Factors associated with successful liberation from continuous renal replacement therapy in children and young adults: analysis of the worldwide exploration of renal replacement outcomes collaborative in Kidney Disease Registry

PURPOSE

Continuous renal replacement therapy (CRRT) is used for supportive management of acute kidney injury (AKI) and disorders of fluid balance (FB). Little is known about the predictors of successful liberation in children and young adults. We aimed to identify the factors associated with successful CRRT liberation.

METHODS

The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease study is an international multicenter retrospective study (32 centers, 7 nations) conducted from 2015 to 2021 in children and young adults (aged 0-25 years) treated with CRRT for AKI or FB disorders. Patients with previous dialysis dependence, tandem extracorporeal membrane oxygenation use, died within the first 72 h of CRRT initiation, and those who never had liberation attempted were excluded. Patients were categorized based on first liberation attempt: reinstituted (resumption of any dialysis within 72 h) vs. success (no receipt of dialysis for ≥ 72 h). Multivariable logistic regression was used to identify factors associated with successful CRRT liberation.

RESULTS

A total of 622 patients were included: 287 (46%) had CRRT reinstituted and 335 (54%) were successfully liberated. After adjusting for sepsis at admission and illness severity parameters, several factors were associated with successful liberation, including higher VIS (vasoactive-inotropic score) at CRRT initiation (odds ratio [OR] 1.35 [1.12-1.63]), higher PELOD-2 (pediatric logistic organ dysfunction-2) score at CRRT initiation (OR 1.71 [1.24-2.35]), higher urine output prior to CRRT initiation (OR 1.15 [1.001-1.32]), and shorter CRRT duration (OR 0.19 [0.12-0.28]).

CONCLUSIONS

Inability to liberate from CRRT was common in this multinational retrospective study. Modifiable and non-modifiable factors were associated with successful liberation. These results may inform the design of future clinical trials to optimize likelihood of CRRT liberation success.

Understanding Similarities and Differences in CKD and Dialysis Care in Children and Adults

In lower-income settings there is often a dearth of resources and nephrologists, especially pediatric nephrologists, and individual physicians often find themselves caring for patients with chronic kidney diseases and end-stage kidney failure across the age spectrum. The management of such patients in high-income settings is relatively protocolized and permits high-volume services to run efficiently. The basic principles of managing chronic kidney disease and providing dialysis are similar for adults and children, however, given the differences in body size, causes of kidney failure, nutrition, and growth between children and adults with kidney diseases, nephrologists must understand the relevance of these differences, and have an approach to providing quality and safe dialysis to each group. Prevention, early diagnosis, and early intervention with simple therapeutic and lifestyle interventions are achievable goals to manage symptoms, complications, and reduce progression, or avoid kidney failure in children and adults. These strategies currently are easier to implement in higher-resource settings with robust health systems. In many low-resource settings, kidney diseases are only first diagnosed at end stage, and resources to pay out of pocket for appropriate care are lacking. Many barriers therefore exist in these settings, where specialist nephrology personnel may be least accessible. To improve management of patients at all ages, we highlight differences and similarities, and provide practical guidance on the management of children and adults with chronic kidney disease and kidney failure. It is important that children are managed with a view to optimizing growth and well-being and maximizing future options (eg, maintaining vein health and optimizing cardiovascular risk), and that adults are managed with attention paid to quality of life and optimization of physical health.

Prevalence and temporal trends of anemia in patients with heart failure

BACKGROUND

Anemia is an important comorbidity in heart failure (HF), and it is associated with increased adverse disease experience and mortality. Previous reports have focused mainly on HF presenting in healthcare settings. We, therefore, set out to establish the nationwide prevalence and temporal trends of anemia in community-based patients with HF in the US.

AIM

To establish the nationwide prevalence and temporal trends of anemia in community-based patients with HF in the US.

DESIGN

The NHANES dataset, conducted by the CDC National Center for Health Statistics was used to collect nationally representative data on the health and nutritional status of the non-institutionalized US population.

METHODS

We utilized the National Health and Nutrition Examination data collected over five survey cycles (2007-16). Included were participants aged 20-80 years with self-reported diagnosis of HF. Anemia was defined using 2 sex specific cut offs of 13 and 12 g/dl (cutoff 1), and 12 and 11 g/dl (cutoff 2), for men and women, respectively. The Chi square test was used to compare prevalence across different categories and survey cycles. Data analysis was done using STATA 16 with P-values < 0.05 considered statistically significant.

RESULTS

The median hemoglobin in all HF patients was 13.5 g/dl (IQR 12.4-14.5). The prevalence of anemia among community-based patients with HF in the US was 21.34% (cutoff 1) and 9.03% (cutoff 2) and has been stable from 2007 to 2016. The burden of anemia was disproportionately higher in NH Blacks (34.48%, 95% CI 27.12-42.67) and those with BMI < 25 Kg/m2 (17.4%, 95% CI 10.9-26.64).

CONCLUSION

The prevalence of anemia in patients with HF in the US is at least 9% and has remained stable over the past decade. This high persistent burden with limited proven interventions should spur further efforts aimed at identifying impactful ways of addressing anemia in patients with HF.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Predictors of non-invasive ventilation failure in adult patients with cardiac dysfunction presenting with community acquired pneumonia; an Egyptian multicenter prospective study

Funding Acknowledgements

Type of funding sources: None.

Background

Non-invasive ventilation (NIV) might be successful if properly selected in adult patients with cardiac dysfunction presenting with community acquired pneumonia. The main objective was to identify contributing factors to NIV failure.

Methods

All adult patients with LV EF less than 50% admitted to the ICU with community acquired pneumonia and acute respiratory failure were enrolled in our multicenter prospective study after getting informed consents . The study was registered and given a number (ID ISRCTN14641518). Non-invasive ventilation failure was defined as requirement of intubation after institution of NIV intervention.

Results

We prospectively enrolled 177 patients between February 2019 to July 2020. Fifty-three patients (29.9%) were considered failed NIV. The mean age of studied patients was 64.1±12.6 years with a male predominance (73.4%) and a mean left ventricle EF of 36.4±7.8%. There were insignificant differences between the NIV success and NIV failure groups regarding the underlying morbidities nor the inflammatory markers. The patients who failed NIV were significantly older with higher mean SOFA and APACHE II scores compared to the patients with succeeded NIV. Non-invasive Ventilation failure was associated with longer ICU stay (p&lt;0.001), higher SOFA at 48 hours (p&lt;0.001) and higher mortality (p&lt;0.001) compared to the NIV success group. NIV failure was independently predicted with APACHE II (OR:1.420, p 0.01, 95% CI:1.224 – 1.647), SOFA (OR:17.6 , p &lt;0.001, 95% CI: 4.148-74.68), baseline HACOR (OR:2.041, P 0.026, 95% CI:1.225 –3.401), lung ultrasound score (OR:1.209,P 0.017,95% CI:1.014–1.441) and blood lactate (OR:9.702,P &lt;0.001,95%CI:1.357–69.37).Conclusion: High initial APACHE II and SOFA scores , hindered lactate clearance as well as non-decrementing patterns of HACOR and LUS scores were associated with early NIV failure in patients with heart failure presenting with community acquired pneumonia.

Remission of T2DM by digital twin technology with reduction of cardiovascular risk: interim results of randomised controlled clinical trial

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): TWIN HEALTH INC

Background

 Twin Precision Treatment (TPT) is a novel intervention designed to improve glycemia and reverse T2D using a Whole-Body Digital Twin (WBDT) platform powered by Artificial Intelligence and the Internet of Things. Technology enabled precision nutrition, a combination of macro, micro and biota nutrients, along with Continuous Glucose Monitoring (CGM) have been demonstrated to be a key for reversal of diabetes. WBDT platform captures 174 health markers and 3000 daily data points through a panel of blood tests and connected devices that measure weight, physical activity, sleep and BP. CGM is used initially and then the algorithm predicts personalized glucose responses from multiple inputs. Nutritional, physical activity and sleep counseling is through an app or phone to provide individualized meal plans that balance 87 macro, micro and probiotic nutrients to reduce glucotoxicity and lipotoxicity. Program physicians titrate medications and monitor metabolic outcomes. 

Purpose

 To assess the initial change, in glycemic, extra glycemic, cardiovascular parameters for patients who completed 3 months longitudinal follow up.

Methods

 We performed an interim analysis [n = 173, 139 TWIN Intervention arm (T), 34 Control group (C)] of ongoing randomized controlled trial of TPT across India

Results

 The mean age (years) in the T was 43.04 (±8.6, 95% CI 41.57 to 44.52) which was significantly less as compared to the C 51.4 (±9.6, 95% CI 48.3 to 54.5); p &lt; 0.0001. The mean duration of diabetes (years) in the T was 3.5 (±2.6) which was comparable to the C 4.3 (±2.6); p = 0.12 ns. In the T there were 113 male (84.3%) and 21 female (15.6%) as compared to C, 15 male (38.4%) and 24 female (61.5%); p &lt; 0.0001. The difference of change for HbA1c (%), small dense LDL-C sdLDL (mg/dL), TG/HDL Ratio, HOMA 2IR (%), Visceral Adiposity Index (VAI), Systolic BP (mmHg), BMI (kg/m2), Framingham Risk Score (%), in T when compared to C, were significant. The mean reduction HbA1c, sdLDL, HOMA 2IR, VAI, SBP, BMI, FRS in T was -3.2 % (8.8 to 5.6), -14.1 mg/dL, (52.6 to 38.5), -0.9 % (1.9 to 1), -2.3 (4.6 to 2.3), -10.3mmHg (128.4 to 118.1), -2.9 kg/m2 (27.1 to 24.2), -7.9% (16 to 8.1), respectively. (figure) At baseline in T, mean daily intake of medication was 1.7 which reduced significantly (p &lt; 0.0001) to 0.05. 96 patients in T were able to stop anti-diabetic medications

Discussion

 The initial results are an early indicator for the translation of the scientific rationale for the technological intervention, through digital twin technology, powered by Internet of Things and Artificial Intelligence, as a modality to enable reversal of diabetes. TPT appears to have potential to mitigate the cardiovascular risk as assessed by Framingham Risk Score and modulate the non glycemic parameters, including BMI and SBP. However, larger, long-term studies would yield precise insights for the durability of the significant change that has been observed in this study Abstract Figure. Comparison for the Change in the Glycemi

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Abstract 014: B1 Integrin is Essential for Kidney Structure, Function and Vascular Development

Integrins are the largest family of cell adhesion molecules. β1-Integrin (Itgb1) is the most abundantly expressed β subunit and is present in almost every cell type. Previous studies showed that Itgb1 is required for normal development of the ureteric bud and podocytes and for the function of the proximal tubule. However, its role in the kidney vasculature has not been explored. Renin cells are crucial for blood pressure homeostasis and for normal nephrovascular development. The mechanisms involved in their morphogenetic functions are not well understood. We found that Itgb1 is highly expressed in renin expressing cells throughout development. Therefore, to study the role of Itgb1 in renin cells we generated a conditional deletion (cKO) of Itgb1 in cells of the renin lineage by crossing floxed Itgb1 mice with mice expressing cre recombinase driven by the renin locus. Itgb1 cKO mice were smaller in size (20.32 ± 4.35 g vs 29.55 ± 7.39 g, p=0.016 ), had smaller kidney to body weight ratio (0.92 ± 0.30 vs 1.31 ± 0.30, p=0.017 ), hypotension (MABP 82.33 ± 4.00 mmHg vs 92.55 ± 7.72 mmHg, p=0.02 ), anemia (hemoglobin 11.26 ± 1.48 g/dL vs 15.07 ± 1.31 d/dL, p=0.003 ; hematocrit 40.39 ± 5.48% vs 53.8 ± 4.21%, p=0.002 ), renal failure (BUN 71.44 ± 32.81 mg/dL vs 29.4 ± 7.67mg/dL, p=0.004), and lower plasma renin levels (6664.58 ± 3251.92 vs 43357.09 ± 17032.63 pg/ml, p =0.001 ). Mutants also developed hyposthenuria (urine osmolality 452 ± 138.98 mOsm/kg vs 1460.5 ± 482.09 mOsm/kg, p<0.02 ). Histological analysis revealed excessive collagen deposition in the interstitium and peri-glomerular areas; fibrocystic glomeruli; tubular dilatation and protein casts in the tubules. Immunostaining for renin and α-smooth muscle actin showed a marked decrease in renin protein expression and abundant α-smooth muscle actin expression in the interstitium. Microdissection of the renal arterial tree combined with renin immunostaining confirmed the marked decrease in renin and evidenced the overall vascular abnormalities including fewer and shorter arterial and arteriolar branches. Overall, this study shows that β1-Integrin in cells of the renin lineage is crucial for renin expression, morphogenesis of the renal vasculature and maintenance of the normal kidney architecture and function.

Multipass cell based on confocal mirrors for sensitive broadband laser spectroscopy in the near infrared

We report on broadband absorption spectroscopy in the near IR using a multipass cell design based on highly reflecting mirrors in a confocal arrangement having the particular aim of achieving long optical paths. We demonstrate a path length of 314 m in a cell consisting of two sets of highly reflecting mirrors with identical focal length, spaced 0.5 m apart. The multipass cell covers this path length in a relatively small volume of 1.25 l with the light beam sampling the whole volume. In a first application, the absorption spectra of the greenhouse gases CO(2), CH(4), and CO were measured. In these measurements we used a femtosecond fiber laser with a broadband spectral range spanning the near IR from 1.5 to 1.7 μm. The absorption spectra show a high signal-to-noise ratio, from which we derive a sensitivity limit of 6 ppmv for methane observed in a mixture with air.

Study of the role of interleukin-6 and highly sensitive C-reactive protein in diabetic nephropathy in type 1 diabetic patients

BACKGROUND

Diabetes Mellitus (DM) is becoming an increasingly common disease which is the leading cause of chronic renal failure. The pathogenesis of diabetic nephropathy is still a matter of debate. There are conflicting results regarding the relation of C reactive protein (CRP), interleukin-6 (IL-6) and diabetic nephropathy in type 1 diabetes.

OBJECTIVES

This study was aiming to determine the association between higly sensitive (Hs)-CRP and IL6 with nephropathy in a sample of type 1 diabetic Egyptian patients.

MATERIALS AND METHODS

The study was conducted on forty type-1 diabetic patients (Group I), who subdivided into three subgroups according to their urine albumin excretion rate (AER); Group IA: 10 patients with AER <20 microg/min, Group IB: 15 patients with AER ranges from 20-200 microg/min. Group IC: 15 patients with AER is > 200 microg/min and 10 healthy subjects as a control (Group II).

RESULTS

There were high statistical significant difference (p < 0.001) between group I with group II regarding HsCRP (4.39 +/- 1.94, 1.32 +/- 0.39), and IL-6 (2.82 +/- 0.76, 1.95 +/- 0.35). In group I, we found a positive significant correlation (p < 0 .001) between UAE and levels of Hs-CRP (r = 0.927), and IL-6 (r = 0.838), respectively. Also, a positive significant correlation between Hs-CRP and IL-6 (r = 0.728, p < 0.001) was found. Fasting plasma glucose (FPG) level and HbA1c showed a significant positive correlation (p < 0.001) with Hs-CRP (r = 0.531) (r = 0.750), and IL-6 (r = 0. 490) (r = 0.680) respectively.

CONCLUSION

Hs-CRP and IL-6 are sensitive markers for diabetic nephropathy predicting its progression and severity in type 1 diabetics.

Clinicopathological findings and echocardiographic prediction of the localisation of bovine endocarditis

Thirty-six cows with confirmed vegetative endocarditis at postmortem examination were examined in this study. In 33 cows, echocardiography showed lesions of the pulmonic, tricuspid and mitral valves. Ten healthy cows were enrolled in the study as controls. In diseased cows, clinical signs included recurrent fever, dyspnoea, epistaxis, tachycardia, murmurs, weight loss, decreased milk production, jugular and mammary vein distension with palpable pulse, and ventral and submandibular oedema. Laboratory abnormalities included neutrophilic leukocytosis, elevated protein concentrations, hypoalbuminaemia, hypergammaglobulinaemia, azotaemia and elevated serum creatinine concentration. High serum activities of aspartate aminotransferase, γ-glutamyl transpeptidase and lactate dehydrogenase were also detected. Echocardiography showed small, medium-sized or large hyperechogenicity, thickening, and proliferative or vegetative lesions of the tricuspid (n=11), mitral (n=5) and pulmonic valves (n=19). Confirmatory diagnosis was made at postmortem examination. Echocardiography could detect vegetations in 33 of the 36 cows (92 per cent). The sensitivity of ultrasound in detecting valvular endocarditis was 89 per cent for tricuspid valves, 83 per cent for mitral valves and 95 per cent for pulmonic valves.

Clinicopathological and ultrasonographic findings in 40 water buffaloes (Bubalus bubalis) with traumatic pericarditis

Forty buffaloes with traumatic pericarditis were examined to characterise the ultrasonographic findings in buffaloes with traumatic pericarditis, determine the extent of the lesions and assess the prognosis. The most noticeable clinical presentations were presternal oedema (73 per cent) and jugular and mammary vein distension (88 per cent). Laboratory findings included neutrophilic leucocytosis, elevated total protein concentration, hypoalbuminaemia, hypergammaglobulinaemia and increased concentration of free fatty acids. Ultrasonographically, fluid in the pericardium appeared as either mild or massive anechoic accumulations containing fibrin threads or were imaged as homogenous, echogenic pericardial effusions. Moderate to severe corrugation of the reticular wall was observed. Deposits of fibrinous tissue interspersed with fluid pockets were seen between the reticulum, dorsal ruminal sac and diaphragm. Perireticular and mediastinal abscesses were imaged and appeared as echogenic lines with anechoic, echogenic, homogenous or heterogeneous contents. Additional ultrasonographic findings included hepatomegaly, dilation of the caudal vena cava, hepatic and portal veins, ascites, echogenic pleural effusions and vegetations of the tricuspid, mitral and pulmonary valves. The ultrasonographic findings were confirmed at postmortem examination.

Determinants of failure of venous access devices in outpatient oncology

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Background: Little guidance is available regarding the optimum placement and use of implantable venous access devices (VAD) in cancer treatment. We present herein 10 years of experience with VAD in a university hospital oncology clinic. Methods: Post hoc analysis of prospectively collected records of 346 cancer patients in whom 362 VAD (Port-a-Caths) were placed between January 1995 to December 2005. Primary end points included need for instillation of tissue plasminogen activator (TPA) to restore patency, need for an x-ray dye study to determine catheter salvageability, and premature removal because of VAD failure. We used Chi-square analysis to compare VAD placement by the Radiology service under fluoroscopy vs. placement by Surgery in the operating room (OR), placement in the right vs. left chest and internal jugular (IJ) vs. subclavian (SC) vein placement. Results: OR-placed VAD, more often than Radiology-placed VAD required TPA for patency (18.6% vs 8.07%, p<0.01), a dye study (11.7% vs 2.69%, p=0.001) or premature removal (14.7% vs 5.38%, p<0.01). Right- and left-sided VAD were equally likely to receive TPA (9.2% vs 16.1%, p=0.11) but left-sided VAD required more dye studies (3.3% vs 10.7%, p=0.013) and were prematurely removed more often (5.5% vs 15%, p=0.007). 29 (8%) of VAD were prematurely removed because of infection (n=11), thrombosis(n=6), pain (n=2), mechanical malfunction (n=6) and others (n=4). Gender, age (< vs. > 60 years), site of placement (IJ vs. SC) or body mass index (< vs. > 25) had no bearing on the primary endpoints. Intrathoracic cancer was associated with more TPA treatment of the VAD (16.8% vs. 8.4%, p<0.023) but not with dye studies (7.9% vs. 4%, p=0.191) or removal (6.1% vs. 8.8%, p=0.517). Conclusions: AVAD will usually last until completion of cancer therapy. Occlusion or premature removal is less likely in a VAD placed on the right side under fluoroscopic guidance by an experienced radiologist. Thoracic disease, site of placement, obesity, age or gender do not determine adverse outcomes for VAD.

No significant financial relationships to disclose.

Dielectronic resonance method for measuring isotope shifts

Long standing problems in the comparison of very accurate hyperfine-shift measurements to theory were partly overcome by precise measurements on few-electron highly charged ions. Still the agreement between theory and experiment is unsatisfactory. In this Letter, we present a radically new way of precisely measuring hyperfine shifts, and demonstrate its effectiveness in the case of the hyperfine shift of 4s1/2 and 4p1/2 in 207Pb53+. It is based on the precise detection of dielectronic resonances that occur in electron-ion recombination at very low energy. This allows us to determine the hyperfine constant to around 0.6 meV accuracy which is on the order of 10%.

Metabolic profiles and bile acid extraction rate in the liver of cows with fasting-induced hepatic lipidosis

This study was designed to monitor lipid profile in the portal and hepatic blood of cows with fasting-induced hepatic lipidosis, and to compare the results with those in the jugular blood. The work was also carried out to investigate bile acid (BA) in these vessels, and further to investigate BA extraction rate in the liver. Five cows were equipped with catheters in the portal, hepatic and jugular veins (day 0), fasted for 4 days (day 1-day 4) and then refed (day 5-day 11). Before morning feeding, blood was sampled before, during and after fasting from the catheterized vessels. In the portal blood, the concentration of non-esterified fatty acids (NEFA) showed a progressive increase and at day 5 there was an approximate twofold rise. Increased NEFA concentrations were also found similarly in the other two veins. At day 5, beta-hydroxybutyrate (BHBA) in the portal, hepatic and jugular blood rose to 197, 190 and 186% of the pre-fasting value, respectively. However, the concentrations of NEFA and BHBA in the three veins gradually returned to pre-fasting concentration during the refeeding period. Compared with the pre-fasting value at day 0, the content of liver triglyceride (TG) increased significantly at day 5 (P < 0.01). In the liver, the hepatic extraction rate of BA dropped from 3.1 times pre-fasting to 2.2 times during fasting. There were no significant differences in the concentrations of glucose, TG, total cholesterol, cholesterol esters, free cholesterol and phospholipids. The results of the current study show that metabolic alterations occur in the portal, hepatic and jugular veins during induction of hepatic lipidosis in cows, and mostly metabolites, with exception of BA concentration, run parallel. The decreased BA extraction rate in the liver of fasted cows was considered to reflect hepatic cell impairment caused by TG accumulation. Hopefully, the findings, at least in part, contribute to the explanation of the pathophysiology of hepatic lipidosis in dairy cows.

Transcutaneous ultrasound-guided pancreatic biopsy in cattle and its safety: a preliminary report

This study describes a free-hand technique for percutaneous pancreatic biopsy in cattle with ultrasound-guidance using a 14G spinal biopsy needle. Its safety was evaluated based on 36 consecutive procedures. To assess the immediate effects of pancreatic biopsy, 31 cows were necropsied shortly after the procedure and examined. The remaining five cows were examined daily for eight days and then necropsied and examined. No life-threatening complications nor clinically detectable abnormalities were observed. Changes indicative of inflammation were not apparent in total and differential WBC counts or in total protein and fibrinogen concentrations. A small increase of amylase activity was detected in only one cow kept for the eight-day observation period. Serum lipase activity increased significantly on day four after biopsy. Urea nitrogen, creatinine, glucose and the activities of aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltransferase remained within reference ranges. Changes in the peritoneum and pancreas observed at necropsy were negligible. We conclude that percutaneous ultrasound-guided pancreatic biopsy did not appear to influence the cow's condition adversely and the procedure provided an excellent method of obtaining a pancreatic specimen for histological examination. The procedure was considered safe, fast, cost-effective, and practical when performed properly. We believe that the technique can be used in cows with suspected pancreatic disease for making an ante mortem diagnosis.

Ultrasonographic imaging of experimentally induced pancreatitis in cattle

This study was conducted to determine the ultrasonographic patterns of pancreatitis evoked in cattle, with reference to laboratory and pathological findings. Using ultrasonographic guidance, acute necrotizing pancreatitis was induced in six cows by injecting chloroform into the pancreatic tissue. Ultrasonographic examination was then performed once daily for nine days. Pancreatic lesions were visible 24h after induction of pancreatitis, as represented by a uniform increase in echogenicity and by intralobular and subcapsular fluid accumulation. As the experiment progressed, patchy hypoechogenic foci appeared within the gland parenchyma. Amylase and lipase activities showed rapid increases. Post mortem examination revealed gross and microscopic necrotic and haemorrhagic lesions in the body and right lobe of the pancreas, accompanied by oedema and fibrosis. Ultrasonography was found to be extremely useful for the detection and characterization of experimentally induced pancreatitis and to monitor its progression in the cow. These findings are of potential value as a reference for the diagnostic workup of bovine pancreatitis, and ultrasonography is seen as a promising non-invasive technique for the diagnosis of suspected pancreatitis in cattle.

Bile acid extraction rate in the liver of cows fed high-fat diet and lipid profiles in the portal and hepatic veins

The purposes of this study are to assess the responses of increased supplemental dietary fat in the cow, without upsetting rumen fermentation, on the bile acid (BA) extraction rate in the liver and to determine whether this diet would affect the postprandial lipid profiles in the portal and hepatic venous blood. Six Holstein cows were equipped with catheters fitted in the portal and hepatic veins. Two cows each were assigned randomly to a sequence of three dietary treatments of 21-day period. The methodology of this study was based on the supplementation of the basal concentrate diet with 0 (control), 5, or 10% calcium salts of fatty acids (CSFA). The total bile acids were significantly increased in the portal and hepatic veins with the 5% CSFA diet, whereas no increase occurred with the 10% CSFA diet. Data obtained in this study showed that 10% CSFA diet failed to stimulate BA secretion to exceed the values obtained with 5% CSFA-diet. Moreover, there was no change in the hepatic extraction rate of BA in animals fed either the 0 or 5% CSFA diets which ranged from 2.4 to 6.5-fold and 3.1 to 7.3-fold, respectively. However, the extraction rate increased sharply with the 10% CSFA diet (27-fold). The median portal and hepatic concentrations of total lipids, triglycerides, total cholesterol, phospholipids and non-esterified fatty acids did not show any significant increase during feeding of the control diet. Moreover, feeding either the 5 or 10% CSFA diet did not significantly increase these values in either vein.

[A voluminous vascular leiomyoma of the pancreas treated by personal technique of resection of the pancreatic head without duodenectomy]

A new technique variation of complete resection of the pancreatic head with preservation of the duodenum is described. The steps of this intervention are the partial mobilization of the duodenum, the mobilization of the gastric antrum, the section of the pancreatic neck and the complete resection of the pancreatic head with a meticulous dissection/section of the small blood vessels connecting the duodenum and the head of the pancreas. The terminal part of choledochus is removed with the specimen of the pancreas. The intervention is completed with cholecystectomy, end-to-side pancreaticojejunostomy, end-to-side choledocho-jejunostomy and side-to-side jejunojejunal anastomosis. The authors carried out this intervention on a 74-year old woman with a voluminous vascular leiomyoma of the pancreatic head. The patient, two years after the operation, is well with a normal clinical and laboratory follow-up.