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Addressing health inequalities in times of austerity: implementation of a place-based approach in multitiered local government. Perspect Public Health 2024; 144:153-161. [PMID: 38676341 PMCID: PMC11103920 DOI: 10.1177/17579139241241194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
AIMS This article focuses on how local authorities in England are tackling wider determinants of health and inequalities in their population's outcomes while budgets for public services are diminishing. METHODS It reports the experience from one case study engaged in rolling out a devolved, place- and asset-based strategy over multiple tiers of local government. Relating these findings to relevant social theory, we draw out aspects of context and mechanisms of change. We offer plausible hypotheses for the experiences observed, which supports transferability and implementation of place-based strategies in other local authority areas struggling with similar challenges. RESULTS Findings highlight the importance of high-level and political buy-in, as well as the role of the COVID-19 pandemic as a potential catalyst to rollout. Creating the foundations for a new, place-based working was important for achieving coherence among partners around what local government was trying to achieve. These included investment in infrastructure, both relational and tangible inputs such as organisational and human resources, to establish the conditions for systemic change towards early intervention and prevention. CONCLUSION This study identified clear foundations for place-based action, plus enablers and barriers to significant transformation of practice towards asset-based approaches between local authorities, partners and the public.
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Review: Environmental enrichment builds functional capacity and improves resilience as an aspect of positive welfare in production animals. Animal 2024; 18:101173. [PMID: 38761442 DOI: 10.1016/j.animal.2024.101173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/20/2024] Open
Abstract
The success of the animal in coping with challenges, and in harnessing opportunities to thrive, is central to its welfare. Functional capacity describes the capacity of molecules, cells, organs, body systems, the whole animal, and its community to buffer against the impacts of environmental perturbations. This buffering capacity determines the ability of the animal to maintain or regain functions in the face of environmental perturbations, which is recognised as resilience. The accuracy of physiological regulation and the maintenance of homeostatic balance underwrite the dynamic stability of outcomes such as biorhythms, feed intake, growth, milk yield, and egg production justifying their assessment as indicators of resilience. This narrative review examines the influence of environmental enrichments, especially during developmental stages in young animals, in building functional capacity and in its subsequent expression as resilience. Experience of enriched environments can build skills and competencies across multiple functional domains including but not limited to behaviour, immunity, and metabolism thereby increasing functional capacity and facilitating resilience within the context of challenges such as husbandry practices, social change, and infection. A quantitative method for measuring the distributed property of functional capacity may improve its assessment. Methods for analysing embedded energy (emergy) in ecosystems may have utility for this goal. We suggest functional capacity provides the common thread that links environmental enrichments with an ability to express resilience and may provide a novel and useful framework for measuring and reporting resilience. We conclude that the development of functional capacity and its subsequent expression as resilience is an aspect of positive animal welfare. The emergence of resilience from system dynamics highlights a need to shift from the study of physical and mental states to the study of physical and mental dynamics to describe the positive dimension of animal welfare.
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Exploring the cause of reduced production responses to feeding corn dried distillers' grains in lactating dairy cows. J Dairy Sci 2024:S0022-0302(24)00752-5. [PMID: 38642660 DOI: 10.3168/jds.2023-24356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/10/2024] [Indexed: 04/22/2024]
Abstract
An experiment was conducted to identify the factors that cause reduced production of cows fed a diet with high corn distiller's grains with solubles (DDGS). We hypothesized that the factors could be high S content in DDGS which may directly (S toxicity) or indirectly [dietary cation-anion difference (DCAD)] cause reduced production. We also hypothesized that high polyunsaturated fatty acids (PUFA) in DDGS could be another major factor. In a randomized complete block design, 60 lactating cows (15 primiparous and 45 multiparious; average ± SD at the beginning of the trial: milk yield, 44.0 ± 6.9 kg/d; DIM, 123 ± 50; BW, 672 ± 82 kg) were blocked and cows in each block were randomly assigned to one of the following treatments: SBM [4.7% fatty acids (FA), 0.22% S, and 178 mEq/kg DM of DCAD], a diet containing soybean meal as the main protein source; DG, SBM replacing mainly soybean byproducts and supplemental fat with DG at 30% dietary DM (4.7% FA, 0.44% S, and 42 mEq/kg DM of DCAD); SBM+S, SBM with sodium bisulfate for additional dietary S (4.8% FA, 0.37% S, and 198 mEq/kg DM of DCAD); SBM+CO, SBM with corn oil (4.7% FA, 0.23%, and 165 mEq/kg DM of DCAD); and DG+DCAD, DG with increased DCAD (4.7% FA, 0.40% S, and 330 mEq/kg DM of DCAD). Due to the limited tie stalls, the blocks of 1 to 6 started the experiment first as phase 1 and the rest of the blocks as phase 2 started the experiment after phase 1. All cows were fed the SBM diet for 10 d as a covariate period followed by the experimental period for 35 d. Data were analyzed using the PROC MIXED of SAS, block and phase were random effects and treatments, repeated wk, and interaction were fixed effects. There was an interaction of wk by treatment for DMI. While milk yield did not change, milk fat concentration tended to decrease (2.78 vs. 3.34%) for DG compared with SBM. Dry matter, OM, NDF, and CP digestibilities were lower when cows were fed the DG diet compared with SBM. Additionally, cows fed DG had lower blood concentrations of HCO3-, base excess, and tCO2 compared with SBM. The SBM+S diet did not affect production, nutrient digestibility, or blood parameters when compared with SBM. The SBM+CO diet decreased milk fat concentration and yield compared with SBM. The DG+DCAD diet tended to increase milk fat yield and concentration (1.24 vs. 1.47 kg/d; 2.78 vs. 3.37%) and increased ECM (40.9 vs. 45.1 kg/d) compared with DG but did not improve nutrient digestibility. However, blood HCO3-, base excess, and tCO2 were greater for DG+DCAD compared with DG. In conclusion, the indirect role of S-, altering DCAD, along with the high PUFA content in DDGS appears to be the factors causing reduced production responses to a high DDGS diet. Increasing DCAD to 300 mEq/kg DM in a high DDGS diet can be a feeding strategy to alleviate the reduced production responses.
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Measuring bioavailability, utilization, and excretion of rumen-protected lysine in lactating cows using an isotope technique. Animal 2024; 18:101127. [PMID: 38574452 DOI: 10.1016/j.animal.2024.101127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Supplementing a diet with rumen-protected amino acids (AAs) is a common feeding strategy for efficient production. For a cost-effective use of rumen-protected AA, the accurate bioavailability of rumen-protected amino acids should be known and their metabolism after absorption needs to be well understood. The current study determined the bioavailability, absorption, utilization, and excretion of rumen-protected Lys (RP-Lys). Four ruminally cannulated cows in a 4 × 4 Latin square design (12 d for diet adaptation; 5 or 6 d for total collections) received the following treatments: L0, a basal diet; L25, the basal diet and L-Lys infused into the abomasum to provide 25.9 g/d L-Lys; L50, the basal diet and L-Lys infused into the abomasum to provide 51.8 g/d L-Lys; and RPL, the basal diet supplemented with 105 g/d (as-is) of RP-Lys to provide 26.7 g of digestible Lys. During the last 5 or 6 d in each period, 15N-Lys (0.38 g/d) was infused into the abomasum for all cows to label the pool of AA, and the total collection of milk, urine, and feces were conducted. 15N enrichment of samples on d 4 and 5 were used to calculate the bioavailability and Lys metabolism. We used a model containing a fast AA turnover (≤ 5 d) and slow AA turnover pool (> 5 d) to calculate fluxes of Lys. The Lys flux to the fast AA turnover pool (absorbed Lys + Lys from the slow AA turnover pool to fast AA turnover pool) was calculated using 15N enrichment of milk Lys. The flux of Lys from the fast AA turnover pool to milk and urine was calculated using 15N transfer into milk and urine. Then, absorbed Lys was estimated by the sum of Lys flux to milk and urine assuming no net utilization of Lys by body tissues. Duodenal Lys flow was estimated by 15N enrichment of fecal Lys. The bioavailability of RP-Lys was calculated from duodenal Lys flows and Lys absorption for RPL. Increasing Lys supply from L25 to L50 increased Lys utilization for milk by 9 g/d but also increased urinary excretion by 10 g/d. For RPL, absorbed Lys was estimated to be 136 g/d where 28 g of absorbed Lys originated from RP-Lys. In conclusion, 68% of bioavailability was obtained for RP-Lys. The Lys provided from RP-Lys was not only utilized for milk protein (48%) but also excreted in urine (20%) after oxidation.
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Effects of saturated fatty acids with lysophospholipids on production and nutrient digestibility in lactating cows. J Dairy Sci 2024:S0022-0302(24)00505-8. [PMID: 38395396 DOI: 10.3168/jds.2023-24457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
The objective of the experiment was to determine the effects of supplemental saturated fatty acid (SFA) sources, lysophospholipids (LPL), and their interaction on production and nutrient digestibility in lactating dairy cows. The experiment was conducted with 48 cows in a randomized complete block design. Cows were blocked (total 12 blocks) by parity and days in milk and randomly assigned to 4 dietary treatments in each block (2 × 2 factorial arrangement), i.e., 2 sources of fat supplements, C16:0 (palmitic acid, PA)- or C18:0 (stearic acid, SA)-enriched fat, with or without LPL. The experiment was conducted for 6 wk to measure daily dry matter intake and milk yield and weekly milk composition. During the last week of the experiment, spot fecal and urine samples were collected to determine total-tract nutrient digestibility. Milk samples in the last week were also collected to analyze for milk fatty acid (FA) profile. All data were analyzed using the mixed procedure of SAS where block was used as a random effect and FA, LPL, and the interaction of FA by LPL were used as fixed effects. Week and interactions of week by FA or LPL were included for production measures. Different sources of SFA did not affect dry matter intake and milk yield. However, PA increased (39.7 vs. 36.8 kg) energy-corrected milk compared with SA due to increased milk fat yield. No effect of LPL on production measures was observed. Total-tract digestibilities of dry matter, organic matter, crude protein, and total FA were not different between PA and SA, but PA increased (41.4 vs. 38.8%) neutral detergent fiber digestibility compared with SA. Supplementation of LPL increased (64.7 vs. 60.5%) total FA digestibility, especially 18-carbon FA (74.1 vs. 68.2%). An interaction of SFA by LPL was found for 16-carbon FA digestibility. The PA diet increased the concentration of 16-carbon FA in milk fat and SA increased the concentration of preformed FA (≥18 carbons). Supplementation of LPL decreased the concentration of trans-10 C18:1. No difference in N utilization and excretion among treatments was observed. In conclusion, PA was more effective in improving milk fat yield of lactating cows compared with SA. Supplementation of LPL increased digestibility of total FA, especially 18-carbon FA but did not affect production.
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The Clinical Significance of Myosteatosis in Survival Outcomes in Patients with Hepatocellular Carcinoma Treated with Sorafenib. Cancers (Basel) 2024; 16:454. [PMID: 38275895 PMCID: PMC10814239 DOI: 10.3390/cancers16020454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
The role of body composition parameters in sorafenib-treated hepatocellular carcinoma (HCC) patients is still not fully elucidated. Here, we aimed to evaluate the impact of computed tomography (CT)-based body composition parameters on the survival of such patients. In this multicenter study, we analyzed the data of 245 sorafenib-treated HCC patients from January 2008 to December 2019. Sarcopenia, visceral obesity, and myosteatosis were defined by using cross-sectional CT images at the third lumbar vertebra level. The effects of these parameters on overall survival (OS) and progression-free survival (PFS) were evaluated. The median age was 67.0 years (interquartile range: 61.0-78.0 year), and 211 patients (86.1%) were male. The median OS and PFS were 7.9 months and 4.8 months, respectively. Vascular invasion (hazard ratio (HR), 1.727; 95% confidence interval (CI), 1.258-2.371; p = 0.001), extrahepatic metastasis (HR, 1.401; 95% CI, 1.028-1.908; p = 0.033), alpha-fetoprotein level > 200 ng/mL (HR, 1.559; 95% CI, 1.105-2.201; p = 0.012), and myosteatosis (HR, 1.814; 95% CI, 1.112-2.960; p = 0.017) were associated with OS. Patient mortality was significantly higher in the group with two or more risk factors than in the group with fewer risk factors. In conclusion, myosteatosis may be a novel prognostic CT-based radiological biomarker in sorafenib-treated HCC patients.
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Diffusion MRI correlation with p16 status and prediction for tumor progression in locally advanced head and neck cancer. Front Oncol 2023; 13:998186. [PMID: 38188292 PMCID: PMC10771284 DOI: 10.3389/fonc.2023.998186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/06/2023] [Indexed: 01/09/2024] Open
Abstract
Purpose To investigate p16 effects on diffusion image metrics and associations with tumor progression in patients with locally advanced head and neck cancers. Methods Diffusion images pretreatment and after 20 Gy (2wk) of RT were analyzed in patients with cT4/N3 p16+ oropharynx cancer (OPSCC) (N=51) and locoregionally advanced head and neck squamous cell carcinoma (LAHNSCC) (N=28), enrolled onto a prospective adaptive RT trial. Mean ADC values, subvolumes with ADC <1.2 um2/ms (TVLADC), and peak values of low (µL) and high (µH) components of ADC histograms in primary and total nodal gross tumor volumes were analyzed for prediction of freedom from local, distant, or any progression (FFLP, FFDP or FFLRDP) using multivariate Cox proportional-hazards model with clinical factors. P value with false discovery control <0.05 was considered as significant. Results With a mean follow up of 36 months, 18 of LAHNSCC patients and 16 of p16+ OPSCC patients had progression. After adjusting for p16, small µL and ADC values, and large TVLADC of primary tumors pre-RT were significantly associated with superior FFLRDP, FFLP and FFDP in the LAHNSCC (p<0.05), but no diffusion metrics were significant in p16+ oropharynx cancers. Post ad hoc analysis of the p16+ OPSCC only showed that large TVLADC of the total nodal burden pre-RT was significantly associated with inferior FFDP (p=0.05). Conclusion ADC metrics were associated with different progression patterns in the LAHNSCC and p16+ OPSCC, possibly explained by differences in cancer biology and morphology. A deep understanding of ADC metrics is warranted to establish imaging biomarkers for adaptive RT in HNSCC.
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Supplementing branched-chain volatile fatty acids in dual-flow cultures varying in dietary forage and corn oil concentrations. II: Biohydrogenation and incorporation into bacterial lipids. J Dairy Sci 2023; 106:7548-7565. [PMID: 37532628 DOI: 10.3168/jds.2022-23192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/17/2023] [Indexed: 08/04/2023]
Abstract
To maintain membrane homeostasis, ruminal bacteria synthesize branched-chain fatty acids (BCFA) or their derivatives (vinyl ethers) that are recovered during methylation procedures as branched-chain aldehydes (BCALD). Many strains of cellulolytic bacteria require 1 or more branched-chain volatile fatty acid (BCVFA). Therefore, the objective of this study was to investigate BCVFA incorporation into bacterial lipids under different dietary conditions. The study was an incomplete block design with 8 continuous culture fermenters used in 4 periods with treatments (n = 4) arranged as a 2 × 2 × 2 factorial. The factors were high (HF) or low forage (LF, 67 or 33% forage, 33:67 alfalfa:orchardgrass), without or with supplemental corn oil (CO; 3% dry matter, 1.5% linoleic fatty acid), and without or with 2.15 mmol/d (5 mg/d 13C each of isovalerate, isobutyrate, and 2-methylbutyrate). After methylation of bacterial pellets collected from each fermenter's effluent, fatty acids and fatty aldehydes were separated before analysis by gas chromatography and isotope ratio mass spectrometry. Supplementation of BCVFA did not influence biohydrogenation extent. Label was only recovered in branched-chain lipids. Lower forage inclusion decreased BCFA in bacterial fatty acid profile from 9.45% with HF to 7.06% with LF and decreased BCALD in bacterial aldehyde profile from 55.4% with HF to 51.4% with LF. Supplemental CO tended to decrease iso even-chain BCFA and decreased iso even-chain BCALD in their bacterial lipid profiles. The main 18:1 isomer was cis-9 18:1, which increased (P < 0.01) by 25% from CO (data not shown). Dose recovery in bacterial lipids was 43.3% lower with LF than HF. Supplemental CO decreased recovery in the HF diet but increased recovery with LF (diet × CO interaction). Recovery from anteiso odd-chain BCFA and BCALD was the greatest; therefore, 2-methylbutyrate was the BCVFA primer most used for branched-chain lipid synthesis. Recovery in iso odd-chain fatty acids (isovalerate as primer) was greater than label recovery in iso even-chain fatty acids (isobutyrate as primer). Fatty aldehydes were less than 6% of total bacterial lipids, but 26.0% of 13C recovered in lipids were recovered in BCALD because greater than 50% of aldehydes were branched-chain. Because BCFA and BCALD are important in the function and growth of bacteria, especially cellulolytics, BCVFA supplementation can support the rumen microbial consortium, increasing fiber degradation and efficiency of microbial protein synthesis.
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Supplementing branched-chain volatile fatty acids in dual-flow cultures varying in dietary forage and corn oil concentrations. III: Protein metabolism and incorporation into bacterial protein. J Dairy Sci 2023; 106:7566-7577. [PMID: 37641344 DOI: 10.3168/jds.2022-23193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/11/2023] [Indexed: 08/31/2023]
Abstract
Some cellulolytic bacteria cannot transport branched-chain AA (BCAA) and do not express complete synthesis pathways, thus depending on cross-feeding for branched-chain volatile fatty acid (BCVFA) precursors for membrane lipids or for reductive carboxylation to BCAA. Our objective was to assess BCVFA uptake for BCAA synthesis in continuous cultures administered high forage (HF) and low forage (LF) diets without or with corn oil (CO). We hypothesized that BCVFA would be used for BCAA synthesis more in the HF than in LF diets. To help overcome bacterial inhibition by polyunsaturated fatty acids in CO, BCVFA usage for bacterial BCAA synthesis was hypothesized to decrease when CO was added to HF diets. The study was an incomplete block design with 8 dual-flow fermenters used in 4 periods with 8 treatments (n = 4) arranged as a 2 × 2 × 2 factorial. The factors were: HF or LF (67 or 33% forage, 33:67 alfalfa:orchardgrass pellets), without or with supplemental CO (3% of dry matter), and without or with 2.15 mmol/d (5 mg/d 13C) each of isovalerate, isobutyrate, and 2-methylbutyrate for one combined BCVFA treatment. The flow of bacterial BCAA increased by 10.7% by supplementing BCVFA and 9.14% with LF versus HF; similarly, dosing BCVFA versus without BCVFA increased BCAA by 1.98% in total bacterial AA, whereas LF increased BCAA by 1.92% versus HF. Additionally, BCVFA supplementation increased bacterial AA flow by 16.6% when supplemented in HF - CO and 12.4% in LF + CO diets, but not in the HF + CO (-1.5%) or LF - CO (+6.7%) diets (Diet × CO × BCVFA interaction). The recovery of 13C in bacterial AA flow was 31% lower with LF than with HF. Of the total 13C recovered in bacteria, 13.8, 17.3, and 30.2% were recovered in Val, Ile, and Leu, respectively; negligible 13C was recovered in other AA. When fermenters were dosed with BCVFA, nonbacterial and total effluent flows of AA, particularly of alanine and proline, suggest decreased peptidolysis. Increased ruminal outflow of bacterial AA, especially BCAA, but also nonbacterial AA could potentially support postabsorptive responses from BCVFA supplementation to dairy cattle.
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Supplementing branched-chain volatile fatty acids in dual-flow cultures varying in dietary forage and corn oil concentrations. I: Digestibility, microbial protein, and prokaryotic community structure. J Dairy Sci 2023; 106:7530-7547. [PMID: 37532627 DOI: 10.3168/jds.2022-23165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/17/2023] [Indexed: 08/04/2023]
Abstract
Branched-chain amino acids are deaminated by amylolytic bacteria to branched-chain volatile fatty acids (BCVFA), which are growth factors for cellulolytic bacteria. Our objective was to determine the dietary conditions that would increase the uptake of BCVFA by rumen bacteria. We hypothesized that increased forage would increase cellulolytic bacterial abundance and incorporation of BCVFA into their structure. Supplemental polyunsaturated fatty acids, supplied via corn oil (CO), should inhibit cellulolytic bacteria growth, but we hypothesized that additional BCVFA would alleviate that inhibition. Further, supplemental BCVFA should increase neutral detergent fiber degradation and efficiency of bacterial protein synthesis more with the high forage and low polyunsaturated fatty acid dietary combination. The study was an incomplete block design with 8 dual-flow continuous cultures used in 4 periods with 8 treatments (n = 4 per treatment) arranged as a 2 × 2 × 2 factorial. The factors were: high forage (HF) or low forage (LF; 67 or 33%), without or with supplemental CO (3% dry matter), and without or with 2.15 mmol/d (which included 5 mg/d of 13C each of BCVFA isovalerate, isobutyrate, and 2-methylbutyrate). The isonitrogenous diets consisted of 33:67 alfalfa:orchardgrass pellet, and was replaced with a concentrate pellet that mainly consisted of ground corn, soybean meal, and soybean hulls for the LF diet. The main effect of supplementing BCVFA increased neutral detergent fiber (NDF) degradability by 7.6%, and CO increased NDF degradability only in LF diets. Supplemental BCVFA increased bacterial N by 1.5 g/kg organic matter truly degraded (6.6%) and 0.05 g/g truly degraded N (6.5%). The relative sequence abundance decreased with LF for Fibrobacter succinogenes, Ruminococcus flavefaciens, and genus Butyrivibrio compared with HF. Recovery of the total 13C dose in bacterial pellets decreased from 144 µg/ mg with HF to 98.9 µg/ mg with LF. Although isotope recovery in bacteria was greater with HF, BCVFA supplementation increased NDF degradability and efficiency of microbial protein synthesis under all dietary conditions. Therefore, supplemental BCVFA has potential to improve feed efficiency in dairy cows even with dietary conditions that might otherwise inhibit cellulolytic bacteria.
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Association of body mass index with 30-day outcomes following groin hernia repair. Hernia 2023; 27:1095-1102. [PMID: 37076751 DOI: 10.1007/s10029-023-02773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/03/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Although groin hernia repairs are relatively safe, efforts to identify factors associated with greater morbidity and resource utilization following these operations are warranted. An emphasis on obesity has limited studies from a comprehensive evaluation of the association between body mass index (BMI) and outcomes following groin hernia repair. Thus, we aimed to ascertain the association between BMI class with 30-day outcomes following these operations. METHODS The 2014-2020 National Surgical Quality Improvement Program database was queried to identify adults undergoing non-recurrent groin hernia repair. Patient BMI was used to stratify patients into six groups: underweight, normal, overweight, and obesity classes I-III. Association of BMI with major adverse events (MAE), wound complication, and prolonged length of stay (pLOS) as well as 30-day readmission and reoperation were evaluated using multivariable regressions. RESULTS Of the 163,373 adults who underwent groin hernia repair, the majority of patients were considered overweight (44.4%). Underweight patients more commonly underwent emergent operations and femoral hernia repair compared to others. After adjustment of intergoup differences, obesity class III was associated with greater odds of an MAE (AOR 1.50), wound complication (AOR 4.30), pLOS (AOR 1.40), and 30-day readmission (AOR 1.50) and reoperation (AOR 1.75, all p < 0.05). Underweight BMI portended greater odds of pLOS and unplanned readmission. CONCLUSION Consideration of BMI in patients requiring groin hernia repair could help inform perioperative expectations. Preoperative optimization and deployment of a minimally invasive approach when feasible may further reduce morbidity in patients at the extremes of the BMI spectrum.
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Superiority of BNCT Treatment Planning Metrics Achieved Using Novel vs. Reference (BPA-F) Pharmaceuticals in Head and Neck Locations. Int J Radiat Oncol Biol Phys 2023; 117:e678. [PMID: 37785996 DOI: 10.1016/j.ijrobp.2023.06.2136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Several novel boron delivery compounds currently under investigation by our group have demonstrated formulation, biodistribution, and dose response benefits in small animal models [1]. In this study we analyze the potential clinical impact of these compounds for boron neutron capture therapy (BNCT) in human patients. MATERIALS/METHODS Pharmacokinetic models were used to estimate the tumor and normal tissue boron concentrations after continuous infusion of the novel compounds and BPA-F. Patient model segmentation, material assignment, and alignment of one or more treatment beams were exported from a commercial treatment planning system (TPS) to a novel dose calculation tool. This information was used to generate a voxelized model that incorporated the source, beam shaping assembly, collimator, and patient materials so that the full albedo effect was included in each dose calculation. Physical dose from 10B(n,α), 14N(n,p), 1H(n,n') interactions plus gamma rays from 1H(n,γ) and other reactions within the patient and treatment equipment were calculated by Monte Carlo transport of particles originating in a pre-generated phase space at the cover surface. RBE and CBE weighting factors are applied to combine these four physical dose volumes into an equivalent dose volume, and these five dose volumes were passed back to the TPS for evaluation. RESULTS Tumor dose was increased by up to 2.6x for the novel compounds while normal tissue doses were constant or slightly reduced in comparison to BPA-F plans. Alternatively, for identical tumor dose the normal tissue doses and treatment time were reduced by up to 2.6x. In addition, in some cases it was possible to generate a single beam treatment plan using the new compounds that delivered higher tumor dose and lower normal tissues doses than a multiple beam plan using BPA-F. CONCLUSION This study demonstrates both dosimetric and practical benefits of the new compounds in comparison to BPA-F, including the potential to deliver treatment using fewer beam directions and correspondingly easier treatment setups and higher patient throughput. The potential of these compounds to extend the range of clinical indications for BNCT is also discussed. These results motivate upcoming experimental testing of the key assumptions involved in their calculation.
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Increasing prevalence of gonorrhoea and chlamydia among female sex workers in northern Sydney, 2005-2019. Int J STD AIDS 2023; 34:869-875. [PMID: 37350164 DOI: 10.1177/09564624231173024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Recent reports indicate increasing gonorrhoea and chlamydia among female sex workers (FSWs) in Australia, with decreasing condom use for oral sex. METHODS We determined trends in prevalence and positivity of gonorrhoea and chlamydia among FSWs attending our clinic from 2005 to 2019, by analysing data from medical and pathology records. We conducted a sensitivity analysis by using an alternative prevalence definition of first test result only per calendar year. RESULTS Prevalence of gonorrhoea (all sites: pharynx, genital, rectal) increased from 1/130 (0.8%) in 2005 to 14/166 (8.4%) in 2012, to 31/257 (12.1%) in 2019; rate ratio (RR) 1.19, 95%CI 1.14-1.24, ptrend < 0.001. There were rising trends for pharyngeal (RR 1.11, 95% CI 1.05-1.17, ptrend = 0.001) and genital gonorrhoea (RR 1.17, 95% CI 1.08-1.26, ptrend < 0.001). Prevalence of chlamydia (all sites) increased from 4/130 (3.1%) in 2005 to 8/166 (4.8%) in 2012, to 20/257 (7.8%) in 2019; RR 1.05, 95%CI 1.01-1.09, ptrend = 0.006. This rise reflected predominately pharyngeal chlamydia (RR 1.16, 95%CI 1.04-1.29, ptrend = 0.004). Qualitatively similar trends with similar significant results, were seen for gonococcal and chlamydial infections in the sensitivity analyses, indicating robustness of results to potential changes in testing frequency. Gonorrhoea and chlamydia were significantly associated with FSWs born in China. Chlamydia was significantly associated with age group 18-25. In the 2015-2019 period, of 89 women with gonococcal infections, 56 (62.9%) were pharyngeal-only; of 93 with chlamydial infections, 32 (34.4%) were pharyngeal-only infections. CONCLUSIONS FSWs require screening for pharyngeal as well as genital infections. Enhanced and sustainable health promotion is required.
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Ultra-Wideband Electromagnetic Composite Absorber Based on Pixelated Metasurface with Optimization Algorithm. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5916. [PMID: 37687607 PMCID: PMC10489064 DOI: 10.3390/ma16175916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023]
Abstract
An ultra-wideband electromagnetic (EM) absorber is proposed. The proposed absorber consists of two thin metasurfaces, four dielectric layers, a glass fiber reinforced polymer (GFRP), and a carbon fiber reinforced polymer (CFRP) which works as a conductive reflector. The thin metasurfaces are accomplished with 1-bit pixelated patterns and optimized by a genetic algorithm. Composite materials of GFRP and CFRP are incorporated to improve the durability of the proposed absorber. From the full-wave simulation, more than 90% absorption rate bandwidth is computed from 2.2 to 18 GHz such that the fractional bandwidth is about 156% for the incidence angles from 0° to 30°. Absorptivity is measured using the Naval Research Laboratory (NRL) arch method in an EM anechoic environment. It was shown that the measured results correlated with the simulated results. In addition, the proposed absorber underwent high temperature and humidity tests under military environment test conditions in order to investigate its durability.
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First Dark Matter Search Results from the LUX-ZEPLIN (LZ) Experiment. PHYSICAL REVIEW LETTERS 2023; 131:041002. [PMID: 37566836 DOI: 10.1103/physrevlett.131.041002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/06/2023] [Accepted: 06/07/2023] [Indexed: 08/13/2023]
Abstract
The LUX-ZEPLIN experiment is a dark matter detector centered on a dual-phase xenon time projection chamber operating at the Sanford Underground Research Facility in Lead, South Dakota, USA. This Letter reports results from LUX-ZEPLIN's first search for weakly interacting massive particles (WIMPs) with an exposure of 60 live days using a fiducial mass of 5.5 t. A profile-likelihood ratio analysis shows the data to be consistent with a background-only hypothesis, setting new limits on spin-independent WIMP-nucleon, spin-dependent WIMP-neutron, and spin-dependent WIMP-proton cross sections for WIMP masses above 9 GeV/c^{2}. The most stringent limit is set for spin-independent scattering at 36 GeV/c^{2}, rejecting cross sections above 9.2×10^{-48} cm at the 90% confidence level.
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Corporate social and community-oriented support by UK food retailers: a documentary review and typology of actions towards community wellbeing. Perspect Public Health 2023; 143:211-219. [PMID: 35506700 PMCID: PMC10466974 DOI: 10.1177/17579139221095326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM This article provides a comprehensive exploration of the varied Corporate Social Responsibility (CSR) actions in relation to supporting communities reported by the UK's leading food retailers. Findings are discussed against a backdrop of enduring inequalities, exacerbated by the on-going global Coronavirus pandemic, with actions considered for their potential contribution to community-based approaches to addressing local wellbeing and inequalities. METHOD This article presents the structure and key characteristics of community-oriented CSR in food retailing in the UK. A thematic analysis of comprehensive documentary evidence from the 11 principle UK food retailers was conducted, drawing on asset-based frameworks of community-centred actions towards wellbeing. FINDINGS The findings suggest an increasing acknowledgement in food retail that local community is of key importance. Initiatives were categorised according to a typology, comprising national partnerships, local store-based funding and support actions, targeted programmes on healthy lifestyles or employability, and changes to store operations, in the favour of priority groups, prompted by the pandemic. CONCLUSION The article combines an up to date overview of community-focused CSR agendas and support by food retailers at a time of significant economic and social challenge for the UK. It highlights the potential of the sector to contribute more strategically to reducing inequalities and supporting community wellbeing, alongside statutory and voluntary sector partners.
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Author Correction: A quinary WTaCrVHf nanocrystalline refractory high-entropy alloy withholding extreme irradiation environments. Nat Commun 2023; 14:3490. [PMID: 37311813 DOI: 10.1038/s41467-023-39294-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
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Effects of corn silage and grain expressing α-amylase on ruminal nutrient digestibility, microbial protein synthesis, and enteric methane emissions in lactating cows. J Dairy Sci 2023; 106:3932-3946. [PMID: 37225579 DOI: 10.3168/jds.2022-22770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/23/2023] [Indexed: 05/26/2023]
Abstract
Increasing ruminal starch digestibility has the potential to improve microbial protein synthesis (MPS), milk production, and feed efficiency. Enogen corn (Syngenta Seeds LLC) expresses high α-amylase activity, and we evaluated effects of Enogen corn silage (CS) and grain (CG) on ruminal starch digestibility, MPS, and milk production in lactating dairy cows. Fifteen Holstein cows (6 ruminally cannulated and 9 noncannulated; average ± standard deviation at the beginning of the trial: 170 ± 40 d in milk; milk yield, 37.2 ± 7.73 kg/d; body weight, 714 ± 37 kg) were used in a replicated 3 × 3 Latin square design (28 d per period) with 3 treatments: a diet containing isoline CS and CG (control, CON); a diet with Enogen CS and isoline CG (ECS); and a diet with Enogen CS and CG (ECSCG). Dry matter (DM; 30%), starch (35% of DM), and particle size distribution of the isoline and Enogen CS were similar. However, the mean particle size of Enogen CG was larger (1.05 vs. 0.65 mm) than that of the isoline CG. Cannulated cows were used for digestibility and nutrient flow measurements, noncannulated cows were used for enteric CH4 measurements, and all cows were used for production evaluation. Dry matter intake (DMI) and milk yield were greater for ECS and ECSCG compared with CON (26.7 and 26.6 vs. 25.1 kg/d and 36.5 and 34.1 vs. 33.1 kg/d, respectively) without a difference between ECS and ECSCG. Milk protein yield was greater (1.27 vs. 1.14 and 1.17 kg/d) for ECS compared with CON and ECSCG. Milk fat content was greater (3.79 vs. 3.32%) for ECSCG compared with ECS. Milk fat yield and energy-corrected milk did not differ among treatments. Ruminal digestibilities of DM, organic matter, starch, and neutral detergent fiber were not different among treatments. However, ruminal digestibility of nonammonia, nonmicrobial N was greater (85 vs. 75%) for ECS compared with ECSCG. Total-tract apparent starch digestibility was lower (97.6 and 97.1 vs. 98.3%) for ECS and ECSCG compared with CON, respectively, and tended to be lower (97.1 vs. 98.3%) for ECSCG compared with ECS. Ruminal outflows of bacterial OM and nonammonia N tended to be greater for ECS than for ECSCG. Efficiency of MPS tended to be greater (34.1 vs. 30.6 g of N/kg of organic matter truly digested) for ECS versus ECSCG. Ruminal pH and total and individual short-chain fatty acid concentrations did not differ among treatments. Concentration of ruminal NH3 for ECS and ECSCG was lower (10.4 and 12.4 vs. 13.4 mmol/L, respectively) compared with CON. Methane per unit of DMI decreased for ECS and ECSCG compared with CON (11.4 and 12.2 vs. 13.5 g/kg of DMI, respectively) without a difference between ECS and ECSCG. In conclusion, ECS and ECSCG did not increase ruminal or total-tract starch digestibility. However, the positive effects of ECS and ECSCG on milk protein yield, milk yield, and CH4 per unit of DMI may show potential benefits of feeding Enogen corn. Effects of ECSCG were not apparent when compared with ECS, partly due to larger particle size of Enogen CG compared with its isoline counterpart.
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A quinary WTaCrVHf nanocrystalline refractory high-entropy alloy withholding extreme irradiation environments. Nat Commun 2023; 14:2516. [PMID: 37130885 PMCID: PMC10154406 DOI: 10.1038/s41467-023-38000-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/10/2023] [Indexed: 05/04/2023] Open
Abstract
In the quest of new materials that can withstand severe irradiation and mechanical extremes for advanced applications (e.g. fission & fusion reactors, space applications, etc.), design, prediction and control of advanced materials beyond current material designs become paramount. Here, through a combined experimental and simulation methodology, we design a nanocrystalline refractory high entropy alloy (RHEA) system. Compositions assessed under extreme environments and in situ electron-microscopy reveal both high thermal stability and radiation resistance. We observe grain refinement under heavy ion irradiation and resistance to dual-beam irradiation and helium implantation in the form of low defect generation and evolution, as well as no detectable grain growth. The experimental and modeling results-showing a good agreement-can be applied to design and rapidly assess other alloys subjected to extreme environmental conditions.
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LVAD as a Bridge to Candidacy in a Patient with Left Ventricular Noncompaction Cardiomyopathy Complicated by RHF. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Sympathetic Dysfunction is Associated with Physical Symptoms Among Adults with Moderate to Advanced Heart Failure. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Severe Myocardial Necrosis and Acute Allograft Failure from Fulminant Clostridium Perfringens Sepsis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Successful Use of Right Ventricular Assist Device after Pulmonary Endarterectomy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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A253 PRIMARY PROPHYLAXIS FOR SPONTANEOUS BACTERIAL PERITONITIS IN HOSPITALIZED CIRRHOTIC PATIENTS WITH LOW PROTEIN ASCITES AND RENAL DYSFUNCTION OR LIVER FAILURE: A RETROSPECTIVE REVIEW FROM A TERTIARY CENTRE IN BRITISH COLUMBIA. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991183 DOI: 10.1093/jcag/gwac036.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Spontaneous bacterial peritonitis (SBP) is a severe and often fatal infection that can occur in patients with cirrhosis and ascites. The benefits of primary prophylaxis with antibiotics for SBP have been demonstrated in patients with cirrhosis presenting with gastrointestinal (GI) bleeding; patients hospitalized for other reasons with an ascitic protein less than 10 g/L; and patients with ascitic protein less than 15 g/L with either impaired renal function (serum creatinine greater than 106 µmol/L, BUN greater than 8.9 mmol/L, or serum sodium less than or equal to 130 mEq/L) or liver failure (Child-Pugh score greater than or equal to 9 or bilirubin greater than 50 umol/L). Purpose To evaluate the rate of primary prophylaxis in patients discharged from a tertiary care hospital with low protein ascites and impaired renal function or liver failure, and subsequent episodes of SBP, hospitalizations, or deaths. Method A retrospective chart review at St. Paul’s Hospital in Vancouver, British Columbia, from November 2019 to August 2021 was conducted. Hospitalized patients with cirrhosis who had an ascitic protein less than 15 g/L and met criteria for either renal dysfunction or liver failure were included in the study. The rate of primary prophylaxis prescribed in eligible patients as well as the subsequent incidence of SBP, hospitalizations, or all-cause mortality were evaluated. Patients were followed up to 12 months after the index paracentesis. Result(s) A total of 279 patients with cirrhosis were hospitalized during the study period. 69 patients underwent a diagnostic paracentesis and 41 patients met the inclusion criteria for primary SBP prophylaxis. 28 patients were excluded with most common reasons being ascitic protein above 15 g/L (n=12), no documented ascitic protein concentration (n=9), or index paracentesis met the criteria for the diagnosis of SBP (n=5). Of the patients included, 37 (90.2%) did not receive primary prophylaxis. 8 of these patients (21.6%) developed subsequent SBP. 30 patients (81.1%) were hospitalized at least once in the following 12 months. 18 (48.6%) died during the follow-up period with 1 death attributed to SBP. 4 patients (9.76%) received primary prophylaxis and were prescribed either ciprofloxacin or trimethoprim/sulfamethoxazole. None of these patients developed SBP, however, 3 (75%) were hospitalized and died from other causes. Conclusion(s) The rate of primary prophylaxis for SBP in hospitalized patients with low protein ascites and impaired renal function or liver failure at our institution is low. The guarded prognosis in this subset of patients is also demonstrated. Further studies are needed to assess the root causes for the lack of primary prophylaxis given. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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A9 INTESTINAL ORGANOID TRANSPLANTATION REVERSED THE INTESTINAL EPITHELIUM DAMAGE IN EXPERIMENTAL NECROTIZING ENTEROCOLITIS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991355 DOI: 10.1093/jcag/gwac036.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
NOT PUBLISHED AT AUTHOR’S REQUEST
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Abstract No. 171 Benchtop Testing with Procedural Feasibility and Safety Evaluation of an Ultrahigh-Resolution Optical Coherence Tomography Catheter for Assessment of the Biliary Tree. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Effects of different vitamin A supplies on performance and the risk of ketosis in transition cows. J Dairy Sci 2023; 106:2361-2373. [PMID: 36823005 DOI: 10.3168/jds.2022-22491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/29/2022] [Indexed: 02/25/2023]
Abstract
This experiment investigated the effects of feeding low and high supplies of vitamin A (VA) during the transition period on plasma metabolites, prevalence of ketosis, and early milk production. In a randomized complete block design, 42 prefresh Holstein cows and 21 heifers were blocked by parity and calving date and assigned to 1 of 3 dietary treatments (n = 21 per treatment unless noted): CON, a transition diet with supplemental VA (75,000 IU/d) to meet the requirement; LVA, a transition diet with no supplemental VA; or HVA, a transition diet receiving supplemental VA (187,500 IU/d) 2.5 times greater than the requirement. Experimental periods were prepartum (-14 d prepartum), postpartum (1 to 30 d in milk), and carryover period (31 to 58 d in milk; common lactating diet with adequate VA was fed). Differences in dry matter intake in the pre- and postpartum periods and milk yield were not detected among treatment. Milk fat, protein, and lactose yields were similar among treatments and not affected by VA. Somatic cell count increased linearly with increasing VA. Body weight and body condition score decreased postpartum, but no VA effect was observed. Plasma retinol concentrations (n = 10 per treatment) decreased at d 2 postpartum and increased as lactation progressed, but the concentrations were unaffected by treatment. Plasma β-carotene (n = 10 per treatment) had a treatment by time interaction and its concentration decreased after parturition and remained low for 2 wk. Plasma fatty acids and β-hydroxybutyrate did not differ among treatments. Milk retinol concentration and yield (n = 10 per treatment) increased as VA supply increased. Segmented neutrophils (%) decreased, and lymphocytes (%) increased in blood with increasing VA supply. In conclusion, providing different supplies of VA did not affect production, mobilization of body fat, and risk of ketosis; however, excessive VA supply may have negatively affected the immune response, in part contributing to increased milk somatic cell counts during early lactation.
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Association between anaemia and hospital readmissions in patients undergoing major surgery requiring postoperative intensive care. Anaesthesia 2023; 78:45-54. [PMID: 36074010 PMCID: PMC9742142 DOI: 10.1111/anae.15859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 01/07/2023]
Abstract
Anaemia is a common sequela of surgery, although its relationship with patient recovery is unclear. The goal of this investigation was to assess the associations between haemoglobin concentrations at the time of hospital discharge following major surgery and early post-hospitalisation outcomes, with a primary outcome of 30 day unanticipated hospital readmissions. This investigation includes data from two independent population-based observational cohorts of adult surgical patients (aged ≥ 18 years) requiring postoperative intensive care unit admission between 1 January 2010 and 31 December 2019 in hospitals in Olmsted County, Minnesota, and between 1 July 2010 and 30 June 2017 in the Kaiser Permanente Northern California integrated healthcare system, California. Cox proportional hazards models assessed the associations between discharge haemoglobin concentrations (per 10 g.l-1 ) and outcomes, with prespecified multivariable adjustment. A total of 3260 patients were included from Olmsted County hospitals and 29,452 from Kaiser Permanente Northern California. In adjusted analyses, each 10 g.l-1 decrease in haemoglobin at hospital discharge was associated with a 9% (hazard ratio 1.09, 95%CI 1.02-1.18; p = 0.014) and 8% increase (hazard ratio 1.08, 95%CI 1.06-1.11; p < 0.001) in the hazard for readmission within 30 days in Olmsted County and Kaiser Permanente Northern California, respectively. In a sensitivity analysis exploring relationships across varying levels of pre-operative anaemia severity, these associations remained consistent, with lower discharge haemoglobin concentrations associated with higher readmissions irrespective of pre-operative anaemia severity. Anaemia at hospital discharge in surgical patients requiring postoperative intensive care is associated with increased rates of hospital readmission in two large independent cohorts. Future studies are necessary to evaluate strategies to prevent and/or treat anaemia in these patients for the improvement of post-hospitalisation outcomes.
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OD2-4 Efficient and noninvasive T cell therapy platform using autologous peripheral blood PD-1+CD8+ T cells instead of tumor-infiltrating lymphocytes in solid tumors: Ex vivo efficacy. ESMO Open 2022. [DOI: 10.1016/j.esmoop.2022.100668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Long-Term Outcome of Novel Intraoperatively-Placed Brachytherapy for Rapid Completion of Breast Conserving Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Development of a Clinical Neutron Source for Boron Neutron Capture Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Estimates of daily oxygen consumption, carbon dioxide and methane emissions, and heat production for beef and dairy cattle using spot gas sampling. J Dairy Sci 2022; 105:9623-9638. [DOI: 10.3168/jds.2022-22213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
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Proteomics profiling reveals signaling pathways associated with major adverse cardiovascular events in patients with hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy affecting 1 in 200–500 people in the US. It is characterized by a diverse clinical course, and only a subset of patients with HCM experience major adverse cardiovascular events (MACE) such as arrhythmias (e.g., ventricular tachycardia/fibrillation [VT/VF], atrial fibrillation [AF]), stroke, and heart failure. However, the molecular mechanisms underlying the presence of MACE in HCM are still not well understood.
Purpose
Our aim was to reveal signaling pathways associated with prior MACE in patients with HCM by applying plasma proteomics profiling.
Methods
We conducted a multicenter case-control study of patients with HCM comparing those with and without a prior history of MACE. We performed plasma proteomics profiling of 5032 proteins. We defined prior MACE as a composite outcome of sustained VT/VF, AF, stroke/transient ischemic attack, left ventricular ejection fraction ≤50%, New York Heart Association functional class ≥2 symptoms, resuscitated cardiac arrest, or appropriate implantable cardioverter defibrillator therapy. We applied the random forest method to derive a proteomics-based discrimination model developed in patients enrolled at one institution (training set) and externally validated the model on patients enrolled at another institution (test set). We then performed pathway analysis of proteins differentially regulated in patients with prior MACE. Pathways with a false discovery rate (FDR) <0.05 with at least 5 associated proteins were declared positive.
Results
A total of 396 patients were included, with 278 in the training set and 118 in the test set. In this cohort, 251 (63%) patients had prior MACE (171 in the training set and 80 in the test set). Using the proteomics-based model derived from the training set, the area under the receiver operating characteristic curve was 0.81 (95% CI 0.73–0.88) in the test set (Figure 1). There were 632 differentially expressed proteins (univariable p<0.05). Pathway analysis identified significantly dysregulated pathways in patients with prior MACE (Figure 2). This included both pathways known to be associated with MACE (e.g., TGF-β [FDR=0.03]) and novel pathways (e.g., Ras-MAPK [FDR=0.01] and its upstream PI3K-Akt [FDR=7.7x10–7] pathways). Pathways involved in cellular metabolism/proliferation (e.g., HIF 1 [FDR=0.01] and Wnt [FDR=0.04] pathways) and inflammation (e.g., complement and coagulation cascades [FDR=2.7x10–21], cytokine-cytokine receptor interaction [FDR=8.1x10–16]) were also significantly dysregulated.
Conclusions
Our study in patients with HCM reveals that those with a prior history of MACE have a distinctive plasma proteomics profile. We further identified both previously known and novel pathways dysregulated in this subset with a more severe form of HCM. Our findings may aid in development of targeted therapies for the prevention of MACE in HCM.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): R01 HL157216
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Correlation between number of laser pulses and rate of mosaicism in human blastocysts trophectoderm biopsy. Reprod Biomed Online 2022. [DOI: 10.1016/j.rbmo.2022.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2022]
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228 Hold the mayo on the elexacaftor/tezacaftor/ivacaftor special! A single-center experience. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Correlation between endometrial age and blastocyst age: Implantation and Pregnancy Rates with Euploid FET. Reprod Biomed Online 2022. [DOI: 10.1016/j.rbmo.2022.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2022]
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263 Pharmacogenomics in people with cystic fibrosis: A personalized medicine approach. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00953-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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The ability of blastocysts to re-expand after trophectoderm (TE) biopsy using different biopsy techniques. Reprod Biomed Online 2022. [DOI: 10.1016/j.rbmo.2022.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Atypical clinical presentations are common in TIA and minor stroke patients with DWI-MRI confirmed ischaemia. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and AimsCurrent diagnostic criteria for TIA/minor stroke disqualify several atypical clinical presentations, but pre-date DWI-MRI use. We investigated the proportion of DWI-positive patients with atypical presentations, identifying clinical factors predicting DWI positivity.MethodsWe retrospectively reviewed consecutive patients with suspected TIA/minor stroke (NIHSS<5) undergoing MRI at our comprehensive stroke centre from March 2020-February 2021. We identified pre- dictors of DWI positivity using logistic regression.ResultsOf 1615 patients, 442 DWI-positive, 39% had atypical presentations including 20% with progres- sive symptom onset. Atypical symptoms common in DWI-positive patients included headache(17%), unsteadiness(15%), positive sensory symptoms(11%), presyncope(10%), confusion(9%) and vertigo(8%). Symptoms independently associated with DWI-positivity included weakness(OR 1.30, 95% CI 1.01-1.67), dysarthria(OR 2.06, CI 1.56-2.70), and ataxia (OR 3.75, CI 2.27-6.20). Fluctuating symptoms(22%) predicted DWI positivity(OR 1.37, CI 1.00-1.81), but sudden onset(80%) did not (OR 1.05, CI 0.80-1.38). Risk factors associated with DWI positivity included increasing age(OR 1.01/year, CI 1.01-1.02), hypertension (OR 1.70, CI 1.30-2.22), diabetes(OR 1.44, CI 1.07-1.93), and smoking(OR 1.68, CI 1.19-2.39). DWI-positive patients had significantly more risk factors (mean 2.65 vs 1.95 p=<0.001).ConclusionsOver one-third with DWI-confirmed TIA/minor stroke present atypically. The value of atypical symptoms in excluding ischaemia, particularly in patients with vascular risk factors, appears limited.
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1048P Molecular predictors of immunotherapy efficacy in lung squamous-cell carcinoma (LSCC): Results from the randomized prospective SQUINT trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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LBA1 Mechanism of action and an actionable inflammatory axis for air pollution induced non-small cell lung cancer: Towards molecular cancer prevention. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Effects of corn distillers grains with yeast bodies and manipulation of dietary cation and anion difference on production, nutrient digestibility, and gas emissions from manure in lactating cows. J Dairy Sci 2022; 105:8054-8068. [PMID: 36028344 DOI: 10.3168/jds.2021-21456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/26/2022] [Indexed: 11/19/2022]
Abstract
In a randomized complete block design, 40 lactating Holstein cows (average 98 d in milk and 41 kg/d of milk yield) were randomly assigned to 1 of 4 diets: (1) containing soybean meal as the major protein supplement (CON diet); (2) CON diet with high-protein dried corn distillers grains at 20% on a dry matter (DM) basis by replacing mainly soybean meal (DG diet); (3) DG diet except that high-protein dried corn distillers grains with yeast bodies (extracted after corn ethanol production) was used (DGY diet); or (4) DG diet supplemented with sodium bicarbonate and potassium carbonate to elevate the dietary cation and anion difference (DCAD; DG-DCAD diet). The DCAD of CON, DG, DGY, and DG-DCAD were 185, 62, 67, and 187 mEq/kg of DM, respectively. The experiment began with a 10-d covariate period and then cows were fed the experimental diets for 5 wk (2-wk diet adaptation and 3-wk data collection periods). Dry matter intake and milk yield were measured daily, and spot urine and fecal samples were collected in the last week of the experiment to measure nutrient digestibility; N, S, and P utilization and excretion; and in vitro NH3 and H2S emissions from manure. All data were analyzed using the MIXED procedure of SAS (random effect: block; fixed effects: diets, repeated week, and interactions). During data collection, DM intake was not different among treatment groups, but milk yield tended to be lower (42.4 vs. 39.9 kg/d) for DG, DGY, and DG-DCAD versus CON, which could have been caused by decreases in organic matter and neutral detergent fiber digestibility. Milk protein yield tended to be lower (1.33 vs. 1.24 kg/d) for DG, DGY, and DG-DCAD versus CON. Milk fat yield was lower (1.26 vs. 1.55 kg/d) for DG and DGY versus CON, but that for DG-DCAD (1.43 kg/d) did not differ from CON. Similarly, energy-corrected milk was lower (38.0 vs. 43.3 kg/d) for cows on DG and DGY versus those on CON, but it did not differ between DG-DCAD (40.7 kg/d) and CON. Urinary and fecal N excretion were greater for DG, DGY, and DG-DCAD compared with CON due to greater dietary crude protein content and N intake. However, NH3 emissions did not differ across treatments. Intakes of dietary P and S were greater for DG, DGY, and DG-DCAD, resulting in greater excretion of those in manure and greater H2S emissions from manure compared with CON. These data suggest that the negative effects of feeding distillers grains on production of lactating cows can be partly explained by a decrease in nutrient digestibility (milk yield) and excessive anion load (milk fat). The milk fat response to DG-DCAD suggests that milk fat depression observed with a diet with high content of distillers grains can be partially alleviated by supplementation of cations. In the current study, we observed no beneficial effects of DG containing yeast bodies.
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LB997 Detecting the world’s smallest solid malignant tumor: The role of reflectance confocal microscopy in the diagnosis and management of a micro-melanoma. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.1023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Residual risk of major adverse cardiovascular and limb events among different atherosclerotic cardiovascular disease phenotypes receiving guideline-recommended antiplatelet monotherapy: The resrisk study. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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759 Mechanical tension mobilizes Lgr6+ epidermal stem cells to drive skin growth. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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LB916 The war on melanomaTM: A statewide public health initiative. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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024 Asymmetric cell division for fate induction of chimeric antigen receptor (CAR) T cells. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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054 IL-18 regulates nerve growth factor and semaphorin 3A in dermatomyositis-related pruritus. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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627 Inhibition of PAI-1 blocks PD-L1 endocytosis and improves the response of melanoma cells to immune checkpoint blockade. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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