Comparison of oil and fat supplementation on lactation performance of Nili Ravi buffaloes

The effects of feeding rumen-inert fat sources on production responses of lactating dairy cows have been well reported but less thoroughly described in lactating dairy buffalo. The objective of this study was to investigate the effect of oil and 2 different rumen-inert fat sources on dry matter intake, milk yield, milk composition, and milk fatty acid (FA) profile in Nili Ravi buffalo. Twelve multiparous mid-lactating Nili Ravi buffaloes received 4 treatments in a 4 × 4 Latin square design with a period length of 21 d. The treatments were (1) the basal diet without supplementation of oil or fats (CTRL), (2) the basal diet supplemented with canola oil (CO), (3) the basal diet supplemented with calcium salts of palm FA (Ca-FA), and (4) the basal diet supplemented with high palmitic acid (PA). Dry matter intake was decreased by 4.4% in the CO compared with Ca-FA and PA. Milk yield and milk fat yield were increased by 7.8 and 14.3%, respectively, in CO, Ca-FA, and PA compared with the CTRL. Milk fat content increased by 7.5%, whereas milk fat yield tended to increase with the supplementation of Ca-FA and PA compared with CO. No effect on milk yield and milk composition was observed in Ca-FA versus PA treatments. The yield of medium-chain FA was increased by Ca-FA and PA versus CO. The CO treatment increased the yield of long-chain FA compared with Ca-FA and PA treatments. Plasma glucose level was higher in CO, Ca-FA, and PA compared with the CTRL. In conclusion, feeding rumen-inert fats in the lactating buffalo diet proved to be a useful strategy to increase the 3.5% fat-corrected milk yield due to the higher milk fat content in this study.

Towards an Untethered Ultrasound Beamforming System for Brain Stimulation in Behaving Animals

In this paper, we present a wireless ultrasound transmit (TX) beamforming system, potentially enabling wearable brain stimulation for small awake/behaving animals. The system is comprised of a 16-element capacitive micromachined transducer (CMUT) array, driven by a custom phased-array integrated circuit (IC), which is capable of generating high-voltage (13.5 V) excitation signals with sixteen phase delays and four amplitude levels. In addition, a Bluetooth low-energy module and a power management unit were integrated into the system, which realizes a battery-operated self-contained unit. We validated the functionality of the system by demonstrating beamforming and steering with a hydrophone measurement setup. We achieved an acoustic pressure output of 554 kPa_pp at the depth of 5 mm, which corresponds to a spatial-peak pulse-average intensity (I_SPPA) of 2.9 W/cm². The measured 6-dB beamwidth (0.4 mm) is promising in that it can stimulate a specific region of the brain, especially for small animals such as mice. Further smart partitioning of the system will enable a truly wearable device for small animals.

Integrating Palliative Care in Cancer Care in Kenya

Background and context: Most Africa countries now recognize the pain and suffering of many patients and families who have no access to cure (where cure is possible), cannot afford treatment of cancer or other progressive chronic illnesses, are stigmatized or discriminated against because of their illness among many other dehumanizing issues. This project aims to ensure that all those in need of palliative care and pain relief have access close to their homes. Aim: This project aims to ensure that all those in need of palliative care and pain relief have access close to their homes. Strategy/Tactics: In the recent past Kenya Hospices and Palliative Care Association has extensively advocated for the integration of palliative care into the Kenya health services; thus, resulting in many health care professionals being trained in palliative care; integration of palliative care in public, private and mission health institutions and integration of palliative care in undergraduate medical and nursing curricula, as well as policy documents. Program/Policy process: The process of integrating palliative care in public hospitals involved advocacy at the national level as well as at the institutional level, training of health care professionals and setting up services within the hospitals that we worked with. Technical support was provided to each individual institution as needed. Outcomes: Palliative care units have been set up in over 25 government hospitals across the country. National Palliative Care Guidelines have been developed. A Diploma in Palliative Care for nurses has been initiated at the Kenya Medical Training College since 2012. Palliative care has been included in all the relevant health policies/strategies. Kenya Essential Medicines List includes Opioids. The Ministry of Health is supplying morphine powder for the country. More patients are now able to access quality palliative care. What was learned: National associations are challenged by an enormous need for services, education and training of health care professionals as well as educating the public and policy makers. The government has no budget for palliative care and most of the work is donor funded. Cultural beliefs are a big barrier to accessing PC. Only a small fraction of patients in need of opioids for pain medication are receiving opioids due to lack of awareness; reluctance of HPCs to prescribe. For many years PC in Kenya has been provided by a few hospices, thus making access very limited to many who are in need. Regional and national associations in Africa should work together with African Ministries of Health and other relevant stakeholders to ensure that there is greater access to palliative care for cancer patients. This encompasses addressing issues of accessibility, affordability, quality palliative care (PC) and a human's right approach to PC.

Relation of Coronary Flow Reserve to Other Findings on Positron Emission Tomography Myocardial Perfusion Imaging and Left Heart Catheterization in Patients With End-stage Renal Disease Being Evaluated for Kidney Transplant

Cardiovascular disease is the leading cause of death in patients with end-stage renal disease (ESRD) and often goes undetected. Abnormal coronary flow reserve (CFR), which predicts increased risk of cardiac death, may be present in patients with ESRD without other evidence of coronary artery disease (CAD). We prospectively studied 131 patients who had rest and dipyridamole pharmacologic stress N¹³-ammonia positron emission tomography myocardial perfusion imaging (PET MPI) for kidney transplant evaluation. Thirty-four patients also had left heart catheterization. Abnormal PET MPI was defined as qualitative ischemia or infarct, stress electrocardiogram ischemia, or transient ischemic dilation. CFR was calculated as the ratio of stress to rest coronary blood flow. Global CFR < 2 was defined as abnormal. Of 131 patients who had PET MPI (66% male, 55.6 ± 12.1 years), 30% (39 of 131) had abnormal PET MPI and 59% (77 of 131) had abnormal CFR. In a subset of 34 patients who had left heart catheterization (66% male, 61.0 ± 12.1 years), 68% (23 of 34) had abnormal CFR on PET MPI, and 68% (23 of 34) had ≥70% obstruction on left heart catheterization. Abnormal CFR was not significantly associated with abnormal PET MPI (p = 0.13) or obstructive CAD on left heart catheterization (p = 0.26). In conclusion, in the first prospective study of PET MPI in patients with ESRD, abnormal CFR is highly prevalent and is independent of abnormal findings on PET MPI or obstructive CAD on left heart catheterization.

Determinants of low risk of asthma exacerbation during pregnancy

BACKGROUND

Assessment of asthma control every 4-6 weeks during pregnancy is recommended to reduce risk of exacerbation, and by that improve outcome.

OBJECTIVE

To identify determinants of pregnancies with low risk of asthma exacerbation.

METHODS

All pregnant women enrolled into the Management of Asthma during Pregnancy (MAP) programme at Hvidovre Hospital since 2007. Assessment of asthma control, adjustment of treatment, spirometry and measurement of exhaled nitric oxide (F_E NO) were performed, and baseline characteristics and exacerbation history were collected at enrolment. Determinants of low-exacerbation risk pregnancies were identified by logistic regression analysis (stepwise backward elimination).

RESULTS

In 1283 pregnancies, 107 exacerbations were observed. Multiple regression analysis revealed that no history of pre-pregnancy exacerbations (P < .001), no prescribed controller medication (P < .001), and clinically stable asthma at enrolment (P = .002) were significantly associated with low risk of exacerbation during pregnancy; with these combined characteristics, only two of 385 pregnancies were complicated by an exacerbation (OR 0.04, 95% CI 0.01-0.18, P < .001).

CONCLUSION AND CLINICAL RELEVANCE

Clinically stable asthma at enrolment, together with no history of previous exacerbations and no prescribed controller medication, is a determinant of low risk of an asthma exacerbation during pregnancy, which may guide clinicians in individualizing surveillance of asthma during pregnancy.

Mucocele of appendix with an elevated carcinoembryonic antigen: A case report

Mucocele of the appendix is an uncommon disease in which there is cystic dilatation of the appendix caused by mucus secretion and usually associated with benign or malignant causes. Preoperative diagnosis is difficult as the patient presents with non-specific clinical symptoms. We report a case of mucocele of the appendix with elevated serum carcinoembryonic antigen (CEA) - a condition sparsely reported in literature. Patient presented with pain in the right iliac fossa for 7 months. On exploration, a cystic mass of the appendix without perforation was found in right iliac fossa. There was no lymph nodes enlargement. Appendicectomy was performed with subsequent normalization of CEA level and histopathology confirmed the diagnosis of mucinous neoplasm of the appendix. Patient is feeling well after one year of follow up.

The Impact of Proximal Vessel Tortuosity on the Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry

INTRODUCTION

We examined the impact of proximal vessel tortuosity on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

METHODS

The baseline clinical and angiographic characteristics and procedural outcomes of 1618 consecutive CTO-PCIs performed between 2012 and 2016 at 14 United States centers in 1589 patients were reviewed.

RESULTS

Mean patient age was 65.3 ± 10.0 years and 85% were men. Moderate/severe proximal vessel tortuosity was present in 35.7% of target lesions. Compared with non-tortuous lesions, tortuous lesions had longer length (30 mm [interquartile range, 20-50 mm] vs 28 mm [interquartile range, 16-40 mm]; P<.001), more proximal cap ambiguity (36% vs 28%; P<.01), and more frequent utilization of the retrograde approach (52% vs 37%; P<.001). Moderate/severe proximal vessel tortuosity was associated with lower technical success rates (84.1% vs 91.3%; P<.001) and procedural success rates (82.3% vs 89.9%; P<.001), but similar incidence of major cardiac adverse events (3.0% vs 2.5%; P=.59). Moderate/severe tortuosity was associated with longer procedure time and fluoroscopy time, higher air kerma radiation dose, and larger contrast volume.

CONCLUSION

In a contemporary multicenter registry, moderate/severe proximal vessel tortuosity was present in approximately one-third of target CTO lesions and was associated with more frequent use of the retrograde approach and lower success rates, but similar complication rates.

Plasma activated coating immobilizes apolipoprotein A-I to stainless steel surfaces in its bioactive form and enhances biocompatibility

We utilized a plasma activated coating (PAC) to covalently bind the active component of high density lipoproteins (HDL), apolipoprotein (apo) A-I, to stainless steel (SS) surfaces. ApoA-I suppresses restenosis and thrombosis and may therefore improve SS stent biocompatibility. PAC-coated SS significantly increased the covalent attachment of apoA-I, compared to SS alone. In static and dynamic flow thrombosis assays, PAC+apoA-I inhibited thrombosis and reduced platelet activation marker p-selectin. PAC+apoA-I reduced smooth muscle cell attachment and proliferation, and augmented EC attachment to PAC. We then coated PAC onto murine SS stents and found it did not peel or delaminate following crimping/expansion. ApoA-I was immobilized onto PAC-SS stents and was retained as a monolayer when exposed to pulsatile flow in vivo in a murine stent model. In conclusion, ApoA-I immobilized on PAC withstands pulsatile flow in vivo and retains its bioactivity, exhibiting anti-thrombotic and anti-restenotic properties, demonstrating the potential to improve stent biocompatibility.