The gut microbiome and cardiac surgery an unusual symphony

The relationship between the gut microbiome and various organ systems has gained interest throughout the scientific community in recent times. The understanding of these complex relationships has greatly improved with clinical benefits now being seen. Cardiopulmonary bypass (CPB) is a form of extracorporeal circulation that provides circulatory and respiratory support during cardiac surgery. This physiological support facilitates a still and bloodless field facilitating operations on the heart to be performed. Through various mechanisms CPB results in a systemic inflammatory response syndrome (SIRS). This response can vary from mild hypotension to multiple organ failure. It remains difficult to predict the degree to which a patient will experience SIRS post-operatively. The relationship between the composition of the gut microbiome and inflammatory processes associated with disease has been seen across several fields including gastroenterology, neurology, psychiatry and cardiology. To date, minimal research has been undertaken to examine the impact the gut microbiome has on outcomes following cardiac surgery. This review paper explores the pathophysiology behind the SIRS response associated with CPB for cardiac surgery and the hypothesis that a correlation exists between a patients gut microbiome composition and the degree of inflammatory response experienced following cardiac surgery.

Comprehensive Report of the Caseload of Donkeys and Mules Presented to a Veterinary Medical Teaching Hospital over a Ten-Year Period

Simple Summary

We sought to provide a comprehensive report of the caseload of donkeys and mules at the Veterinary Medical Teaching Hospital at the University of California, Davis for a ten-year period. The caseload of donkeys and mules was 1.06% of the total equid caseload and was comprised of animals that received a good standard of veterinary care, including both routine wellness and medical care. Most animals tended to be older, around 10 years of age, and possessed high body condition scores. Obesity was reported, especially in donkeys. Most mules were used for riding, packing or driving, and most donkeys were in sanctuary and rescue farms. We report in detail the preventative health and veterinary medical care of these donkeys and mules. Our findings provide a greater understanding of the health and welfare of donkeys and mules residing in the western United States.

Abstract

Comprehensive reports of the caseload of donkeys and mules in veterinary hospitals in the United States are lacking. We compiled the information of the caseload of donkeys and mules at the Veterinary Medical Teaching Hospital at the University of California, Davis for a ten-year period, from 2008 to 2017. The overall equid caseload was 94,147, of which 996 (1.06%) were donkeys and mules. Most of the neonates seen were mules. Most miniature donkeys were between 2 and 10 years of age, and standard donkeys and mules were 10 to 20 years old. The body condition scores were predominantly high, especially in donkeys. Most miniature and standard donkeys resided in sanctuary and rescue farms and their use was not stated. Most mules were used for riding, packing or driving. Medical complaints represented 62% of the total visits and wellness visits represented 38% of total visits. The donkeys and mules in the case population described here received a good standard of veterinary care with regular vaccinations, deworming, routine dental care, and treatment of ailments. Our study is the first report of the life expectancy, use, body condition, preventative health and veterinary medical care of a population of donkeys and mules in the western United States.

A model to infer the demographic structure evolution of endangered donkey populations

Stemming from The Worldwide Donkey Breeds Project, an initiative aiming at connecting international researchers and entities working with the donkey species, molecularly tested pedigree analyses were carried out to study the genetic diversity, structure and historical evolution of the Andalusian donkey breed since the 1980s to infer a model to study the situation of international endangered donkey breeds under the remarkably frequent unknown genetical background status behind them. Demographic and genetic variability parameters were evaluated using ENDOG (v4.8). Pedigree completeness and generation length were quantified for the four gametic pathways. Despite mean inbreeding was low, highly inbred animals were present in the pedigree. Average coancestry, relatedness, and non-random mating degree trends were computed. The effective population size based on individual inbreeding rate was about half when based on individual coancestry rate. Nei's distances and equivalent subpopulations number indicated differentiated farms in a highly structured population. Although genetic diversity loss since the founder generations could be considered small, intraherd breeding policies and the excessive contribution of few ancestors to the gene pool could lead to narrower pedigree bottlenecks. Long average generation intervals could be considered when reducing inbreeding. Wright's fixation statistics indicated slight inbreeding between farms. Pedigree shallowness suggested applying new breeding strategies to reliably estimate descriptive parameters and control the negative effects of inbreeding, which could indeed, mean the key to preserve such valuable animal resources avoiding the extinction they potentially head towards, making the present model become an international referent when assessing endangered donkey populations.

Individual risk assessment of adverse pregnancy outcome by multivariate regression analysis may serve as basis for drug intervention studies: retrospective analysis of 426 high-risk patients including ethical aspects

OBJECTIVE

To identify patients at very high risk for adverse pregnancy outcome (APO) at the 20- to 23-week scan and to assess the effectiveness of Aspirin (ASS) and low molecular weight heparin (LMWH) starting after this examination.

PATIENTS AND METHODS

By applying an algorithm based on multivariate logistic regression analysis using the parameters maternal age, parity, body mass index (BMI), mean pulsatility index of both uterine arteries (meanPI), presence of uni- or bilateral notch, and depth of notch (mean notch index (meanNI), we retrospectively calculated the individual risk for APO of 21,302 singleton pregnancies. We isolated a subgroup of 426 patients with the highest calculated probability for APO (cpAPO > 27.8 %). 147 had been treated with ASS; 73 with LMWH, 15 patients with a combination of ASS and LMWH, and 191 patients had not received anticoagulants.

RESULTS

Administration of ASS starting after 20 gestational weeks in comparison to non-treated patients significantly reduced the frequency of intrauterine/neonatal death (IUD/NND), preeclampsia <33 weeks (PE < 33), and preterm delivery <33 weeks (PD < 33), while the frequency of IUGR showed a tendency to be elevated (P = 0.061). The subgroup of high-risk patients treated with LMWH was characterised by a higher a priori risk for APO and showed no significant reduction of any form of APO but an increased frequency of PE.

CONCLUSION

Individual assessment of risk for APO by applying a simple algorithm based on biometrical/biographical as well as sonographic parameters may serve as basis for drug intervention studies. The administration of ASS in high-risk patients starting after 20 gestational weeks reduced the frequency of most of the severe forms of adverse pregnancy outcome in high-risk patients. A complication-reducing effect of LMWH starting after 20 weeks of gestation in patients could not be proven. From an ethical point of view, it may not be justified any more to preclude high-risk patients from administration of ASS or to perform studies of ASS against placebo.