Plasma NT-proBNP and Cell-Free DNA Concentrations after Prolonged Strenuous Exercise in Working Farm Dogs

BACKGROUND

Plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration is increased in dogs with myocardial dysfunction, and cell-free DNA (cfDNA) increases in numerous disease states. In humans, both of these biomarkers can be altered after endurance exercise.

OBJECTIVE

To investigate the effect of prolonged strenuous exercise on circulating NT-proBNP and cfDNA concentrations in working farm dogs.

ANIMALS

Six healthy, privately owned working farm dogs (4 Huntaways and 2 heading dogs) from the same hill country farm in New Zealand.

METHODS

Prospective, nonrandomised cohort study. Venous blood samples were collected before and after the dogs worked over 4 days. Plasma NT-proBNP concentrations were measured by a commercially available ELISA assay and cfDNA concentrations were determined by fluorometry without prior DNA extraction.

RESULTS

The baseline (before work, Day 1) median plasma NT-proBNP concentration was 664 pmol/L. A linear mixed-effects model showed that work increased plasma NT-proBNP concentrations by 101 ± 9% (P < 0.001), but with each consecutive day of work, NT-proBNP concentrations declined by 16 ± 4% (P < 0.001). The baseline median plasma cfDNA concentration was 653 ng/mL, and plasma cfDNA concentrations increased by 138 ± 45 ng/mL after work (P = 0.004).

CONCLUSIONS AND CLINICAL IMPORTANCE

The plasma concentration of NT-proBNP in healthy Huntaways and heading dogs after work can exceed the upper limit of the reference range. Results in dogs sampled on the day of prolonged strenuous exercise should be interpreted with caution. Plasma concentrations of cfDNA also increase with exercise, but further studies are needed to establish reference ranges in healthy dogs.

Multi-energy SXR cameras for magnetically confined fusion plasmas (invited)

A compact multi-energy soft x-ray camera has been developed for time, energy and space-resolved measurements of the soft-x-ray emissivity in magnetically confined fusion plasmas. Multi-energy soft x-ray imaging provides a unique opportunity for measuring, simultaneously, a variety of important plasma properties (T_e, n_Z, ΔZ_eff, and n_e,fast). The electron temperature can be obtained by modeling the slope of the continuum radiation from ratios of the available brightness and inverted radial emissivity profiles over multiple energy ranges. Impurity density measurements are also possible using the line-emission from medium- to high-Z impurities to separate the background as well as transient levels of metal contributions. This technique should be explored also as a burning plasma diagnostic in-view of its simplicity and robustness.

Long-term responses to treatment in UK veterans with military-related PTSD: an observational study

OBJECTIVES

Military-related trauma can be difficult to treat. Evaluating longer term responses to treatment and identifying which individuals may need additional support could inform clinical practice. We assessed 1-year outcomes in UK veterans treated for post-traumatic stress disorder (PTSD).

DESIGN

Within-participant design.

SETTING

The intervention was offered by Combat Stress, a mental health charity for veterans in the UK.

PARTICIPANTS

The sample included 401 veterans who completed a standardised 6-week residential treatment. Of these, 268 (67%) were successfully followed up a year after the end of treatment.

METHODS

A range of health outcomes were collected pretreatment and repeated at standard intervals post-treatment. The primary outcome was severity of PTSD symptoms, and secondary outcomes included measures of other mental health difficulties (depression, anxiety and anger), problems with alcohol, and social and occupational functioning.

RESULTS

Significant reductions in PTSD severity were observed a year after treatment (PSS-I: -11.9, 95% CI -13.1 to -10.7). Reductions in the secondary outcomes were also reported. Higher levels of post-treatment functional impairment (0.24, 95% CI 0.08 to 0.41) and alcohol problems (0.18, 95% CI 0.03 to 0.32) were associated with poorer PTSD treatment response at 12 months.

CONCLUSIONS

This uncontrolled study suggests the longer term benefits of a structured programme to treat UK veterans with PTSD. Our findings point to the importance of continued support targeted for particular individuals post-treatment to improve longer term outcomes.

Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort

BACKGROUND

Although preterm birth <37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates.

OBJECTIVE

We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages.

STUDY DESIGN

This was a secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008 through 2011. All liveborn nonanomalous singleton preterm (23.0-36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade I/II, necrotizing enterocolitis stage I, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome for which criteria was met.

RESULTS

In all, 8334 deliveries met inclusion criteria. There were 119 (1.4%) neonatal deaths. In all, 657 (7.9%) neonates had major morbidity, 3136 (37.6%) had minor morbidity, and 4422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25 weeks of gestation. As frequencies of death and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31 weeks of gestation. The frequency of all morbidities fell >32 weeks. After 25 weeks, neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26-32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median postmenstrual age at discharge nadired around 36 weeks' postmenstrual age for babies born at 31-35 weeks of gestation.

CONCLUSION

Our data show that there is a continuum of outcomes, with each additional week of gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.

Falls and injury prevention should be part of every stroke rehabilitation plan

Objective: To evaluate falls incidence, circumstances and consequences in people who return home after stroke rehabilitation, so that appropriate falls and injury prevention strategies can be developed.

Design: Prospective cohort study.

Setting: Community.

Subjects: Fifty-six subjects with stroke who were participating in a rehabilitation programme and returning to live in a community setting completed the study.

Main measures: Subjects completed a prospective falls diary for six months after discharge from rehabilitation, and were interviewed after falls. Physical function was measured by the Berg Balance Scale (BBS) and the Functional Independence Measure (FIM).

Results: Forty-six per cent of people (26/56) fell, with most falls (63/103 falls) occurring in the two months after discharge from rehabilitation. One subject had 37 similar falls and these falls were excluded from further analysis. Falls occurred more often indoors (50/66), during the day (46/66) and towards the paretic side (25/66). People required assistance to get up after 25 falls (38%) and 36 falls (55%) resulted in an injury. People sought professional health care after only 16 falls, and activity was restricted after 29 falls (44%). The Berg Balance Scale and Functional Independence Measure scores were lower in people who had longer lies after a fall, and who restricted their activity after a fall (p < 0.05). Lower physical function scores were also associated with falling in the morning, wearing multifocal glasses at the time of a fall, and injurious falls (p < 0.05).

Conclusion: Falls are common when people return home after stroke. Of concern are the small number seeking health professionals’ assistance after a fall, the high proportion restricting their activity as a result of a fall and the number of falls occurring towards the paretic side.

A ribosome-related signature in peripheral blood CLL B cells is linked to reduced survival following treatment

We have used polysome profiling coupled to microarray analysis to examine the translatome of a panel of peripheral blood (PB) B cells isolated from 34 chronic lymphocytic leukaemia (CLL) patients. We have identified a ‘ribosome-related' signature in CLL patients with mRNAs encoding for ribosomal proteins and factors that modify ribosomal RNA, e.g. DKC1 (which encodes dyskerin, a pseudouridine synthase), showing reduced polysomal association and decreased expression of the corresponding proteins. Our data suggest a general impact of dyskerin dysregulation on the translational apparatus in CLL and importantly patients with low dyskerin levels have a significantly shorter period of overall survival following treatment. Thus, translational dysregulation of dyskerin could constitute a mechanism by which the CLL PB B cells acquire an aggressive phenotype and thus have a major role in oncogenesis.

A brain-lesion pattern based algorithm for the diagnosis of posttraumatic olfactory loss

BACKGROUND

Brain areas processing olfactory information exhibit functionally relevant morphological dynamics. This suggests the exploitation of anatomical information in the diagnosis of an olfactory dysfunction. Following previous identifications of olfactory eloquent areas such as the olfactory bulbs and tracts, we focused at a brain-morphology based algorithm for establishing the diagnosis of olfactory loss following brain injury.

METHODOLOGY

Forty-one patients with a history of head trauma dated back 40 ± 39 months, and additional 23 patients without head trauma, were assessed for damages in 11 olfaction-relevant brain areas using magnetic resonance imaging (MRI). Olfactory function was derived from the use of a standardized, reliable and validated olfactory test. An olfactory diagnostic algorithm was derived following classification and regression tree analysis of the brain lesion pattern.

RESULTS

Subjects were assigned to olfactory diagnoses of anosmia, hyposmia or normosmia. These diagnoses were predictable at an accuracy of 62.3 % from the degree of damage in the olfactory bulb and in the left temporal lobe pole. The main diagnosis algorithm addressed the presence of anosmia, which could be predicted from the degree of damage in these brain areas at an accuracy of 81.3 %.

CONCLUSIONS

We independently reproduced previously identified brain regions in which morphological damage is associated with olfactory loss. Based on this reproduction, an algorithm was developed for the diagnosis of anosmia from central-nervous damage. Thus, we introduce a morphological component to the olfactory diagnosis that specifically addresses clinical cases of olfactory loss following head trauma.

Physical activity and sedentary behaviour: applying lessons to chronic obstructive pulmonary disease

In health and disease, the benefits of regular participation in moderate to vigorous intensity physical activity are well documented. However, individuals with chronic conditions, such as those with chronic obstructive pulmonary disease (COPD), typically do very little activity at a moderate or vigorous intensity. Much of their day is instead spent in sedentary behaviour, such as sitting or reclining, which requires very little energy expenditure. This high level of time spent in sedentary behaviour can have serious health consequences, including increased risk of diabetes, cardiovascular disease and premature mortality. There is emerging evidence to suggest that participation in light intensity physical activities (e.g. standing or slow walking) may have benefits for cardio-metabolic health. Given the low aerobic capacity of individuals with moderate to severe COPD, increasing light intensity activity (through reducing sedentary time) may be a feasible additional strategy to improve health in this population, alongside traditional recommendations to increase the time spent in moderate to vigorous intensity physical activity. This review provides an overview of physical activity and sedentary behaviour, with a particular emphasis on these behaviours for people with COPD. It provides suggestions for the measurement of these behaviours within the clinical setting, as well as for interventions that may be effective at increasing physical activity and reducing sedentary behaviour in this population.

Foraging at wastewater treatment works affects brown adipose tissue fatty acid profiles in banana bats

In this study we tested the hypothesis that the decrease in habitat quality at wastewater treatment works (WWTW), such as limited prey diversity and exposure to the toxic cocktail of pollutants, affect fatty acid profiles of interscapular brown adipose tissue (iBrAT) in bats. Further, the antioxidant capacity of oxidative tissues such as pectoral and cardiac muscle may not be adequate to protect those tissues against reactive molecules resulting from polyunsaturated fatty acid auto-oxidation in the WWTW bats. Bats were sampled at two urban WWTW, and two unpolluted reference sites in KwaZulu-Natal, South Africa. Brown adipose tissue (BrAT) mass was lower in WWTW bats than in reference site bats. We found lower levels of saturated phospholipid fatty acids and higher levels of mono- and polyunsaturated fatty acids in WWTW bats than in reference site bats, while C18 desaturation and n-6 to n-3 ratios were higher in the WWTW bats. This was not associated with high lipid peroxidation levels in pectoral and cardiac muscle. Combined, these results indicate that WWTW bats rely on iBrAT as an energy source, and opportunistic foraging on abundant, pollutant-tolerant prey may change fatty acid profiles in their tissue, with possible effects on mitochondrial functioning, torpor and energy usage.

Summary: Brown adipose tissue of banana bats foraging at wastewater treatment works contained lower saturated and higher mono- and polyunsaturated phospholipid fatty acids than that of bats foraging at reference sites.

Initial analysis of a community-based bereavement programme

It is well evidenced that childhood bereavement has a negative impact upon a range of psychological and educational outcomes. This article describes a service evaluation of the national child bereavement charity, Winston's Wish SWITCH programme. SWITCH is a community outreach bereavement programme targeted at children that are at risk of antisocial and self-destructive behaviour. A preliminary evaluation of baseline to follow up of parent (n=31) and young person (n=96) Strength and Difficulties (SDQ) data suggests that the programme contributes to a positive impact upon emotional distress, relationships, and concentration. Further, more robust evaluation needs to be conducted to understand the long-term implications of the programme on vulnerable young people.

The evolutionary context of chronic allergic conditions : The Hiwi of Venezuela

The question of why populations with ecologies that resemble our evolutionary past rarely experience allergic conditions such as asthma has intrigued many biomedical scientists. Here we present descriptive data on the ecological context of allergic sensitization among the Hiwi of southwestern Venezuela and suggest reasons for why this and other lowland South American Indian groups do not express the allergic response at levels seen in industrialized contexts. Allergic sensitization among the Hiwi appears to be negligible. This absence occurs in the context of high exposure to macroparasites (mainly hookworm), nutritional stress, frequent and prolonged breastfeeding, low indoor allergen deposition, and few hours spent per day indoors. We conclude that seeking unidimensional answers to the question of why isolated human groups generally experience few allergic conditions is potentially flawed because allergies are produced by a multifaceted immunoglobulin E (IgE) system that responds in complex ways to the environmental and behavioral exposures we examined. Instead, we propose a general model of physiological trade-offs in energy allocation between production of IgE of undefined specificity and production of allergen-specific IgE. In addition, we consider the simultaneous effects that exposures such as nutritional stress, allergen exposure, and breastfeeding may have on these trade-offs.

Reservation food sharing among the Ache of Paraguay

We describe food transfer patterns among Ache Indians living on a permanent reservation. The social atmosphere at the reservation is characterized by a larger group size, a more predictable diet, and more privacy than the Ache typically experience in the forest while on temporary foraging treks. Although sharing patterns vary by resource type and package size, much of the food available at the reservation is given to members of just a few other families. We find significant positive correlations between amounts transferred among pairs of families, a measure of the "contingency" component required of reciprocal altruism models. These preferred sharing partners are usually close kin. We explore implications of these results in light of predictions from current sharing models.

A Novel early pregnancy assessment unit/Gynaecology assessment unit dashboard: An experience from a UK district general hospital

The establishment of early pregnancy assessment units (EPAUs)/Gynaecology assessment units (GAUs) started more than 20 years ago in the UK to decrease hospital admissions of patients with early pregnancy problems. However, there are still wide variations in the quality of services provided by these units. The objective of this study was to create a method that can be used for continuous assessment of these units on a regular basis. We designed a dashboard covering all aspects of EPAU/GAU activities depending upon the early pregnancy unit association guidelines, and the department of health data and statistics. The EPAU/GAU dashboard has been used successfully in the early assessment pregnancy unit of Yeovil District hospital for few years and is still implemented until now. It is an excellent tool for continuous audit. It is a simple method that should be adopted by different EPAUs/GAUs for their objective assessment in order to improve the services provided by these units.