlands. We hypothesized that these values derived mostly from a known Br autocatalytic (heterogeneous) chemical cycle, starting at the seawater-aqueous interface and progressing in altitude. Br-bearing air masses are carried far from the Atlantic Ocean by moist westerlies, with Br^- rainout from the atmosphere supplying the neighbouring mountain peatlands. Average [Br] in sampled wetland soils/sediments (111-253 mg/kg) agreed with values from other coastal regions, and they were directly correlated with the abundance of organic matter, varying irrespective the [Br^-] of interstitial waters (129 μg/L-79 mg/L). According to the computed bioconcentration factors, the aqueous component was the major source of Br for all plant species investigated (BF_plant/water = 2.1-508.0), as described elsewhere. However, Br contents in plants (14-173 mg/kg) evidenced interspecific differences, also suggesting a divergence from the acknowledged halophytic-glycophytic "model". As plants are recognized producers of Br volatile molecules (e.g., methyl bromide, CH₃Br), we interpreted translocation factors less than one in vascular species as explanatory of phytovolatilization rather than restriction of Br^- upward movement in plants. Further investigation is needed, since considerable intrinsic plant variations in CH₃Br emissions are mentioned in the literature.

Gender differences in use of prolonged non-operative therapies prior to index ACDF surgery

Prior to anterior cervical discectomy and fusion (ACDF) surgery, patients suffering from cervical stenosis traditionally trial non-operative treatments for pain management. There is a paucity of data evaluating gender disparities in the prolonged utilization of conservative therapy prior to ACDF surgery. Therefore, the purpose of this study was to assess for gender-based differences in the utilization and cost of maximal non-operative therapy (MNT) for cervical stenosis prior to ACDF surgery. Medical records from patients with symptomatic cervical stenosis undergoing 1, 2, or 3-level index ACDF procedures between 2007 and 2016 were gathered from an insurance database consisting of 20.9 million covered lives. The utilization of MNTs within 5 years prior to index ACDF surgery was assessed. A total of 2254 patients (females: 53.1%) underwent an index ACDF surgery. There were a significantly greater percentage of female patients that utilized NSAIDs (p < 0.0001), opioids (p = 0.0019), muscle relaxants (p < 0.0001), cervical epidural steroid injections (p = 0.0428), and physical therapy/occupational therapy treatments (p < 0.0001). The total direct cost associated with all MNT prior to index ACDF was $4,833,384. On average, $2028.01 was spent per male patient while $2247.29 was spent per female patient. When normalized by number of pills billed per patient utilizing therapy, female patients utilized more NSAIDs (males: 591.8 pills, females: 669.3 pills), opioids (male: 1342.0 pills, female: 1650.1 pills), and muscle relaxants (males: 823.7 pills, females: 1211.1 pills). The results suggest that there may be gender differences in the utilization of non-operative therapies for symptomatic cervical stenosis prior to ACDF surgery.

Prospection of cyanobacteria producing bioactive substances and their application as potential phytostimulating agents

• Using cyanobacteria extracts at low doses reduces the toxicity risk in cucumber seeds.

• Optimal doses of cytokinins and salicylic acid benefit the early plant growth stages.

• Cyanobacterial siderophores favor plant growth during the seedling phase.

• Strain Nostoc SAB-M612 stood out for their stimulant ability in cucumber seedlings.

This work clarifies some of the substances involved with the biostimulant effect shown by 28 cyanobacteria isolated from different aquatic environments. The production of salicylic acid, cytokinins, siderophores and phosphate solubilization were analyzed in vitro, as well as the phytostimulant/phytotoxic effect on watercress seeds at two different extract concentrations (0.5 and 0.2 mg mL⁻¹). The most prominent plant growth promoting cyanobacteria were verified in vivo at two different doses (0.5 and 0.1 mg mL⁻¹). 21.4 % and 7.1 % of the tested strains produced siderophores or phosphate solubilization, respectively. The production of salicylic acid was stood out for the strains Calothrix SAB-B797, Nostoc SAB-B1300 and Nostoc SAB-M612, while Nostoc SAB-M251 and Trichormus SAB-M304 were noticeable regard to cytokinin production. The highest values of germination occurred when the extracts were applied in low dose (0.5 mg mL⁻¹). Nostoc SAB-M612 provoked the stimulation of aerial and radicular growth in cucumber seedlings.

Evaluating the influence of raw materials on the behavior of nitrogen fractions in composting processes on an industrial scale

Success of composting as an ecological technology for organic waste management has allowed its implementation in the current circular economy models. However, composting on an industrial scale often shows drawbacks and peculiarities. In this work, a comparative analysis of 15 industrial composting facilities was carried out in which different anthropogenic organic waste were processed. Results showed that composting process on an industrial scale did not always evolve in a standard way. Monitoring parameters as well as enzymatic activity depended largely on the raw materials and were strongly linked to the transformation of nitrogen fractions. Despite the heterogeneity of the processes and raw materials, microbial activity managed to the optimal biotransformation, obtaining products that comply with the agronomic quality standards. This work represents a breakthrough in composting and provides new knowledge for better management of this process on an industrial scale.

Racial Differences in Perioperative Opioid Utilization in Lumbar Decompression and Fusion Surgery for Symptomatic Lumbar Stenosis or Spondylolisthesis

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

To assess for racial differences in opioid utilization prior to and after lumbar fusion surgery for patients with lumbar stenosis or spondylolisthesis.

METHODS

Clinical records from patients with lumbar stenosis or spondylolisthesis undergoing primary <3-level lumbar fusion from 2007 to 2016 were gathered from a comprehensive insurance database. Records were queried by International Classification of Diseases diagnosis/procedure codes and insurance-specific generic drug codes. Opioid use 6 months prior, through 2 years after surgery was assessed. Multivariate regression analysis was employed to investigate independent predictors of opioid use following lumbar fusion.

RESULTS

A total of 13 257 patients underwent <3-level posterior lumbar fusion. The cohort racial distribution was as follows: 80.9% white, 7.0% black, 1.0% Hispanic, 0.2% Asian, 0.2% North American Native, 0.8% "Other," and 9.8% "Unknown." Overall, 57.8% patients utilized opioid medications prior to index surgery. When normalized by the number opiate users, all racial cohort saw a reduction in pills disbursed and dollars billed following surgery. Preoperatively, Hispanics had the largest average pills dispensed (222.8 pills/patient) and highest average amount billed ($74.67/patient) for opioid medications. The black cohort had the greatest proportion of patients utilizing preoperative opioids (61.8%), postoperative opioids (87.1%), and long-term opioid utilization (72.7%), defined as use >1 year after index operation. Multivariate logistic regression analysis indicated Asian patients (OR 0.422, 95% CI 0.191-0.991) were less likely to use opioids following lumbar fusion.

CONCLUSIONS

Racial differences exist in perioperative opioid utilization for patients undergoing lumbar fusion surgery for spinal stenosis or spondylolisthesis. Future studies are needed corroborate our findings.

Regional Variation in Nonoperative Therapy Utilization for Symptomatic Lumbar Stenosis and Spondylolisthesis: A 2-Year Costs Analysis

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

To characterize regional variations in maximal nonoperative therapy (MNT) costs in patients suffering from lumbar stenosis or spondylolisthesis.

METHODS

Medical records from patients with symptomatic lumbar stenosis or spondylolisthesis undergoing primary ≤3-level lumbar decompression and fusion procedures from 2007 to 2016 were gathered from a large insurance database. Geographic regions (Midwest, Northeast, South, and West) reflected the US Census Bureau definitions. Records were searchable by International Classification of Diseases diagnosis/procedure codes, Current Procedural Terminology codes, and insurance-specific generic drug codes. Utilization of MNT, defined as cost billed, prescriptions written, and number of units disbursed, within 2-years prior to index surgery was assessed.

RESULTS

A total of 27 877 patients underwent 1-, 2-, or 3-level lumbar decompression and fusion surgery. Regional breakdown of the study cohort was as follows: South 62.3%, Midwest 25.2%, West 10.4%, Northeast 2.1%. Regional variations in the number of patients using nonsteroidal anti-inflammatory drugs (NSAIDs) (P < .0001), opioids (P < .0001), muscle relaxants (P < .0001), and lumbar steroid injections (P < .0001) were detected. A significant difference was identified in the regional MNT failure rates (P < .0001). The total cost associated with MNT prior to index surgery was $48 411 125 ($1736.60/patient), with the Midwest ($1943.83/patient) responsible for the greatest average spending. Despite comprising 62.3% of the cohort, the South was accountable for 67.5% of NSAID prescriptions, 64.6% of opioid prescriptions, and 71.2% of muscle relaxant prescriptions.

CONCLUSIONS

Regional differences exist in the costs of MNT in patients with lumbar stenosis and spondylolisthesis prior to surgery. Future studies should focus on identifying patients likely to fail prolonged nonoperative management.

104 SOFaaci-HEPES or holding media can be used for embryo loading without changes in pregnancies per embryo transfer nor pregnancy loss in an invitro-produced embryo transfer program

Time elapsed between removal from culture and embryo transfer (ET) can have a profound effect on the success of an invitro-produced (IVP) ET program. The embryo culture medium provides the necessary nutrients for embryo development and the use of media with a different nutrient composition to load embryos into straws could negatively affect embryo viability. The objective of the present study was to evaluate the effect of type of media used for embryo loading on pregnancy establishment and maintenance. Holstein heifers (n=800) were synchronized using a modified 5-day CO-Synch + controlled internal drug release (CIDR) as follows: Day −8: CIDR inserted, Day −3: CIDR removed, prostaglandin F2α treatment (500μg cloprostenol sodium), Day 0: gonadotrophin-releasing hormone (GnRH; 100μg of gonadorelin acetate). Five days after GnRH, heifers were evaluated by ultrasonography to determine presence of a corpus luteum (CL). Embryos were removed from culture on Day 7 (Day 0=fertilization), placed into tubes containing SOFaaci, and transported in an incubator (LabMix, WTA) to the transfer facility within 1.5h. Upon arrival embryos were removed from transport tubes and randomly assigned to be loaded into 0.25-mL straws containing either holding media (Vigro Holding Plus) or SOFaaci-HEPES. After loading into straws, embryos were placed in an ET gun and AI gun warmers set at 35°C until transfer by 1 of 5 technicians. Heifers with a CL were randomised for transfer of a fresh IVP embryo loaded into a straw containing either holding media or SOFaaci-Hepes on Day 7±1. Interval from embryo loading to transfer ranged from 1 to 3h. Pregnancy was determined by ultrasonography on Days 32 and 60. Data were analysed by logistic regression and included the fixed effects of loading media, embryo stage, embryo quality, interval between GnRH and ET, and biologically relevant interactions. Pregnancies per ET (P/ET) on Day 32 were not different between the groups in which embryos were loaded using holding media and those which used SOFaaci-Hepes, nor there were interactions between loading medium and embryo stage, embryo quality, or interval from GnRH to ET (P&gt;0.10; Table 1). Pregnancies per ET (P/ET) on Day 60 were not different between the loading media groups, nor were there interactions between loading medium, embryo stage, and embryo quality, or interval from GnRH to ET (P&gt;0.10). Pregnancy loss between Days 32 and 60 was not different between groups, nor there were interactions between loading media groups and any other factor (P&gt;0.10). In conclusion, the use of either holding medium or SOFaaci-HEPES for fresh IVP embryo loading does not affect fertility; thus, both are suitable alternatives for loading of embryos into transfer straws. Table 1.Pregnancies per embryo transfer (P/ET) and pregnancy loss in recipient heifers transferred with fresh invitro-produced embryos, using either holding medium or SOFaaci-HEPES medium for loading Item P/ET Day 32 (n) P/ET Day 60 (n) Pregnancy loss (n) Loading medium Holding 47.0% (186/396) 41.3% (163/395) 11.9% (22/185) SOFaaci-HEPES 48.8% (197/404) 43.1% (174/404) 11.7% (23/197) P-value 0.77 0.22 0.84

109 Effect of ruminal infusion with propylene glycol on the invitro embryo production of Holstein (Bos taurus) prepubertal heifers and pregnancy rate of the embryo transfer

The aim of this study was to evaluate the effect of ruminal infusion with propylene glycol (PG) on the invitro embryo production (IVEP) of Holstein (Bos taurus) prepubertal heifers (7 to 8 months). For this study, 16 prepubertal heifers were distributed into two groups: Propylene Glycol Group (PGG; n=8) and Control Group (CG; n=7). Additionally, 8 pubertal heifers were used for the positive control group (PUB). All animals (n=23) underwent an ovum pickup (OPU) for follicular ablation on Day 0, followed by an FSH protocol treatment (160mg performed in 4 injections twice a day in decreasing doses, designated as D2PM, D3AM, D3PM, and D4AM). Animals from PGG received a ruminal infusion with 250mL of PG twice a day on Days 0, 1, 2, 3, and 4, using a drench. Animals from CG and PUB did not receive any additional treatment. On Day 5 all animals underwent another OPU, and oocytes were used for the IVEP (Sexing Technologies commercial laboratory). The produced embryos were transferred fresh to Holstein heifer recipients. Additionally, blood sampling was performed on D4PM (M1) and on the day of OPU (D5AM, M2) for insulin-like growth factor (IGF-1, via radioimmunoassay) and glucose (hexokinase) analysis. Data were analysed using the GLIMMIX procedure of SAS. No difference was observed between groups for number of recovered oocytes (CG: 14.28±1.9; PGG: 14.87±3.9; PUB: 10.50±2.2; P=0.24), number of viable oocytes (CG: 10.71±2.5; PGG: 10.75±2.7; PUB: 9.50±2.0; P=0.80), cleaved oocytes (CG: 7.71±1.5; PGG: 9.50±2.1; PUB: 6.25±1.4; P=0.14), cleavage rate (CG: 54.2% (7.7 out of 14.2); PGG: 64.1% (9.5 of 14.8); PUB: 59.0% (6.2 of 10.5); P=0.35) and number of blastocysts (CG: 1.71±0.5; PGG: 2.00±0.6; PUB: 3.12±1.0; P=0.71). Pubertal heifers had higher blastocyst rates compared with prepubertal heifers, regardless of PG treatment (CG: 11.9% (1.7 of 14.2); PGG: 13.5% (2 of 14.8); PUB: 29.5% (3.1 of 10.5); P=0.01). No difference was observed between groups for 30-day (CG: 41.7% (5 of 12); PGG: 46.7% (7 of 15); PUB: 42.9% (6 of 14); P=0.96) or 60-day pregnancy rates (CG: 41.7% (5 of 12); PGG: 33.3% (5 of 15); PUB: 42.9% (6 of 14); P=0.86). In addition, no difference was observed for pregnancy loss between 30 and 60 days (CG: 0.0% (0 of 12); PGG: 13.3% (2 of 15); PUB: 0.0% (0 of 14); P=0.99). Regarding metabolic blood analysis, no difference was observed for IGF-1 (ngmL−1) between groups (P=0.38), moment of sample collection (P=0.06), and interaction of group×moment (P=0.87; CG/M1: 263.36±15.2; CG/M2: 297.71±18.7; PGG/M1: 304.25±26.9; PGG/M2: 332.61±31.6; PUB/M1: 309.16±19.9; PUB/M2: 311.07±18.8). Glucose (mg dL−1) was higher (P=0.0001) for pubertal heifers (91.63±1.4) compared with the other groups (CG: 102.25±1.1; PGG: 107.71±3.5); however, no difference was observed for moment of sample collection (P=0.35) or interaction of group×moment (P=0.36). These data show that treatment with PG was not efficient to improve the IVEP of prepubertal Holstein heifers, embryos from prepubertal heifers treated with PG did not have increased pregnancy rate, and treatment did not increase IGF-1 or glucose blood levels.

176 Synchronisation of follicle wave emergence prior to superstimulation with purified FSH for ovum pickup affects blastocyst rate in pregnant Holstein heifers

The timing of initiation of superstimulatory treatments relative to follicle wave emergence has been shown to affect ovulatory response and invivo embryo production. The significant increase of invitro embryo production (IVP) and the possibility of using pregnant animals as oocyte donors has created the need to optimise superstimulatory treatments for IVP in pregnant cattle. Thus, the objective of the present study was to evaluate the effect of synchronisation of follicle wave emergence before superstimulation for ovum pickup (OPU) and IVP in pregnant heifers. Pregnant (47-62 days of gestation) Holstein heifers (n=28) 19.5±0.3 months of age were assigned in a completely randomised design to one of two groups: synchronisation of follicular wave emergence by dominant follicle removal (DFR; all follicles &gt;6mm) or untreated control (no DFR). Superstimulatory treatments were initiated 36h after DFR or at random stages of the follicular wave in the no-DFR group and consisted of the administration of 160mg of purified FSH (Folltropin-V, Vetoquinol) over four injections 12h apart as follows: 48.0, 42.7, 37.3, and 32.0mg. Ovum pickup was performed in all heifers 40h after the last purified FSH injection. Heifers were subjected to OPU for oocyte recovery, and the number of follicles was determined. Recovered oocytes were processed in groups by treatment, and IVP was performed. Differences between treatment groups were evaluated using generalised linear mixed models. Results are presented in Table 1 and are expressed as means±s.e.m. for data collected at the time of OPU or as proportions for embryo production results. The number of small follicles (&lt;6mm) at the time of OPU was greater in the no-DFR group than in the DFR group (P=0.04). Conversely, there were no differences between treatments in the number of medium follicles (6-10 mm; P=0.17), large follicles (&gt;10 mm; P=0.11), total follicles (P=0.93), total number of recovered oocytes (P=0.4), or number of viable oocytes (P=0.53). The mean oocyte percentage recovery rate was not different between heifers in the DFR (53.6±4.7%) and no-DFR (56.5±4.7%) groups (P=0.52). Both cleavage and blastocyst rate were greater (P&lt;0.008) in the DFR group than in the no-DFR group; as a result, the number of transferable embryos per animal was 5.6 in the DFR group and 2.8 in the no-DFR group. In summary, initiation of superstimulatory treatments at the time of follicle wave emergence improves cleavage and blastocyst rates, thus leading to greater embryo production. Table 1.Ovarian response and embryo production in pregnant heifers superstimulated with or without synchronisation of follicle wave emergence Variable DFR No DFR Small follicles, n 8.1±1.2A 12.1±1.8B Medium follicles, n 18.3±1.3 13.7±2.0 Large follicles, n 2.4±0.6 1.4±0.4 Total follicles, n 28.8±1.4 27.2±2.2 Total oocytes, n 15.4±1.5 16.0±1.9 Viable oocytes, n 13.7±1.5 13.4±1.8 Cleavage rate,% (n) 77.1 (192)A 64.4 (188)B Blastocyst rate,% (n) 40.6 (192)A 20.7 (188)B A,BMeans within a row with different superscripts differ (P&lt;0.05).

Molecular identification of Leishmania tropica and L. infantum isolated from cutaneous human leishmaniasis samples in central Morocco

BACKGROUND & OBJECTIVES

Cutaneous leishmaniasis (CL) in Marrakesh-Safi region located in the central-south part of Morocco is a public health problem. This study assessed the efficiency of a microscopic examination method in establishing the diagnosis of CL and PCR for the characterization and identification of the circulating Leishmania strains in different CL foci of the study area.

METHODS

A total of 297 smears obtained from cutaneous lesions of suspected patients with CL were stained with May-Grünwald Giemsa (MGG) for microscopic examination. For each positive smear, genomic DNA was extracted and PCR-analysed, targeting the small subunit ribosomal ribonucleic acid (ssu rRNA) gene to detect Leishmania DNA. Then, the internal transcribed spacer 1 (ITS1) was amplified and sequenced in order to identify the Leishmania species. The sensitivity and specificity of the conventional microscopy with ssu rRNA gene were compared by Leishmania nested PCR (LnPCR) and ITS1 gene by ITS-PCR.

RESULTS

A total of 257 smears were positive in the microscopic examination, i.e. the detection rate of amastigotes by optical microscopy was 86.53% (257/297). The LnPCR was found to have a specificity and a sensitivity of 100%, each. Interestingly, the sequencing results showed that 99.61% (256/257) of the isolates had Leishmania tropica and 0.39% (1/257) had L. infantum infection.

INTERPRETATION & CONCLUSION

Though, classical microscopic examination is useful and economical, it is not sensitive enough, especially in endemic regions where several Leishmania species coexist. In such situations, PCR constitutes a complementary method for the identification of the causal species. The results indicate that both the L. tropica (dominant) and L. infantum are the causative agents of CL in the Marrakesh-Safi region. The rate of CL infection is high in Imintanout, and Chichaoua provinces. Hence, early diagnosis and prompt treatment of CL patients is necessary to prevent its extension to neighboring localities.

105 Optimization of a five-day fixed-time embryo transfer program in dairy heifers: Use of gonadotrophin-releasing hormone at initiation of the protocol

Optimized fixed-time embryo transfer (FTET) protocols for synchronization of recipients have the potential to improve the overall efficiency and profitability of embryo transfer (ET) programs. The objective of the present study was to evaluate the effect of dose of gonadotrophin-releasing hormone (GnRH) at initiation of a 5-day synchronization protocol for FTET. Holstein heifers (n=2689) at two locations were synchronized using a 5-day CO-Synch protocol as follows: Day 0: CIDR inserted, Day 5: CIDR removed, prostaglandin (PG)F2α treatment (500μg cloprostenol), Day 6: PGF2α treatment, Day 8: GnRH (100μg of gonadorelin). On Day 0, at the time of CIDR insertion, heifers were assigned in a completely randomised design to the following groups: Single (a single dose of GnRH; 100μg of gonadorelin), Double (200μg of gonadorelin) or No GnRH (control). All heifers received an Estrotect patch placed on Day 5 and evaluated for signs of oestrus on Day 8. At location A, heifers were evaluated by ultrasonography 5 days after GnRH to determine presence and size of corpus luteum (CL), whereas at location B presence and location of CL were determined by transrectal palpation at the time of transfer. Heifers with a CL received an embryo 7±1 days after GnRH administration, and pregnancy was determined by ultrasonography 41 and 63 days after GnRH. Data were analysed by generalized linear mixed models. Oestrus expression was greater in heifers that received Single and Double GnRH than in the No GnRH group (P=0.001). Similarly, utilisation rate (number transferred per number treated) was greater for heifers in the Single and Double GnRH group than for those in the No GnRH group (P=0.02). Pregnancy data were analysed for a subset of recipients using data from Day 41 (n=2267) and Day 63 (n=2042). The analysis of fertility outcomes included as covariates the type of embryo (invitro fresh or frozen and invivo fresh or frozen), embryo stage, embryo quality, interval from GnRH to transfer, and oestrus expression. Pregnancies per embryo transfer (P/ET) at Days 41 and 63 were not different between treatment groups (P=0.86), and there was no interaction between type of embryo and treatment (P&gt;0.15). Pregnancy loss between Days 41 and 63 was not different (P=0.49) between treatments groups. In conclusion, the removal of the initial GnRH from a 5-day FTET protocol resulted in a slight but significant reduction in the utilisation rate and the percentage of heifers showing oestrus. However, there was no detrimental effect on fertility. As a result, the overall cost of the FTET program can be reduced by eliminating the need for the initial GnRH treatment without compromising fertility. Table 1.Reproductive performance in recipients receiving different doses of gonadotrophin-releasing hormone (GnRH) at initiation of the synchronization protocol Treatment Oestrus (n) Utilisation rate (n) P/ET1 D41 (n) P/ET D63 (n) Pregnancy loss (n) No GnRH 69.2%B (621/898) 85.0%B (763/898) 41.6% (308/740) 39.9% (268/672) 4.3% (12/280) Single GnRH 76.1%A (685/900) 88.8%A (799/900) 42.7% (329/770) 39.5% (272/689) 6.5% (19/291) Double GnRH 75.3%A (671/891) 88.7%A (790/891) 41.5% (314/757) 38.9% (265/681) 5.4% (15/280) A,BValues with different superscripts within a column differ (P&lt;0.05). 1P/ET=pregnancies per embryo transfer.

Enzymatic profiles associated with the evolution of the lignocellulosic fraction during industrial-scale composting of anthropogenic waste: Comparative analysis

In the new European Waste Law, composting is proposed as one of the best options to properly manage organic waste of anthropogenic origin. Currently, the massive generation of this type of waste, as well as its heterogeneity, makes difficult in many cases control this process of degradation on an industrial scale. In this work, 15 facilities were selected based on 5 types of organic waste: Urban Solid Waste, Vegetable Waste, Sewage Sludges, Agrifood Waste and "Alpeorujo". The samples were collected in different thermal phases. The results revealed very different physicochemical and enzymatic profiles, as well as different degrees of humification depending on the process and the raw materials. However, parameters such as β-glucosidase, amylase, lignin/holocellulose ratio and humification rate showed similar trends in all cases. All of them could act as important indicators to evaluate the quality of a composting process, despite the heterogeneity of the starting materials.

P2839The golden age of ablation: results for atypical flutter ablation in the very elderly

Introduction

Atypical flutter ablation (AFL) is a challenging procedure with limited long-term benefits and not exempt from significant risks.

Purpose

To compare the efficacy and safety of this procedure in a population of octogenarian patients over a population of younger patients.

Methods

From 2015 to 2018, all patients in which AFL ablation was attempted were included. Activation and voltage mapping were used to define AFL circuit. Radiofrequency lesions were performed to operator's discretion until AFL termination. Programmed atrial stimulation was repeated to test inducibility, and any sustained induced arrhythmia was ablated. Follow-up included visits with ECG and/or 24h Holter-ECG at 3 and 12 months.

Results

107 patients (55 females) were included, 26 (24%) aged 80 or older (table). Successful ablation of the original circuit was achieved in 96% in both groups (acute success rate, p=0.973), with induction of other AFL circuits in 43% (46% octogenarians, 42% younger, p=0.708), successfully ablated in 88% in both groups (total success rate, p=0.952). No significant difference was detected in the rate of adverse events (8% in octogenarians versus 7% in younger, p=0.962), with a case of cardiac tamponade in the former, successfully resolved. After a mean follow-up of 11±12 months, 52 patients (49%) were free from recurrence, 13 (50%) in the octogenarian group and 39 (48%) in the younger, with an estimated median survival free from atrial arrhythmias of 26 months (95% CI: 4–48) in the octogenarian group and 18 months (95% CI: 5–32) in the younger group (p=0.716). After multivariate analysis, history of prior AF and indexed left atrial volume, but not age, predicted recurrence.

Demographical and clinical variables All patients (n=107) Octogenarians (n=26) No octogenarians (n=81) p-value Age (years) 69±13 83±3 65±11 <0.0001* Cardiomyopathy (%) 54 (50%) 13 (26%) 41 (51%) 0.956 Left ventricular ejection fraction (%) 60±13 57±17 61±11 0.24 Indexed left atrial volume (ml/m2) 45±19 48±14 43±19 0.55 Prior AF history 49 (46%) 7 (27%) 42 (52%) 0.026* Prior ablation procedures 53 (50%) 8 (31%) 45 (56%) 0.028* Prior cardiac surgery 30 (28%) 2 (8%) 28 (35%) 0.008* Left AFL origin (%) 87 (81%) 24 (92%) 63 (78%) 0.098 *Statistically significant difference.

Survival function

Conclusion

AFL ablation was as effective and safe in octogenarian as in younger ones, with a median survival time free from atrial arrhythmias of more than 2 years.

Reduction in Narcotic Use After Lumbar Decompression and Fusion in Patients With Symptomatic Lumbar Stenosis or Spondylolisthesis

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

The purpose of this study is to assess change in opioid use before and after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis.

METHODS

A large insurance database was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index lumbar decompression and fusion procedures between 2007 and 2016. This database consists of 20.9 million covered lives and includes private/commercially insured and Medicare Advantage beneficiaries. Opioid use 6 months preoperatively through 2 years postoperatively was assessed.

RESULTS

The study included 13 257 patients that underwent 1-, 2-, or 3-level posterior lumbar instrumented fusion. Overall, 57.8% of patients used opioids preoperatively. Throughout the 6-month preoperative period, 2 368 008 opioid pills were billed for (51.6 opioid pills/opioid user/month). When compared with preoperative opioid use, patients billed fewer opioid medications in the 2-year period postoperatively: 33.6 pills/patient/month (8 851 616 total pills). In a multivariate logistic regression analysis, obesity (odds ratio [OR] 1.10, 95% CI 1.004-1.212), preoperative narcotic use (OR 3.43, 95% CI 3.179-3.708), length of hospital stay (OR 1.02, 95% CI 1.010-1.021), and receiving treatment in the South (OR 1.18, 95% CI 1.074-1.287) or West (OR 1.26, 95% CI 1.095-1.452) were independently associated with prolonged postoperative (>1 year) opioid use. Additionally, males (OR 0.87, 95% CI 0.808-0.945) were less likely to use long-term opioid therapy.

CONCLUSIONS

This study demonstrates that reduction in opioid use was observed postoperatively in comparison with preoperative values in patients with symptomatic lumbar stenosis or spondylolisthesis that underwent lumbar decompression with fusion. Further prospective studies that are more methodologically stringent are needed to corroborate our findings.

A 2-Year Cost Analysis of Maximum Nonoperative Treatments in Patients With Symptomatic Lumbar Stenosis or Spondylolisthesis That Ultimately Required Surgery

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

The purpose of this study is to characterize the utilization and costs of maximal nonoperative therapies (MNTs) within 2 years prior to spinal fusion surgery in patients with symptomatic lumbar stenosis or spondylolisthesis.

METHODS

A large insurance database was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index 1-, 2-, or 3-level lumbar decompression and fusion procedures between 2007 and 2016. This database consists of 20.9 million covered lives and includes private/commercially insured and Medicare Advantage beneficiaries. The utilization of MNTs within 2 years prior to index surgery was assessed by cost billed to the patient, prescriptions written, and number of units billed.

RESULTS

A total of 27 877 out of 3 423 114 (0.8%) eligible patients underwent posterior lumbar instrumented fusion. Patient MNT utilization was as follows: 11 383 (40.8%) used nonsteroidal anti-inflammatory drugs (NSAIDs), 19 770 (70.9%) used opioids, 12 414 (44.5%) used muscle relaxants, 14 422 (51.7%) received lumbar epidural steroid injection (LESI), 11 156 (40.0%) attended physical therapy/occupational therapy, 4005 (14.4%) presented to the emergency department, and 4042 (14.5%) received chiropractor treatments. The total direct cost associated with all MNTs prior to index spinal fusion was $28 241 320 ($1013.07 per/patient). LESI comprised the largest portion of the total cost of MNT ($15 296 941, 54.2%), followed by opioids ($3 702 463, 13.1%) and NSAIDs ($3 058 335, 10.8%).

CONCLUSIONS

Opioids are the most frequently prescribed and most used therapy in the preoperative period. Assuming minimal improvement in pain and functional disability after maximum nonoperative therapies, the incremental cost effectiveness ratio for MNT could be highly unfavorable.

A Two-Year Cost Analysis of Maximum Nonoperative Treatments in Patients with Cervical Stenosis that Ultimately Required Surgery

OBJECTIVE

The aim of this study is to characterize the use and associated costs of maximal nonoperative therapy (MNT) received within 2-years before anterior cervical discectomy and fusion (ACDF) surgery in patients with symptomatic cervical stenosis.

METHODS

An insurance database, including private/commercially insured and Medicare Advantage beneficiaries, was queried for patients undergoing 1-level, 2-level, or 3-level ACDF procedures between 2007 and 2016. Research records were searchable by International Classification of Diseases diagnosis and procedure, Current Procedural Terminology, and generic drug codes. The use of MNTs within 2 years before index ACDF surgery was assessed by cost billed to patients, prescriptions written, and number of units billed.

RESULTS

Of 220,902 (7.16%) eligible patients, 15,825 underwent index surgery. Patient breakdown of the use of MNT modalities was as follows: 5731 (36.2%) used nonsteroidal antiinflammatory drugs; 9827 (62.1%) used opioids; 7383 (46.7%) used muscle relaxants; 3609 (22.8%) received cervical epidural steroid injection; 5504 (34.8%) attended physical therapy/occupational therapy; 1663 (10.5%) received chiropractor treatments; and 200 (1.3%) presented to the emergency department. During the 2-year preoperative period, there were 51,675 prescriptions for diagnostic cervical imaging. The total direct cost associated with all MNTs before ACDF was $16,056,556. Cervical spine imaging comprised the largest portion of the total MNT cost ($8,677,110; 54.0%), followed by cervical epidural steroid injection ($3,315,913; 20.7%) and opioids ($2,228,221; 13.9%). Opiates were the most frequently prescribed therapy (71,602 prescriptions).

DISCUSSION

Opioids are the most frequently prescribed and most used therapy in the preoperative period for cervical stenosis. Further studies and improved guidelines are necessary to determine which patients may benefit from ACDF earlier in the course of nonoperative therapies.

Outpatient and inpatient readmission rates of 3- and 4-level anterior cervical discectomy and fusion surgeries

OBJECTIVE

With the costs related to the United States medical system constantly rising, efforts are being made to turn traditional inpatient procedures into outpatient same-day surgeries. In this study the authors looked at the various comorbidities and perioperative complications and their impact on readmission rates of patients undergoing outpatient versus inpatient 3- and 4-level anterior cervical discectomy and fusion (ACDF).

METHODS

This was a retrospective study of 337 3- and 4- level ACDF procedures in 332 patients (5 patients had both primary and revision surgeries that were included in this total of 337 procedures) between May 2012 and June 2017. In total, 331 procedures were analyzed, as 6 patients were lost to follow-up. Outpatient surgery was performed for 299 procedures (102 4-level procedures and 197 3-level procedures), and inpatient surgery was performed for 32 procedures (11 4-level procedures and 21 3-level procedures). Age, sex, comorbidities, number of fusion levels, pain level, and perioperative complications were compared between both cohorts.

RESULTS

Analysis was performed for 331 3- and 4-level ACDF procedures done at 6 different hospitals. The overall 30-day readmission rate was 1.2% (outpatient 3 [1.0%] vs inpatient 1 [3.1%], p = 0.847). Outpatients had increased readmission risk, with comorbidities of coronary artery disease (OR 1.058, p = 0.039), autoimmune disease (OR 1.142, p = 0.006), diabetes (OR 1.056, p = 0.001), and chronic kidney disease (OR 0.933, p = 0.035). Perioperative complications of delirium (OR 2.709, p < 0.001) and surgical site infection (OR 2.709, p < 0.001) were associated with increased risk of 30-day hospital readmission in outpatients compared to inpatients.

CONCLUSIONS

This study demonstrates the safety and effectiveness of 3- and 4-level ACDF surgery, although various comorbidities and perioperative complications may lead to higher readmission rates. Patient selection for outpatient 3- and 4-level ACDF cases might play a role in the safety of performing these procedures in the ambulatory setting, but further studies are needed to accurately identify which factors are most pertinent for appropriate selection.