Why are antithrombotic drugs not prescribed to octogenarian patients with atrial fibrillation at risk of stroke?

OBJECTIVE

In non-valvular atrial fibrillation (NVAF) patients at risk of stroke, anticoagulant drugs are less likely to be received by older patients than younger patients. In this study, an attempt is made to discover whether the reasons reported by physicians for denying anticoagulant drugs prescription differ between older and younger atrial fibrillation patients.

MATERIALS AND METHODS

A retrospective, cross-sectional, multicentre study was conducted from October 2014 to July 2015. The study comprised patients aged ≥18 years diagnosed with NVAF, with a moderate to high stroke risk (CHADS2 score ≥2). Patients were stratified according to age (<80 and ≥80 years).

RESULTS

A total of 1309 NVAF patients were evaluated, of whom 40.1% were ≥80 years old. Older patients were predominantly women with higher mean time since diagnosis of AF, with a higher rate of permanent NVAF, and with higher thromboembolic risk. In patients for whom physicians decided not to prescribe any anticoagulant agents, the following reasons were significantly more frequent in patients aged ≥80 years compared to younger patients: cognitive impairment, perceived high bleeding risk, falls, difficult access to monitoring, non-neoplastic terminal illness, and perceived low thromboembolic risk. Uncontrolled hypertension was a significantly more frequent reason for non-prescription of anticoagulant agents in patients aged <80 year.

CONCLUSIONS

Octogenarian patients with NVAF and a moderate to high risk of stroke had a different as regards reasons for not being prescribed anticoagulant agents, which should be taken into account in order to improve.

Evaluation of ultraviolet-C and spray-drying processes as two independent inactivation steps on enterotoxigenic Escherichia coli K88 and K99 strains inoculated in fresh unconcentrated porcine plasma

The objectives of this study were to assess the effectiveness of an ultraviolet (UV‐C, 254 nm) irradiation system and the spray‐drying method as two independent safety steps on inactivation of Escherichia coli K88 and K99 spiked in porcine plasma at 6·46 ± 0·04 log₁₀ ml⁻¹ and 6·78 ± 0·67 log₁₀ ml⁻¹ respectively for UV‐C method, and at 7·31 ± 0·39 log₁₀ ml⁻¹ and 7·66 ± 0·11 log₁₀ ml⁻¹, respectively for the spray‐drying method. The UV‐C method was performed at different UV light doses (from 750 to 9000 J l⁻¹) using a pilot plant UV‐C device working under turbulent flow. Spray‐drying treatment was done at inlet temperature 220 ± 1°C and two different outlet temperatures, 80 ± 1°C or 70 ± 1°C. Results indicated that UV‐C treatment induced a 4 log₁₀ viability reduction for both E. coli at 3000 J l⁻¹. Full inactivation of both E. coli strains was achieved in all spray‐dried samples dehydrated at both outlet temperatures. The special UV‐C system design for turbid liquid porcine plasma is a novel treatment that can provide an additional redundant biosafety feature that can be incorporated into the manufacturing process for spray‐dried animal plasma.

Significance and Impact of the Study

The safety of raw materials from animal origin such as spray‐dried porcine plasma (SDPP) may be a concern for the swine industry. Ultraviolet treatment at 254 nm (UV‐C) of liquid plasma has been proposed as an additional biosafety feature in the manufacturing process of SDPP. We found that UV‐C exposure in the liquid plasma at 3000 J l⁻¹ reduces about 4 log10 ml⁻¹ for E. coli K88 and K99. Full inactivation of both E. coli strains was achieved in all spray‐dried samples. The incorporation of UV‐C treatment to liquid plasma improves the robustness of the SDPP manufacturing process.

Damping of Josephson Oscillations in Strongly Correlated One-Dimensional Atomic Gases

We study Josephson oscillations of two strongly correlated one-dimensional bosonic clouds separated by a localized barrier. Using a quantum-Langevin approach and the exact Tonks-Girardeau solution in the impenetrable-boson limit, we determine the dynamical evolution of the particle-number imbalance, displaying an effective damping of the Josephson oscillations which depends on barrier height, interaction strength, and temperature. We show that the damping originates from the quantum and thermal fluctuations intrinsically present in the strongly correlated gas. Because of the density-phase duality of the model, the same results apply to particle-current oscillations in a one-dimensional ring where a weak barrier couples different angular momentum states.

Combined effects of spray-drying conditions and postdrying storage time and temperature on Salmonella choleraesuis and Salmonella typhimurium survival when inoculated in liquid porcine plasma

The objective of this study was to determine the effectiveness of the spray-drying process on the inactivation of Salmonella choleraesuis and Salmonella typhimurium spiked in liquid porcine plasma and to test the additive effect of immediate postdrying storage. Commercial spray-dried porcine plasma was sterilized by irradiation and then reconstituted (1:9) with sterile water. Aliquots of reconstituted plasma were inoculated with either S. choleraesuis or S. typhimurium, subjected to spray-drying at an inlet temperature of 200°C and an outlet temperature of either 71 or 80°C, and each spray-drying temperature combinations were subjected to either 0, 30 or 60 s of residence time (RT) as a simulation of residence time typical of commercial dryers. Spray-dried samples were stored at either 4·0 ± 3·0°C or 23·0 ± 0·3°C for 15 days. Bacterial counts of each Salmonella spp., were completed for all samples. For both Salmonella spp., spray-drying at both outlet temperatures reduced bacterial counts about 3 logs at RT 0 s, while there was about a 5·5 log reduction at RT 60 s. Storage of all dried samples at either 4·0 ± 3·0°C or 23·0 ± 0·3°C for 15 days eliminate all detectable bacterial counts of both Salmonella spp.

SIGNIFICANCE AND IMPACT OF THE STUDY

Safety of raw materials from animal origin like spray-dried porcine plasma (SDPP) may be a concern for the swine industry. Spray-drying process and postdrying storage are good inactivation steps to reduce the bacterial load of Salmonella choleraesuis and Salmonella typhimurium. For both Salmonella spp., spray-drying at 71°C or 80°C outlet temperatures reduced bacterial counts about 3 log at residence time (RT) 0 s, while there was about a 5.5 log reduction at RT 60 s. Storage of all dried samples at either 4.0 ± 3.0°C or 23.0 ± 0.3°C for 15 days was effective for eliminating detectable bacterial counts of both Salmonella spp.

Effects of specialty proteins as alternatives to bovine or porcine spray-dried plasma in non-medicated diets fed to weaned pigs housed in an unsanitary environment

Two experiments were done to compare growth performance of pigs weaned at 21 ± 2 d of age that were housed in unsanitary pens and fed non-medicated diets containing alternative proteins versus spray-dried porcine (SDPP; Exp. 1) or bovine (SDBP; Exp. 2) plasma. Experiment 1 used 360 pigs fed 1 of 6 experimental diets from d 0 to 15, followed by a common diet fed to all pigs from d 15 to 28 post-weaning with 11 pens of 5 or 6 pigs/pen allotted per treatment. Experimental diets were based on 8.04% soy protein concentrate (SPC) as the control protein or a similar diet with either 2.50 or 5.00% SDPP or 0.17, 0.33, or 1.00% activated porcine plasma (APP) replacing SPC on an equal Lys basis. Experiment 2 used 300 pigs that were fed 1 of 6 experimental diets from d 0 to 14 post-weaning with 10 pens of 4 to 6 pigs/pen allotted per diet. Experiment 2 diets were based on 8.04% SPC as the control protein source or similar diets with the following specialty proteins replacing SPC on an equal Lys basis: 0.40% APP; 10.66% enzymatically hydrolyzed soy and yeast protein (EHSY); a combination (CB) of 6.36% EHSY, 0.40% APP, and 2.50% fish meal; 0.44% spray-dried whole egg from hyper-immunized hens (IEGG); or 5.00% SDBP. Results of Exp. 1 indicated pigs fed SDPP diets had greater (P < 0.05) ADG and ADFI at d 7 and 15 compared with pigs fed SPC or APP diets. Gain:feed at d 7 was higher (P < 0.05) for pigs fed diets with SDPP compared with other diets. Average BW at d 7 was greater (P < 0.05) for pigs fed diets with SDPP compared to other diets and pigs fed the 5.00% SDPP diet had greater BW at d 15 compared to diets without SDPP. At d 28 BW was greater (P < 0.05) for pigs fed the 2.50% SDPP diet compared with pigs fed diets with SPC, 0.33% APP, or 1.00% APP. Performance of pigs fed the SPC diet did not differ from APP diets at any period of the study. In Exp. 2, pigs fed the SDBP diet had greater (P < 0.05) BW, ADG, and ADFI at d 7 and 14 compared with pigs fed the other diets. Gain:feed did not differ significantly among diets. Average daily gain and ADFI of pigs did not differ among diets that did not contain SDBP. In conclusion, during the initial 2 wk post-weaning, pigs housed in unsanitary pens and fed non-medicated diets with APP in Exp. 1, or APP, EHSY, CB, or IEGG in Exp. 2 had equivalent performance to pigs fed SPC; however, performance of pigs fed diets with the alternatives was not equivalent to diets containing SDPP in Exp. 1 or SDBP in Exp. 2.

[Use of non-vitamin K antagonist oral anticoagulants in Primary Care: ACTUA study]

OBJECTIVES

Approximately 40% of patients with non-valvular auricular fibrillation (NVAF) who receive vitamin K antagonists (VKA) in Primary Care in Spain have poor anticoagulation control. The objective of the study Actuación en antiCoagulación, Tratamiento y Uso de anticoagulantes orales de acción directa (ACOD) en Atención primaria (ACTUA) (Action in Coagulation, Treatment and Use of direct oral anticoagulants [DOACs]) in Primary Care) was to analyse the current situation regarding the use of VKA and non-vitamin K antagonist oral anticoagulants (NOACs) in patients with NVAF in Primary Care in Spain and the possible issues arising from it.

PATIENTS AND METHODS

An online survey was created covering various aspects of the use of oral anticoagulants in NAFV. A two-round modified Delphi approach was used. Results were compiled as a set of practical guidelines.

RESULTS

Forty-four experts responded to the survey. Consensus was reached in 62% (37/60) of the items. Experts concluded that a considerable number of patients with NVAF who receive VKA do not have a well-controlled INR and that a substantial group of patients who could benefit from being treated with NOACs do not receive them. The use of NOACs increases the probability of having good anticoagulation control and decreases the risk of severe and intracranial haemorrhage. Current limitations to the use of NOACs include administrative barriers, insufficient knowledge about the benefits and risks of NOACs, limited experience of doctors in using them, and their price. Renal insufficiency influences the choice of a particular anticoagulant.

CONCLUSIONS

The ACTUA study highlights the existing controversies about the use of oral anticoagulants for the treatment of NVAF in Primary Care in Spain, and provides consensus recommendations that may help to improve the use of these medications.

Effect of Natural Stabilised Pork Haem Pigment on the Colour, Colour Stability and Texture of Cooked Hams from Pale, Soft and Exudative Meat

The effect of the addition of pork haem pigment on the colour, colour stability and texture of cooked hams from pale, soft and exudative meat (PSE hams) was studied. A total of 62 hams were selected at 15h post mortem on the basis of pH, electrical conductivity (EC) and L* value in semimembranosus (SM) and biceps femoris (BF) muscles. Hams were divided into three groups to be manufactured as cooked hams: group 1 (control, with normal meat quality hams, n 20), group 2 (control, with PSE hams, n 21) and group 3 (with PSE hams to which 0.04% of pork haem pigment was added, n 21). The stability of the colour ( L*, a*, b*) was followed at 0, 30 and 120min after slicing. Pigment content and the instrumental texture of the hams were also evaluated. L* value after slicing was lower in group 3 than in group 2 for both muscles at all three times studied. Colour a* value (redness) was significantly higher for group 3 than for groups 1 and 2 at the three times and in the two muscles. Accordingly, there was an increase in visual redness in BF and SM of hams from group 3 with respect to groups 1 and 2. Iridescence was higher in PSE hams. The muscle pigment content showed no significant differences among groups - neither in the fresh nor in the cooked hams. No effect of the pork pigment was found on the texture properties studied. In conclusion, the addition of stabilised pork haem pigment in the processing of PSE hams resulted in cooked hams with lower L* values and higher a* values and more visual redness, whereas colour stability and texture of hams were not affected.

Blue-detuned optical ring trap for Bose-Einstein condensates based on conical refraction

We present a novel approach for the optical manipulation of neutral atoms in annular light structures produced by the phenomenon of conical refraction occurring in biaxial optical crystals. For a beam focused to a plane behind the crystal, the focal plane exhibits two concentric bright rings enclosing a ring of null intensity called the Poggendorff ring. We demonstrate both theoretically and experimentally that the Poggendorff dark ring of conical refraction is confined in three dimensions by regions of higher intensity. We derive the positions of the confining intensity maxima and minima and discuss the application of the Poggendorff ring for trapping ultra-cold atoms using the repulsive dipole force of blue-detuned light. We give analytical expressions for the trapping frequencies and potential depths along both the radial and the axial directions. Finally, we present realistic numerical simulations of the dynamics of a ⁸⁷Rb Bose-Einstein condensate trapped inside the Poggendorff ring which are in good agreement with corresponding experimental results.

Efficacy of dietary spray dried plasma protein to mitigate the negative effects on performance of pigs fed diets with corn naturally contaminated with multiple mycotoxins

The ability of spray dried plasma protein (SDPP) to reduce the negative effects of multiple mycotoxins from naturally contaminated corn on weaned pig performance and health was investigated (n = 180; 6.84 ± 0.11 kg). For 12 d after weaning, pigs were fed phase 1 nursery diets with either 0% SDPP (PP0) or 6% SDPP (PP6). After 12 d, pigs were fed phase 2 diets for 3 wk. Pigs fed PP0 in phase 1 continued to be fed a phase 2 diet with no SDPP (PP0/PP0) or were fed a diet including corn naturally contaminated with multiple mycotoxins (M), labeled PP0/PP0M. Pigs fed SDPP in phase 1 were fed either a diet with no SDPP (PP6/PP0), a diet with M and no SDPP (PP6/PP0M), a diet with M and 3% SDPP (PP6/PP3M), or a diet with M and 6% SDPP (PP6/PP6M). During phase 1, pigs fed PP6 had increased (P < 0.05) ADG, ADFI, and G:F, whereas immunological parameters were not altered. During phase 2, pigs consuming PP0/PP0M had reduced ADG (P < 0.01) and ADFI (P < 0.05) in contrast to pigs fed PP0/PP0, whereas the performance of pigs fed PP6/PP0M was intermediate to pigs fed PP0/PP0M and PP6/PP0. The ADG and ADFI did not differ for pigs fed PP0/PP0M and PP6/PP0M during phase 2. Performance of pigs fed PP6/PP3M in contrast to pigs fed PP6/PP0M during phase 2 did not differ; however, these pigs had lower (P < 0.05) tumor necrosis factor α and tended (P = 0.094) to have lower DNA damage. During phase 2, ADG and ADFI of pigs fed PP6/PP6M did not differ from pigs fed PP6/PP0M, but G:F tended (P = 0.067) to be increased in pigs fed PP6/PP6M. Over the entire study period, pigs fed PP0/PP0M had reduced (P < 0.05) ADG and tended (P = 0.067) to have reduced ADFI. During this time, pigs fed PP6/PP0M tended to have greater ADG and ADFI (P = 0.093 and P = 0.067, respectively) compared with pigs fed PP0/PP0M. Overall, feeding a diet with SDPP improved growth performance and feed intake of young pigs directly after weaning. Feeding multiple M had a negative impact on growth performance of pigs during this trial. This response was more significant when pigs were not fed SDPP in phase 1. Overall, when combining phase 1 and 2 performance data, daily gain and feed intake tended to be reduced when pigs were not fed 6% SDPP in phase 1. This study indicates that the composition of diets fed immediately after weaning may be important for pigs that subsequently are under a M challenge.

Preparations for colon capsule endoscopy. Prospective and randomized comparative study between two preparations for colon capsule endoscopy: PEG 2 liters + ascorbic acid versus PEG 4 liters

INTRODUCTION

PillCam© colon capsule endoscopy (CCE) enables the study of colonic diseases in a safe and non-invasive way, although there are aspects that need to be improved. Current methods of bowel preparation lead to discordant rates of adequate cleansing and CCE excretion.

AIMS

To compare the efficacy of colon cleansing using two different regimes (2L PEG plus ascorbic acid versus 4L PEG alone) for PillCam Colon (C2) capsule endoscopy.

METHODS

Fifty eight patients included in this prospective study and randomized to: Group A, PEG plus ascorbic acid regimen (n = 28, 12 F/16 M) or group B, PEG alone regimen (n = 30, 14 F/16 M). The degree of cleansing was categorized into "excellent-good" or "fair-poor", according to Leighton´s recently published preparation scale. CCE excretion rate and colon cleansing were assessed. Patients underwent to PillCam colon of second generation (C2).

RESULTS

Cleansing was considered to be excellent-good in 78 % of cases in group A and in 64 % of cases in group B, with no significant difference between the groups (p = 0.252). Nevertheless, when the grade of cleansing was analyzed in segments, a significant difference was found in the cecum and transverse colon. No differences were observed in the bubble effect between preparations. The excretion rate was 93 % in group A versus 70 % in group B (p = 0.043).

CONCLUSIONS

These results suggest that a 2L PEG plus ascorbic acid regimen is at least as effective as a 4L PEG regimen. This regimen may be considered an effective alternative which would improve compliance because a smaller volume is required.

Half-life of porcine antibodies absorbed from a colostrum supplement containing porcine immunoglobulins

Absorption of immunoglobulins (Ig) at birth from colostrum is essential for piglet survival. The objective was to evaluate the half-life of antibodies absorbed in the bloodstream of newborn piglets orally fed a colostrum supplement (CS) containing energy (fat and carbohydrates) and IgG from porcine plasma. Viable piglets (n = 23; 900 to 1,800 g BW) from 6 sows were colostrum deprived and blood sampled and within the next 2 h of life randomly allocated to either control group (n = 9) providing 30 mL of Ig-free milk replacer or a group (n = 14) receiving 30 mL of CS by oral gavage. Piglets were transported to a Biosafety Level 3 facility (Centre de Recerca en Sanitat Animal, Spain) and fed Ig-free milk replacer every 3 to 4 h for 15 d. Survival, weight, plasma IgG content by radial immunodiffusion (RID), and antibodies against porcine circovirus type 2 (PCV2), porcine parvovirus (PPV), porcine reproductive and respiratory syndrome (PRRS), Mycoplasma hyopneumoniae (Mhy), and swine influenza virus (SIV) were determined by specific ELISA before treatment administration, at 24 h, and weekly for 56 d. Clinical symptoms were not observed for either group. Mortality index was lower (17 vs. 38%; P < 0.02) and BW higher (17.7 vs. 15.3 kg; P = 0.035) for pigs supplemented with CS than piglets in the control group. At 24 h postadministration, the CS group had a plasma IgG mean of 7.6 ± 0.06 vs. 0.14 ± 0.03 mg/mL for the control group. The IgG levels in the CS group decayed until day 21 when de novo synthesis of IgG was detected in 25% of piglets. Half-life of antibody concentration (HLAC) by RID was 6.2 d. In the CS group, efficiency of PCV2 and PPV antibody transfer was high. For PCV2, all animals remained positive by day 56 and the calculated HLAC was 17.7 d. For PPV, 72.7% of piglets were ELISA positive by day 35 and HLAC was 12.0 d. For PRRS, all piglets remained positive by day 14 and the calculated HLAC was 11.9 d. For Mhy and SIV the calculated HLAC were 8.4 and 3.0 d. In summary, half-life of antibodies derived from blood plasma in the bloodstream of newborn piglets varied from 3.0 to 17.7 d. The study also confirm that antibodies derived from porcine plasma were well absorbed and can be an useful tool for providing protection against several or specific pathogens and can be a good alternative to formulate CS for newborn piglets.

Estimate of serum immunoglobulin G concentration using refractometry with or without caprylic acid fractionation

Objectives of this study were to develop a rapid calf-side test to determine serum IgG concentrations using caprylic acid (CA) fractionation, followed by refractometry of the IgG-rich supernatant and compare the accuracy of this method with results obtained using refractometry using raw serum. Serum samples (n=200) were obtained from 1-d-old calves, frozen (-20°C), and shipped to the laboratory. Samples were allowed to thaw for 1h at room temperature. Fractionation with CA was conducted by adding 1mL of serum to a tube containing 45, 60, or 75µL of CA and 0.5, 1.0, or 1.5mL of 0.06 M acetic acid. The tube contents were mixed well, allowed to react for 1 min, and then centrifuged at 3,300 × g for 0, 10, or 20 min at 25°C. The %Brix and refractive index of the fractionated supernatant were determined using a digital refractometer. Nonfractionated serum was analyzed for %Brix (BRn), refractive index (nDn), and IgG concentration by radial immunodiffusion. The mean serum IgG concentration was 19.0 mg/mL [standard deviation (SD)=9.7], with a range of 3.5 to 47.0 mg/mL. The mean serum BRn was 8.6 (SD=0.91), with a range of 6.8 to 11.0. The mean serum nDn was 1.34566 (SD=0.00140), with a range of 1.34300 to 1.34930. Serum nDn was positively correlated with IgG concentration (correlation coefficient=0.86; n=185). Fractionated samples treated with 1mL 0.6 M acetic acid and 60µL of CA and not centrifuged before analysis resulted in a strong relationship between the refractive index of the fractionated supernatant and IgG (correlation coefficient=0.80; n=45). Regression was used to determine cut points indicative of 10, 12, and 14 mg of IgG/mL to determine the sensitivity and specificity of refractometry to identify failure of passive transfer (serum IgG <10 mg/mL at 24 h old). The nDn were 1.34414, 1.34448, and 1.34480 to predict 10, 12, and 14 mg of IgG/mL of serum, respectively. The BRn cut points were 7.6, 7.8, and 8.0, respectively. The nDn cut points of 1.34448 and 1.34480 resulted in similar specificities (82.9%), whereas the 1.34414 cut point had a specificity of 60.0%. The BRn cut point of 7.6 and 7.8%Brix resulted in a similar percentage of correctly classified samples (89.7 and 90.8%, respectively); however, the 7.8% Brix cut point resulted in fewer false positives. These results suggest that Brix refractometry of nonfractionated calf serum provides a strong estimate of IgG concentration and 7.8% Brix may be used as the cut point to identify failure of passive transfer in 1-d-old calves.

Neutralizing antibodies against porcine circovirus type 2 in liquid pooled plasma contribute to the biosafety of commercially manufactured spray-dried porcine plasma

Neutralizing antibodies (NA) inherently present in pooled plasma collected at commercial abattoirs may provide some protection against potential porcine circovirus type 2 (PCV2) infectivity of plasma. Moreover, these NA may also contribute to the biosafety of spray-dried porcine plasma (SDPP). The objective of the study was to characterize and quantify the PCV2 antibody neutralizing capacity in pooled liquid porcine plasma and SDPP samples collected from industrial spray-drying facilities located in the Southeast and Midwest regions of the United States and the Northeast region of Spain. In the United States, PCV2 NA was determined in 1 sample of pooled liquid plasma from commercial spray-drying plants in the Southeast and 1 from the Midwest region. Obtained results were compared with those of a plasma sample from a PCV2 vaccinated sow and 1 from a PCV2 antibody negative sow. In Spain, 15 pooled liquid porcine plasma samples and 10 SDPP samples were collected at a commercial spray-drying plant total and NA against PCV2 were determined. Results with pooled liquid porcine plasma from commercial spray-drying facilities in the United States indicated that NA titers against PCV2 in these samples (log2 8.33 ± 0.41 and 9.0 ± 0.0) were similar or greater than the plasma from the PCV2-vaccinated sow (log2 6.33 ± 0.41). The analysis of U.S. samples indicated that liquid plasma diluted to 1:256 (10(-2.41)) was able to neutralize between 100 to 200 PCV2 virus particles or about 4 logs10 median tissue culture infective dose (TCID50) per milliliter. Similarly, samples from the Spanish pooled liquid plasma and the SDPP samples indicated an increased amount of NA activity against PCV2. Specifically, a dilution of 10(-2.47 ± 0.33) of plasma was able to inactivate 100 PCV2 virus particles; therefore, the inactivation capacity of commercial liquid plasma was greater than 10(4) TCID50/mL. The calculated 90% reduction in infected cells because of NA in pooled plasma samples (log2 8.2 ± 0.38) was less (P < 0.05) than in its concentrate form of SDPP (mean, log2 10.2 ± 0.85). In conclusion, PCV2 NA contained in liquid pooled plasma from market pigs was detected at greater concentrations than that from a vaccinated sow and that after spray-drying biological neutralizing activity was conserved, which implies that the inherent NA in liquid plasma may have an important role in the biosafety of commercially produced SDPP.

Evaluation of the Brix refractometer to estimate immunoglobulin G concentration in bovine colostrum

Refractometry using a Brix refractometer has been proposed as a means to estimate IgG concentration in bovine maternal colostrum (MC). The refractometer has advantages over other methods of estimating IgG concentration in that the Brix refractometer is inexpensive, readily available, less fragile, and less sensitive to variation in colostral temperature, season of the year and other factors. Samples of first-milking MC were collected from 7 dairy farms in Maine, New Hampshire, Vermont, and Connecticut (n=84) and 1 dairy farm in California (n=99). The MC was milked from the cow at 6.1 ± 5.6h postparturition and a sample was evaluated for Brix percentage by using an optical refractometer. Two additional samples (30 mL) were collected from the milk bucket, placed in vials, and frozen before analysis of total IgG by radial immunodiffusion (RID) using commercially available plates and by turbidimetric immunoassay (TIA). The second sample was analyzed for total bacterial counts and coliform counts at laboratories in New York (Northeast samples) and California (California samples). The Brix percentage (mean ± SD) was 23.8 ± 3.5, IgG concentration measured by RID was 73.4 ± 26.2g/L, and IgG concentration measured by TIA was 67.5 ± 25.0 g/L. The Brix percentage was highly correlated (r=0.75) with IgG analyzed by RID. The Brix percentage cut point to define high- or low-quality colostrum (50 g of IgG/L measured by RID) that classified more samples correctly given the proportion of high- (86%) and low-quality (14%) samples in this study was 21%, which is slightly lower than other recent estimates of Brix measurements. At this cut point, the test sensitivity, specificity, positive and negative predictive values, and accuracy were 92.9, 65.5, 93.5, 63.3, and 88.5%, respectively. Measurement of IgG by TIA correlated with Brix (r=0.63) and RID (r=0.87); however, TIA and RID methods of IgG measurement were not consistent throughout the range of samples tested. We conclude that Brix measurement of total solids in fresh MC is an inexpensive, rapid, and satisfactorily accurate method of estimating IgG concentration. A cut point of 21% Brix to estimate samples of MC >50 g/L was most appropriate for our data. Measurement of IgG in MC by TIA differed from measurement by RID.

[Primary prevention with aspirin]

The benefit of acetylsalicylic acid and other antiplatelet drugs in secondary prevention is well established, however it use in primary prevention continues to be controversial. On the one hand, the benefit obtained is very near the potential damage arising from its use (mainly gastrointestinal bleeding), and on the other, the net benefit is less, given that its aim is to prevent the occurrence of vascular events in situations with a lower baseline risk. Antiplatelet treatment with aspirin in primary prevention has been evaluated in clinical trials and several meta-analyses, comparing its efficacy with a placebo, and with results noted for their heterogeneity. The mechanisms of action of different antiplatelet drugs, as well as the existing evidence with aspirin in primary prevention, the directions for its use by different Scientific Societies, and the cost/benefit of the intervention are reviewed.

Lack of transmission of porcine circovirus type 2 to weanling pigs by feeding them spray-dried porcine plasma

An experiment was conducted to determine whether spray-dried porcine plasma containing 2.47 x 10(5) dna copies of porcine circovirus type 2 (pcv-2) could infect weanling pigs when fed to them. Five specific pathogen-free (spf) weanling pigs were fed ad libitum for 45 days a control diet and six pigs were fed a test diet containing 8 kg sdpp per 100 kg feed. The two groups were housed in separate biosecurity level-3 rooms. None of the pigs in either group developed any clinical signs or became pcv-2 viraemic or seroconverted.

[Apolipoprotein E4 in dementia with Lewy bodies]

INTRODUCTION

There is a strong association between the e4 allele of apolipoprotein E (APOE) and Alzheimer's disease (AD). This converts this allele into a risk factor for the development of AD. The association between APOE4 and dementia with Lewy bodies (DLB) is under discussion. In DLB, the presence of APOE4 has been related with a greater amount of senile plaques and neurofibrillary tangles.

METHOD

This is a case-control study in which the APOE genotype was determined using the modified PCR technique of Wenham in 306 patients with diagnosis of probably AD, NINCDS-ADRDA criteria, 58 cases of probably DLB, McKeith et al. consensus criteria (1996), all of them with SPECT with pathological 123I-FP-CIT and 80 normal controls (NC) having similar age and gender distribution.

RESULTS

The frequency of alleles was: DLB group epsilon4: 16%; epsilon3: 75%; epsilon2: 9%; AD: epsilon4: 32%; epsilon3: 67%; epsilon2: 1%; and in the normal control group: epsilon4: 12%; epsilon3: 83%; epsilon2: 5%. The percentage of alleles in both genders was similar in the three groups.

CONCLUSIONS

APOE4 percentage in DLB group (16%) was lower than in AD group (32%), and similar to the control group (12%). Considering that the presence of morphopathological Alzheimer type alterations in DBL, essentially neurofibrillary tangles, is inversely correlated with the presence of Parkinsonian signs, this group may represent pure forms of the disease, although the lack of neuropathological demonstration does not make it possible to confirm this hypothesis.

Acromegaly secondary to growth hormone-releasing hormone secreted by an incidentally discovered pheochromocytoma

Ectopic growth hormone-releasing hormone (GHRH)-secreting tumors are rare and cause acromegaly with somatotroph hyperplasia. We report a case of acromegaly secondary to GHRH secretion by an incidentally discovered pheochromocytoma in a normotensive patient. A 23-year-old man presented with signs and symptoms of acromegaly. Laboratory evaluation confirmed the diagnosis and magnetic resonance imaging (MRI) revealed a sellar mass which was thought to be a macroadenoma and surgically resected. The patient was not cured and medical treatment was indicated. An abdominal ultrasound performed before initiation of medical treatment showed a solid/cystic lesion superiorly to the right kidney. An abdominal MRI confirmed an adrenal tumor. Hormonal workup of the adrenal incidentaloma revealed elevated urinary catecholamine and total metanephrines findings strongly suggestive of a pheochromocytoma. Acromegaly was then suspected to be due to ectopic secretion of GHRH by the tumor. Patient underwent surgical resection and histopathologic examination confirmed a pheochromocytoma which stained positively for GHRH. Also, review of the pituitary specimen confirmed somatotrophic hyperplasia. Genetic analysis of the ret proto-oncogene showed no mutation. Pituitary MRI was repeated 10 months after pheochromocytoma resection and revealed a slightly enlarged pituitary and partial empty sella. The diagnosis of acromegaly caused by ectopic production of GHRH is a challenging task. A careful histopathological examination of the surgically excised pituitary tissue has a key role to arouse the suspicion and guide the investigation of a secondary cause of acromegaly.

Efficacy of spray-drying to reduce infectivity of pseudorabies and porcine reproductive and respiratory syndrome (PRRS) viruses and seroconversion in pigs fed diets containing spray-dried animal plasma

Three experiments were conducted to evaluate viral inactivation by the spray-drying process used in the production of spray-dried animal plasma (SDAP). In Exp. 1, bovine plasma was inoculated with pseudorabies virus (PRV) grown in PK 15 cells. Three 4-L batches were spray-dried in the same manner and conditions of industrial SDAP production but with laboratory spray-drying equipment. Presence of infectivity was determined before and after spray-drying by microtiter assay in PK 15 cell cultures. Before spray-drying, all three samples contained 10(5.3) tissue culture infectious dose50 (TCID50)/mL of PRV. After four consecutive passages, no viable virus was detected in samples of spray-dried bovine plasma. In Exp. 2, bovine plasma was inoculated with porcine respiratory and reproductive syndrome (PRRS) virus propagated previously in MARC cell culture to provide approximately 10(6.3) TCID50/mL. Three 4-L batches were spray-dried in the same manner as Exp. 1. Before spray-drying, samples contained TCID50 of 10(4.0), 10(3.5), and 10(3.5)/mL, respectively. After four consecutive passages in MARC cell cultures, no viable virus was detected in spray-dried bovine plasma. In Exp. 3, 36 weaned piglets (28 d of age) were fed a common diet for 14 d and were determined to be negative for PRV, PRRS, and porcine parvovirus titer. Afterwards, pigs were allotted to six pens with six pigs per pen and fed diets containing either 0 or 8% SDAP (as-fed basis) for 63 d. The SDAP used in the feed contained antibody (titer 1:400) against porcine parvovirus. Blood samples were collected from pigs on d 0 and 63 to determine whether feeding SDAP caused seroconversion and development of antibodies against parvovirus, PRRS, or PRV. Inclusion of SDAP in the diet improved growth of pigs without seroconversion. Spray-drying conditions used in this study were effective in eliminating viable pseudorabies and PRRS viruses from bovine plasma. In this study, feeding SDAP that contained functional antibodies did not promote seroconversion in naïve animals.

Effects of spray-dried animal plasma on intake and apparent digestibility in dogs1

Effects of spray-dried animal plasma (SDAP) on intake and apparent digestibility of major dietary components were determined using 22 adult Beagles. Trials 1 and 2 used six and eight dogs, respectively, in a switchback design using 10-d periods. Trial 3 used eight dogs in a replicated 4 x 4 Latin square design with 15-d periods. The final 5 d of each period were used for measurement of intake and fecal collections. In Trial 1, dry extruded dog food kibbles were coated with 5% tallow, 2% commercial flavor, and 0 or 2% SDAP (as-fed basis). In Trial 2, commercially available dry dog food, previously coated with fat and flavor were coated with 0 or 2% SDAP. In Trial 3, SDAP (0, 1, 2, or 3%) was blended with other ingredients and extruded (as-fed basis). Kibbles were subsequently coated with 5% poultry fat and 1% commercial flavor. Intake, fecal consistency, and apparent digestibility of nutrients were determined. Addition of SDAP did not markedly affect chemical composition of diets and did not affect intake. Digestibility of DM was improved (P < 0.04) an average of 3.2% when 2% SDAP was included in the diet for all trials. Organic matter digestibility was improved (P < 0.01) in Trials 2 and 3 by an average of 2.9%. Also, digestibility of crude fiber (Trials 1 and 2) or total dietary fiber (Trial 3) was increased with addition of SDAP to the diet (P < 0.01). Fecal DM excretion was decreased by an average of 15% across all trials with the addition of SDAP. Spray-dried animal plasma was an acceptable ingredient in dry dog food preparations, resulting in improved digestion and decreased fecal output. Changes in digestion that occurred with addition of SDAP suggested alteration in digestive capacity in dogs.

Effects of sex on sleep-disordered breathing in adolescents

This study was conducted to determine the influence of puberty on features of sleep-disordered breathing (SDB) in adolescents. The study was performed in a general population sample of 226 adolescents of both sexes (aged 11-19 yrs) recruited from the secondary school population of the city of Seville, Spain. Subjects were divided into two groups: 1) postpubertal, i.e. females who had undergone menarche and males in whom axillary hair development or peak height velocity had occurred > 1 yr before the study; and 2) peripubertal, i.e. females who had not undergone menarche and males who had not developed axillary hair nor reached peak height velocity, or subjects in whom these pubertal changes had appeared < 1 yr before the study. All subjects answered a questionnaire on SDB and underwent overnight cardiorespiratory polygraphy. There were 50 males and 40 females (mean +/- SD age 13.5 +/- 1.2 yrs) in the peripubertal group, and 54 males and 82 females (age 16.3 +/- 1.7 yrs) in the postpubertal group. Males exhibited significantly higher neck circumference/height index and waist/hip index than females in both the peripubertal and postpubertal groups. In the postpubertal group, snoring and polygraphic alterations (respiratory events and oximetric parameters) were significantly more frequent in males than in females. Postpubertal adolescents showed sex differences in clinical and polygraphic parameters that were not observed at earlier pubertal stages. These findings support the influence of sex hormones on sex differences in sleep-disordered breathing.

Effect of fishmeal replacement with spray-dried animal plasma and colistin on intestinal structure, intestinal microbiology, and performance of weanling pigs challenged with Escherichia coli K99

We evaluated spray-dried animal plasma (SDAP) as an alternative to antimicrobial medication with colistin sulfate in weanling pigs challenged with Escherichia coli K99. Forty-eight piglets weaned at 24 d of age were distributed into 12 pens, and each pen was assigned to one of four dietary treatments. All the piglets were given an oral dose of 5 x 10(7) cfu of E. coli K99 at weaning. The dietary treatments followed a factorial arrangement with two levels of SDAP (0 and 7%) and two levels of colistin (0 and 300 mg/kg of diet). The ADG and ADFI were measured on d 7 and 14 of trial. Three piglets from each treatment were killed on d 7 and 14 to remove the small intestine, and to obtain ileal and cecal digestive contents. The inclusion of SDAP improved ADG by 68 g (P < 0.05) and ADFI by 41 g (P < 0.10) in wk 1 of trial. During wk 2, SDAP improved ADG by 41 g (P < 0.10) and gain:feed ratio (G:F) by 25% (P < 0.01). On the other hand, whereas colistin had no effect on performance in wk 1, it improved ADG by 102 g (P < 0.01), ADFI by 62 g (P < 0.01), and G:F by 26% (P < 0.01) in wk 2. Over the 14 d of the trial, ADG was improved by 54 (P < 0.05) and 75 g (P < 0.05), and G:F was improved by 35 (P < 0.05) and 32% (P < 0.05) due to SDAP and colistin, respectively. There was interaction between colistin and SDAP for ADFI in wk 2 and between d 0 to 14 (P < 0.05), which indicates that their effects were not additive. The use of colistin was advantageous in the maintenance of the integrity of the intestinal mucosa of the pigs, as suggested by a small intestine that was 93 g heavier (P < 0.10) and with the tallest villi 106 microm longer (P < 0.10) than in pigs without colistin. The inclusion of SDAP in the diet favored the growth of lactobacilli in the ileum (P < 0.10) and the cecum (P < 0.05), whereas colistin reduced the number of enterococci in the cecum (P < 0.05) and of Escherichia coli both in the ileum and the cecum (P < 0.001). These results suggest that SDAP may be an alternative to medicated feed with antibiotics since it provided a level of protection against an experimental challenge with E. coli K99 similar to that obtained with colistin, an antibiotic of proven efficacy. The current situation in which the use of antimicrobials in animal feeding is being questioned should encourage further investigation into the use of SDAP as a means of preventing disease in pigs at weaning.

[The special attention to re-admitted patients can be effective. Cost-benefit analysis of a new health care model]

BACKGROUND

Patients with chronic conditions are commonly readmitted to hospital. A study was designed to improve their medical care. The cost/benefit analysis is presented to evaluate its efficiency.

PATIENTS AND METHODS

Patients attended at the Internal Medicine Department in a hospital area who were readmitted three or more times in a year were included in the study. In a prospective study, patients were attended by means of a specific consultation with upon request care or through telephone care, with the possibility of elective admission. A comparison was made of costs of the new care program with costs of their usual care, and it was correlated with attending results.

RESULTS

Patients were followed for 32 months with a 45% decrease in admissions, 50% in visits to the Emergency Department, and 26% in the hospital stay days. The new program involves monthly savings over 5 million pesetas for the attended population.

CONCLUSIONS

The proposed health care program decreases the attending needs in these patients and costs derived from hospital care. An efficient alternative is shown.

Brachial-jugular expanded PTFE grafts for dialysis

The objective of this study was to analyze the long-term outcome of 51 patients with brachial-jugular grafts for dialysis. Age, presence of diabetic nephropathy, complications of the angio-access, and therapeutic methods of treating complications were analyzed. All surgical procedures were performed under local anesthesia in an ambulatory surgical setting. The duration of angio-access was analyzed using the life-table method. Our results showed that brachial-jugular grafts can be performed under local anesthesia and in an ambulatory surgical setting. This procedure can be an alternative to complex intrathoracic procedures, Dacron cuff catheters, or lower limb grafts, in cases of stenosis or occlusion of the subclavian vein.

[Neurologic complications of herpes zoster. A retrospective study in 100 patients]

INTRODUCTION AND OBJECTIVES

The neurologic complications associated with herpes zoster are infrequent except for postherpetic neuralgia. The aim of this study was to review the clinical profile and the distribution of these complications in a retrospective series of patients.

PATIENTS AND METHOD

A retrospective analysis of the last 100 patients admitted with the diagnosis of herpes zoster with neurologic complications to our center from 1992 to 1999 by the Departments of Internal Medicine and Neurology was performed. The characteristics of the complications other than postherpetic neuralgia are reported.

RESULTS

Aside from the 88 patients with postherpetic neuralgia, the 12 remaining patients presented other complications: seven different peripheral neuropathies, including three with Ramsay-Hunt syndrome, two meningitis, one encephalitis and one myelitis. In addition, one patient had ophthalmic herpes zoster with cerebral vasculopathy as ipsilateral Wallenberg's syndrome. Nine patients (75%) were males, four (25%) were under the age of 20 years and seven older than 60 years and only three were immunodepressed. The CSF was abnormal in six out of the eight patients in whom it was studied with lymphocytic pleocytosis being shown on analysis without qualitative or quantitative alteration in intrathecal synthesis of IgG. In the immunosuppressed patients the serology in the CSF of the varicela zoster virus was negative. All patients demonstrated regressive evolution following treatment with acyclovir.

CONCLUSIONS

Neurologic complications other than postherpetic neuralgia occurred in 12% of the patients of this series, there was male predominance and peripheral neuropathies were the most frequent complications. Serology of the varicela zoster virus in immunosuppressed patients may be negative. In this series the prognosis was mainly satisfactory.

Brachiocephalic jump graft fistula: an alternative for dialysis use of elbow crease veins

Elbow crease fistula can be an alternative for autologous vascular access. Either brachiocephalic or brachiobasilic fistulas could be chosen according to the venous anatomy at the elbow crease. When a median antecubital vein is not present, the cephalic vein is usually too far away from the brachial artery. Thus, a end-to-side fistula must usually be performed after an extensive dissection of the distal part of the vein. In this way, only the proximal cephalic vein can be used for dialysis. To overcome this drawback, a brachiocephalic jump graft fistula was designed. A short segment of polytetrafluoroethylene graft, 6 mm in diameter, is tunneled under the skin and anastomosed to the artery and vein through two short longitudinal skin incisions. From 1981 to 1995, 222 brachiocephalic graft jump fistulas were constructed. The mean age of the patients was 56.1 years, 20% had diabetic nephropathy, and 61.7% had a previously failed angioaccess. Follow-up was obtained in 92.4% of the patients, and overall follow-up was 6,665 fistula-months. Early failure was observed in 4% of the cases. The complication rate was two episodes per 100 fistula-months of follow-up. Primary patency rates (event-free patency) were 85%, 67%, 48%, and 34% at 1, 3, 5, and 7 years. Secondary patency rates (overall patency) were 85%, 72%, 56%, and 43% at 1,3, 5, and 7 years. There were no differences between primary and secondary curves. Brachiocephalic graft jump fistula is a reliable technical variation of elbow crease fistulas for dialysis and can be another alternative to graft access when the cephalic vein is dominant at the elbow crease.