Cerebro-spinal fluid glucose and lactate concentrations changes in response to therapies in patIents with primary brain injury: the START-TRIP study

INTRODUCTION

Altered levels of cerebrospinal fluid (CSF) glucose and lactate concentrations are associated with poor outcomes in acute brain injury patients. However, no data on changes in such metabolites consequently to therapeutic interventions are available. The aim of the study was to assess CSF glucose-to-lactate ratio (CGLR) changes related to therapies aimed at reducing intracranial pressure (ICP).

METHODS

A multicentric prospective cohort study was conducted in 12 intensive care units (ICUs) from September 2017 to March 2022. Adult (> 18 years) patients admitted after an acute brain injury were included if an external ventricular drain (EVD) for intracranial pressure (ICP) monitoring was inserted within 24 h of admission. During the first 48-72 h from admission, CGLR was measured before and 2 h after any intervention aiming to reduce ICP ("intervention"). Patients with normal ICP were also sampled at the same time points and served as the "control" group.

RESULTS

A total of 219 patients were included. In the intervention group (n = 115, 53%), ICP significantly decreased and CPP increased. After 2 h from the intervention, CGLR rose in both the intervention and control groups, although the magnitude was higher in the intervention than in the control group (20.2% vs 1.6%; p = 0.001). In a linear regression model adjusted for several confounders, therapies to manage ICP were independently associated with changes in CGLR. There was a weak inverse correlation between changes in ICP and CGRL in the intervention group.

CONCLUSIONS

In this study, CGLR significantly changed over time, regardless of the study group. However, these effects were more significant in those patients receiving interventions to reduce ICP.

Optimization of Swine Breeding Programs Using Genomic Selection with ZPLAN

The objective of this study was to evaluate the present conventional selection program of a swine nucleus farm and compare it with a new selection strategy employing genomic enhanced breeding value (GEBV) as the selection criteria. The ZPLAN+ software was employed to calculate and compare the genetic gain, total cost, return and profit of each selection strategy. The first strategy reflected the current conventional breeding program, which was a progeny test system (CS). The second strategy was a selection scheme based strictly on genomic information (GS1). The third scenario was the same as GS1, but the selection by GEBV was further supplemented by the performance test (GS2). The last scenario was a mixture of genomic information and progeny tests (GS3). The results showed that the accuracy of the selection index of young boars of GS1 was 26% higher than that of CS. On the other hand, both GS2 and GS3 gave 31% higher accuracy than CS for young boars. The annual monetary genetic gain of GS1, GS2 and GS3 was 10%, 12%, and 11% higher, respectively, than that of CS. As expected, the discounted costs of genomic selection strategies were higher than those of CS. The costs of GS1, GS2 and GS3 were 35%, 73%, and 89% higher than those of CS, respectively, assuming a genotyping cost of $120. As a result, the discounted profit per animal of GS1 and GS2 was 8% and 2% higher, respectively, than that of CS while GS3 was 6% lower. Comparison among genomic breeding scenarios revealed that GS1 was more profitable than GS2 and GS3. The genomic selection schemes, especially GS1 and GS2, were clearly superior to the conventional scheme in terms of monetary genetic gain and profit.

Estimation of Genetic Parameters for Pork Belly Components in Yorkshire Pigs

This study was conducted to estimate the genetic parameters for pork belly traits and muscles in Yorkshire pigs. Each pork belly was cut into nine parts perpendicular to the thoracic vertebrae (6th to 14th). Traits of belly muscles including the deep pectoral, latissimus dorsi, cutaneous trunci, rectus abdominis, external and internal abdominal oblique from 382 purebred pigs were recorded and analyzed using SAS Package (9.1) and Derivative-free restricted maximum likelihood methods. Heritability estimates for belly traits ranged from 0.27 to 0.49, while they were 0.12 to 0.66 for belly muscles. Moderate to high heritability estimates were noted in belly weight (0.33), belly length (0.28), and belly width (0.49). In belly muscles, the latissimus dorsi and deep pectoral, which are located only in the 6th to 9th vertebrae sections, were found to have heritability estimates ranging from 0.21 to 0.29 and 0.23 to 0.35, respectively. Strong heritability estimates were observed in the 7th to 13th sections of cutaneous trunci muscle ranging from 0.42 to 0.66. Genetic correlations of latissimus dorsi m. with belly length were positive (0.50), while cutaneous trunci m. with belly weight also revealed a positive relationship that ranged from 0.35 to 0.47. The estimated genetic parameters indicate that belly weight can be improved by genetic selection. Differences in the levels of heritability occurred among various parameters of Yorkshire pork belly, which should be considered when performing selection to improve pork belly quality. Moreover, these results can provide valuable information that can be used as the basis for further investigations to improve pork belly.

Estimation of Genetic Associations between Production and Meat Quality Traits in Duroc Pigs

Data collected from 690 purebred Duroc pigs from 2009 to 2012 were used to estimate the heritability, and genetic and phenotypic correlations between production and meat quality traits. Variance components were obtained through the restricted maximum likelihood procedure using Wombat and SAS version 9.0. Animals were raised under the same management in five different breeding farms. The average daily gain, loin muscle area (LMA), backfat thickness (BF), and lean percent (LP) were measured as production traits. Meat quality traits included pH, cooking loss, lightness (L*), redness (a*), yellowness (b*), marbling score (MS), moisture content (MC), water holding capacity (WHC), and shear force. The results showed that the heritability estimates for meat quality traits varied largely from 0.19 to 0.79. Production traits were moderate to highly heritable from 0.41 to 0.73. Genotypically, the BF was positively correlated (p<0.05) with MC (0.786), WHC (0.904), and pH (0.328) but negatively correlated with shear force (−0.533). The results of genetic correlations indicated that selection for less BF could decrease pH, moisture content, and WHC and increase the shear force of meat. Additionally, a significant positive correlation was recorded between average daily gain and WHC, which indicates pork from faster-growing animals has higher WHC. Furthermore, selection for larger LMA and LP could increase MS and lightness color of meat. The meat quality and production traits could be improved simultaneously if desired. Hence, to avoid further deterioration of pork characteristics, appropriate selection of traits should be considered.

Actuarial outcome after catheter balloon commissurotomy in patients with mitral stenosis

BACKGROUND

The goal of the present study was to determine the intermediate-term survival and the independent predictors of survival and event-free survival for patients who undergo catheter balloon commissurotomy (CBC).

METHODS AND RESULTS

CBC for the treatment of mitral stenosis was performed in 132 patients from 1986 through 1994. The use of CBC increased the mitral valve area (MVA) from 1.0 +/- 0.3 to 1.9 +/- 0.6 cm2 (P < .001). There were six early deaths (4.5%) up to 1 month after CBC ("hospital" deaths). In the past 4.5 years, there have been no hospital deaths. Four late deaths occurred after elective mitral valve replacement (MVR). Actuarial 7-year survival was 95 +/- 1%; when mortality after MVR is included, 7-year survival was 83 +/- 6%. Actuarial 1-, 3-, 5-, and 7-year event-free survival (survival without MVR or repeat CBC) was 80 +/- 4%, 77 +/- 4%, 65 +/- 6%, and 65 +/- 6%. On multivariate analysis, the only two independent predictors (both after CBC) of 7-year event-free survival were MVA of > or = 1.5 versus < 1.5 cm2 (75 +/- 7% versus 32 +/- 12%) and mean pulmonary artery wedge pressure of < or = 18 versus > 18 mm Hg (84 +/- 6% versus 38 +/- 11%) (P < .001 for both). Patients with MVA of > or = 1.5 cm2 (n = 96) could be further subdivided into high- and low-risk subgroups for 7-year event-free survival by two post-CBC variables: mean pulmonary artery wedge pressure of < or = 18 versus > 18 mm Hg (90 +/- 6% versus 48 +/- 14%) (P = .0002) and cardiac index of > or = 2.5 versus < 2.5 L.min-1.m-2 (82 +/- 8% versus 61 +/- 13%) (P = .004). Patients with post-CBC MVA of < 1.5 cm2 (n = 24) had no additional predictors of event-free survival. Of patients who did not undergo MVR or repeat CBC, 8% were in New York Heart Association functional class III and 92% were in class I or early class II at the last follow-up.

CONCLUSIONS

The rates for intermediate-term survival and event-free survival after CBC are very encouraging. Most patients without events were asymptomatic or minimally symptomatic. Thus, in selected patients with mitral stenosis who require an interventional procedure, CBC is the procedure of choice at centers with physicians who have experience and skill in performing this procedure.