Differences in Plasma Fatty Acid Composition Related to Chronic Pancreatitis: A Pilot Study

OBJECTIVES

Chronic pancreatitis (CP) is an inflammatory disease affecting the absorption of fat-soluble nutrients. Signaling in pancreatic cells that lead to inflammation may be influenced by fatty acids (FAs) through diet and de novo lipogenesis. Here, we investigated the relationship between plasma FA composition in CP with heterogeneity of etiology and complications of CP.

MATERIALS AND METHODS

Blood and clinical parameters were collected from subjects with CP (n = 47) and controls (n = 22). Plasma was analyzed for FA composition using gas chromatography and compared between controls and CP and within CP.

RESULTS

Palmitic acid increased, and linoleic acid decreased in CP compared with controls. Correlations between age or body mass index and FAs are altered in CP compared with controls. Diabetes, pancreatic calcifications, and substance usage, but not exocrine pancreatic dysfunction, were associated with differences in oleic acid and linoleic acid relative abundance in CP. De novo lipogenesis index was increased in the plasma of subjects with CP compared with controls and in calcific CP compared with noncalcific CP.

CONCLUSIONS

Fatty acids that are markers of de novo lipogenesis and linoleic acid are dysregulated in CP depending on the etiology or complication. These results enhance our understanding of CP and highlight potential pathways targeting FAs for treating CP.

Estimation of in vivo body composition of Iberian pigs using bioelectric impedance and ultrasonography techniques

Iberian pigs are renowned for their high-quality products and distinctive characteristics, including high fat accumulation, low protein deposition rate, and a long productive cycle. The study aimed to assess in vivo body composition of purebred Iberian pigs using bioimpedance analysis (BIA) and ultrasonography. Accurate estimation of body composition in live animals is crucial for adopting decisions at the farm level. The experiment involved three groups of pure male Iberian pigs differing in body weight (BW; 60, 80 and 100 kg) with the same nutritional management. Body measurements, BIA and back fat and loin thickness (measured by ultrasonography) were obtained before slaughter. After slaughter pig carcasses were chemically analysed. A strong correlation between BIA measurements, specifically resistance (Rs) values, and body chemical parameters (total protein, lipids, ash, and water contents; p < 0.001 for all) was found. Reactance values (Xc), however, did not exhibit significant correlations. Regression analyses were conducted to predict carcass composition based on BIA measurements, BW, ultrasonography and linear corporal measurements. The prediction models achieved high R2 values for lipids, protein, total ash, water, and lean tissue (0.957, 0.968, 0.936, 0.961 and 0.976, respectively, p < 0.001 for all), indicating strong predictive power. These findings demonstrate the potential of non-invasive techniques such as BIA for estimating body chemical composition and quality of pig carcasses. However, it is important to acknowledge that the prediction models developed may not be applicable to other pig populations, as they were based on a specific sample of pigs.

Metabolic Profile of Growing Immune- and Surgically Castrated Iberian Pigs Fed Diets of Different Amino Acid Concentration

The purpose of the current study was to further characterize the performance and nitrogen retention differences previously observed between immunocastrated (IC) and surgically castrated (SC) pure Iberian pigs. Fifty-four pigs were used (three sexes: IC males, IC females and SC males), fed three isoenergetic diets (160, 140 and 120 g CP/kg DM; six pigs/treatment combination) from 40 kg BW until slaughter (105 kg BW). Plasmatic post-absorptive metabolites and hormones, and backfat tissue composition were determined. The IC males showed a trend towards higher plasmatic creatinine (p = 0.06) and IGF-1 concentrations than SC males and IC females (p < 0.001). SC males showed a higher predisposition to carcass fatness and insulin resistance compared to IC males. Plasmatic isoleucine concentration was higher in IC and SC males compared to IC females (p < 0.01), and valine was greater in IC males compared to the rest of the pigs (p < 0.001). Total branched-chain amino acids (AA) were greater in IC males than in IC females (p < 0.01). Total plasmatic essential AA concentrations tended to be greater in IC males (p = 0.09). The present results support the increased performance and nitrogen retention capacity previously observed in IC male Iberian pigs compared to SC males and IC females, which can be attributed to increased anabolic capacity related with lean growth in Iberian IC males.

Obesity and alcoholic etiology as risk factors for multisystem organ failure in acute pancreatitis: Multinational study

BACKGROUND

Multisystem organ failure (MSOF) is the most important determinant of mortality in acute pancreatitis (AP). Obesity and alcoholic etiology have been examined as potential risk factors for MSOF, but prior studies have not adequately elucidated their independent effects on the risk of MSOF.

OBJECTIVE

We aimed to determine the adjusted effects of body mass index (BMI) and alcoholic etiology on the risk of MSOF in subjects with AP.

METHODS

A prospective observational study of 22 centers from 10 countries was conducted. Patients admitted to an APPRENTICE consortium center with AP between August 2015 and January 2018 were enrolled. Multivariable logistic regression was used to estimate the adjusted effects of BMI, etiology, and other relevant covariates on the risk of MSOF. Models were stratified by sex.

RESULTS

Among 1544 AP subjects, there was a sex-dependent association between BMI and the risk of MSOF. Increasing BMI was associated with increased odds of MSOF in males (OR 1.10, 95% confidence interval [CI] 1.04-1.15) but not in females (OR 0.98, 95% CI 0.90-1.1). Male subjects with AP, whose BMIs were 30-34 and >35 kg/m² , had odds ratios of 3.78 (95% CI 1.62-8.83) and 3.44 (95% CI 1.08-9.99), respectively. In females, neither higher grades of obesity nor increasing age increased the risk of MSOF. Alcoholic etiology was independently associated with increased odds of MSOF compared with non-alcohol etiologies (OR 4.17, 95% CI 2.16-8.05).

CONCLUSION

Patients with alcoholic etiology and obese men (but not women) are at substantially increased risk of MSOF in AP.

Muscle quality traits and oxidative status of Iberian pigs supplemented with zinc and betaine under heat stress

The study analyzed the effect of supplemental zinc and betaine on meat quality and redox status of muscles (longissimus lumborum and gluteus medius) from heat- stressed pigs. Twenty-four pure Iberian pigs were assigned to one of three treatments (n = 8): control diet, Zn supplemented diet (120 mg/kg) and betaine supplemented diet (5 g/kg) that were all exposed to 30 °C during 28 days. No significant differences were observed in chemical composition and fatty acid profile of the muscles. The Zn diet improved the water retention capacity of longissimus, increased the antioxidant properties (ABTS and FRAP) and the glutathione peroxidase activity, and reduced the level of MDA. No significant effects associated to the betaine diet were observed in quality traits and antioxidant markers of muscles. These findings suggest that Zn supplementation may be used as a nutritional strategy to improve the antioxidant properties of meat of Iberian pigs subjected to heat stress conditions.

Changes in Plasma Fatty Acid Abundance Related to Chronic Pancreatitis: A Pilot Study

Objectives

Chronic pancreatitis (CP) is an inflammatory disease that affects the absorption of nutrients like fats. Molecular signaling in pancreatic cells can be influenced by fatty acids (FAs) and changes in FA abundance could impact CP-associated complications. Here, we investigated FA abundance in CP compared to controls and explored how CP-associated complications and risk factors affect FA abundance.

Methods

Blood and clinical parameters were collected from subjects with (n=47) and without CP (n=22). Plasma was analyzed for relative FA abundance using gas chromatography and compared between controls and CP. Changes in FA abundance due to clinical parameters were also assessed in both groups.

Results

Decreased relative abundance of polyunsaturated fatty acids (PUFAs) and increased monounsaturated fatty acids (MUFAs) were observed in subjects with CP in a sex-dependent manner. The relative abundance of linoleic acid increased, and oleic acid decreased in CP subjects with exocrine pancreatic dysfunction and a history of substance abuse.

Conclusions

Plasma FAs like linoleic acid are dysregulated in CP in a sex-dependent manner. Additionally, risk factors and metabolic dysfunction further dysregulate FA abundance in CP. These results enhance our understanding of CP and highlight potential novel targets and metabolism-related pathways for treating CP.

Impact of Cannabis Use on Inpatient Inflammatory Bowel Disease Outcomes in 2 States Legalizing Recreational Cannabis

Background

We evaluated the impact of recreational cannabis legalization on use and inpatient outcomes of patients with inflammatory bowel disease (IBD).

Methods

Hospitalized adult patients in Colorado and Washington before (2011) and after (2015) recreational cannabis legalization were compared by chi-square tests for categorical variables and t-tests for continuous variables. Multivariable regression models adjusting for demographic data were fit to assess the association of cannabis use with hospital outcomes.

Results

Reported cannabis use increased after legalization (1.2% vs 4.2%, P < .001). On multivariable analysis, in 2011, cannabis users were less likely to need total parenteral nutrition (odds ratio 0.12, P = .038), and in 2015 had less hospital charges ($-8418, P = .024).

Conclusions

The impact of cannabis legalization and use on IBD is difficult to analyze but may have implications on inpatient IBD outcomes as described in this retrospective analysis. Large, prospective studies are needed to evaluate other IBD outcomes based on cannabis legalization and use.

Breaking Down Barriers: Easter Island's First Telestroke Thrombolysis Experience and Case Report

Easter Island (Rapa Nui), Chile, is remote, located in the Polynesian Triangle in Oceania. The closest continental point is Chile, 3,512 km east. It has a population of 7,750 inhabitants, who are Chilean citizens, and receives more than 60,000 tourists a year. For this entire population, there is a medium complexity hospital without a neurology specialist. In 2019, local professionals were trained in a Telestroke program with remote clinical support conducted by neurologists located on mainland Chile. We present a 50-year-old native male, with unknown medical history, who suddenly presented right-half-body weakness and aphasia. He was evaluated via Telestroke consultation, and thrombolysis with tenecteplase was indicated. The patient improved rapidly and 45 min later the NIHSS score was 0 points. To our knowledge, this is the first reported case of Telestroke treatment in such a remote area, highlighting the importance of telemedicine to overcome geographical and technological stroke care barriers and to improve patients' outcome, no matter where they live.

Protein retention, growth performance and carcass traits of individually housed immunocastrated male- and female- and surgically castrated male Iberian pigs fed diets of increasing amino acid concentration

Immunocastration (IC, vaccination against gonadotropin releasing hormone (GnRH)) is one alternative to surgical castration (SC) for preventing sexual development and boar taint in male pigs. A temporal increase in performance has been described for IC pigs before the second vaccination against GnRH. The objective of this work was to assess the effects of IC on Iberian male and female pigs (fed diets of increasing CP content) on performance, nitrogen retention (NR) and digestibility, and carcass traits. Fifty-four pure Iberian pigs individually housed were allocated to a 3 × 3 factorial arrangement with three sex groups (IC males, IC females and SC males), three diets (153, 137 and 119 g CP/kg DM; 14 MJ metabolisable energy/kg DM) and six pigs per treatment combination. Pigs were vaccinated at 18 weeks of age (40 kg BW) and seven weeks later (70-80 kg BW) and fed at 0.9 × ad libitum on BW basis. Two digestibility and nitrogen balance assays were performed before and after the second vaccination, respectively. Pigs were slaughtered at 105 kg BW. Before the second vaccination, Iberian IC males showed higher growth rate (g/day), feed efficiency, NR (g/day) and efficiency of NR than the other groups (P < 0.001). The NR and efficiency of NR was 40% greater in IC v. SC males (P < 0.001). After the second vaccination, no differences in performance between sex groups were detected (P > 0.05). Growth rate and feed efficiency were higher in IC males than in the other groups for the whole experimental period (from the first vaccination to slaughter; P < 0.001). After the second vaccination, differences among sex groups in NR and the efficiency of NR disappeared (P > 0.05). NR efficiency was 0.177 on average. No significant effects of dietary CP were detected on performance. The NR was greater in pigs fed the 153 CP diet (17 to 37%; P > 0.05). Lean components of carcass (sirloin, loin and butt lean) were greater in IC males than in the other groups (0.001 < P < 0.05). There were no significant sex group×dietary CP interactions. Iberian IC males grew at higher rate, deposited more protein, and more efficiently, than Iberian SC males before the second vaccination against GnRH. Iberian IC females showed similar growth performance to SC males and intermediate protein deposition efficiency between IC and SC males. Despite the higher growth performance, protein deposition rate, and efficiency of protein deposition of IC males v. SC males, no significant differences in amino acid requirements were detected between them.

Predictors of hospital transfer and associated risks of mortality in acute pancreatitis

BACKGROUND

There is limited research in prognosticators of hospital transfer in acute pancreatitis (AP). Hence, we sought to determine the predictors of hospital transfer from small/medium-sized hospitals and outcomes following transfer to large acute-care hospitals.

METHODS

Using the 2010-2013 Nationwide Inpatient Sample (NIS), patients ≥18 years of age with a primary diagnosis of AP were identified. Hospital size was classified using standard NIS Definitions. Multivariable analyses were performed for predictors of "transfer-out" from small/medium-sized hospitals and mortality in large acute-care hospitals.

RESULTS

Among 381,818 patients admitted with AP to small/medium-sized hospitals, 13,947 (4%) were transferred out to another acute-care hospital. Multivariable analysis revealed that older patients (OR = 1.04; 95%CI 1.03-1.06), men (OR = 1.15; 95%CI 1.06-1.24), lower income quartiles (OR = 1.54; 95%CI 1.35-1.76), admission to a non-teaching hospital (OR = 3.38; 95%CI 3.00-3.80), gallstone pancreatitis (OR = 3.32; 95%CI 2.90-3.79), pancreatic surgery (OR = 3.14; 95%CI 1.76-5.58), and severe AP (OR = 3.07; 95%CI 2.78-3.38) were predictors of "transfer-out". ERCP (OR = 0.53; 95%CI 0.43-0.66) and cholecystectomy (OR = 0.14; 95%CI 0.12-0.18) were associated with decreased odds of "transfer-out". Among 507,619 patients admitted with AP to large hospitals, 31,058 (6.1%) were "transferred-in" from other hospitals. The mortality rate for patients "transferred-in" was higher than those directly admitted (2.54% vs. 0.91%, p < 0.001). Multivariable analysis revealed that being "transferred-in" from other hospitals was an independent predictor of mortality (OR = 1.47; 95% CI 1.22-1.77).

CONCLUSIONS

Patients with AP transferred into large acute-care hospitals had a higher mortality than those directly admitted likely secondary to more severe disease. Early implementation of published clinical guidelines, triage, and prompt transfer of high-risk patients may potentially offset these negative outcomes.

OR26-04 Immediate Post-Operative Insulin Requirements May Predict Metabolic Outcome After Total Pancreatectomy and Islet Autologous Cell Transplant (TPIAT)

Immediate Post-Operative Insulin Requirements may Predict Metabolic Outcome after Total Pancreatectomy and Islet Autologous Cell Transplant (TPIAT) Introduction: Chronic pancreatitis (CP) is a progressive disease that leads to eventual loss of endocrine and exocrine function. Patients with CP experience abdominal pain, which in some instances can be refractory to medical and endoscopic intervention. Total pancreatectomy and islet auto transplantation (TPIAT) is a treatment option however predicting postoperative metabolic outcomes remains elusive. In this single-center retrospective study, we report pre-TPIAT characteristics, beta cell function indices, islet yield as well as post-TPIAT glucose management data to further understand their relationship.Methods:A total of 13 TPIAT subjects were included who underwent beta cell function assessment via intravenous glucose tolerance tests and oral mixed meal tolerance tests. Islet yield, glucose level and insulin requirement for 72 hours postoperatively were collected. In addition, their glucose control and insulin requirements at 3, 6 and 12-month post TPIAT were analyzed.Results:The median age was 45 years with median duration of CP for 5 years. The main cause of CP was idiopathic. All 13 subjects had normal baseline fasting glucose levels. Median islet yield was 4882 IEq/kg (interquartile range 3412 to 8987). Median post-operative total insulin requirement on day 3 was 0.43 units/kg. Pre-TPIAT baseline glucose, insulin or c-peptide level did not have a significant correlation with the islet yield. Similarly, there was no correlation between islet yield and insulin requirement at 72-hour post operatively. However, there was an inverse correlation between the absolute islet yield (IEq) and insulin requirement at 6 months and 12 months following post-TPIAT. Further analysis of the relationship between 72-hour post-op insulin requirement and insulin requirement at discharge, 3, 6 and 12 month showed a positive correlation. Despite the new finding of inverse correlation of islet yield with long-term insulin requirement, this study was not able to detect a correlation between the preoperative parameters to postoperative short-term or long-term outcome as noted in other studies.Conclusion: The 72-hour postoperative insulin requirement is a helpful postoperative predictor of patients needing long term insulin management following TPIAT. This observation may identify a high risk group of patients in need of more intensive diabetes education and treatment prior to hospital discharge.

Immediate Postoperative Insulin Requirements May Predict Metabolic Outcome after Total Pancreatectomy and Islet Autotransplantation

Chronic pancreatitis (CP) is a progressive disease that leads to eventual loss of endocrine and exocrine function. Total pancreatectomy and islet autotransplantation (TPIAT) is a treatment option for patients with CP; however, predicting postoperative metabolic outcomes remains elusive. In this single-center retrospective study, we report pre-TPIAT characteristics, beta cell function indices, islet yield, and post-TPIAT glucose management data to further understand their relationship. Islet yield, glucose level, and insulin requirement for 72 hours postoperatively were collected for a total of 13 TPIAT recipients between 9-2013 and 9-2018. In addition, their glucose control and basal insulin requirements at 3, 6, and 12 months post-TPIAT were analyzed. All 13 subjects had normal baseline fasting glucose levels. Median islet yield was 4882 IEq/kg (interquartile range 3412 to 8987). Median postoperative total insulin requirement on day 3 was 0.43 units/kg. Pre-TPIAT baseline glucose, insulin, or c-peptide level did not have a significant correlation with the islet yield. Similarly, there was no correlation between islet yield and insulin requirement at 72-hour postoperatively. However, there was an inverse correlation between the absolute islet yield (IEq) and insulin requirement at 6 months and 12 months following post-TPIAT. Further analysis of the relationship between 72-hour post-op insulin requirement and insulin requirement at discharge, 3, 6, and 12 months showed a positive correlation. Despite the finding of inverse correlation of islet yield with long-term basal insulin requirement, this study was not able to detect a correlation between the preoperative parameters to postoperative short-term or long-term outcome as noted in other studies. The 72-hour postoperative insulin requirement is a helpful postoperative predictor of patients needing long-term insulin management following TPIAT. This observation may identify a high-risk group of patients in need of more intensive diabetes education and insulin treatment prior to hospital discharge.

Hg and Se in Organs of Three Cetacean Species from the Murcia Coastline (Mediterranean Sea)

We determinated Hg and Se concentrations in liver, kidney, brain, lung and muscle of five bottlenose dolphin (Tursiops truncatus), four common dolphins (Delphinus delphis) and four Risso's dolphin (Grampus griseus) stranded along the Murcia coast, Southeast Spain, in order to evaluate the risk of Hg toxicity. Hg concentrations showed similar concentrations to other individuals in the Mediterranean Sea with the same length in the same period. We observed a positive correlation of Hg and Se in liver (r = 0.948, p < 0.001) and kidney (r = 0.939; p = 0.001) and ratio the Se/Hg molar was higher than 1 in most cases. Our results suggest that the protective effects of Se against Hg toxicity occur in cetaceans. However, we detected levels of Hg described as responsible liver damage and neurotoxicological effects so other tools, as biochemical markers, should be included. Besides, more studies are needed to evaluate the risk of Hg exposure in dolphins from Murcia coastline.

Cathepsin E expression and activity: Role in the detection and treatment of pancreatic cancer

Cathepsin E (CTSE) is an intracellular, hydrolytic aspartic protease found to be expressed in cells of the immune and gastrointestinal systems, lymphoid tissues, erythrocytes, and cancer cells. The precise functions are not fully understood; however, various studies have investigated its numerous cell-type specific roles. CTSE expression has been shown to be a potential early biomarker for pancreatic ductal adenocarcinoma (PDAC). PDAC patients have low survival rates mostly due to the lack of early detection methods. CTSE-specific activity probes have been developed and tested to assist in tumor imaging and functional studies investigating the role of CTSE expression in PDAC tumors. Furthermore, a CTSE protease-specific, photodynamic therapy pro-drug was developed to explore its potential use to treat tumors that express CTSE. Since CTSE is expressed in pancreatic diseases that are risk factors for PDAC, such as pancreatic cysts and chronic pancreatitis, learning about its function in these disease types could assist in early PDAC detection and in understanding the biology of PDAC progression. Overall, CTSE expression and activity shows potential to detect PDAC and other pancreatic diseases. Further research is needed to fully understand its functions and potential translational applicability.

Genotype and dietary lysine deficiency affect carcass and muscle amino acid composition of pigs growing from 10 to 25 kg body weight

Amino acid (AA) composition of body protein is considered constant although there are evidences that AA pattern in pigs may be altered by different factors. Pigs with different body composition and protein deposition rates-like fatty and lean pigs-may differ in AA composition, with possible consequences on their AA requirements. This work investigates effects of genotype and dietary lysine deficiency on AA composition of carcass and muscles of Iberian and Landrace × Large White pigs. Twenty-eight barrows (10 kg body weight [BW]), 14 from each breed, were used. They were randomly assigned to two experimental diets according to a factorial arrangement (two breeds × two diets). Diets were isonitrogenous and isoenergetic (200 ± 1 g CP/kg dry matter (DM); 14.7 ± 0.1 MJ ME/kg DM) and with identical chemical composition except for lysine concentration (10.9 and 5.20 g lysine/kg DM, for lysine-adequate (AL) diet and lysine-deficient (DL) diet respectively). Pigs were individually housed, and daily feed allowance was adjusted on a weekly basis according to BW. Pigs were slaughtered at 25 kg BW. Isoleucine, valine and phenylalanine concentration were higher in carcass protein of Iberian pigs (p < .01). In longissimus muscle, higher concentration of arginine, isoleucine, phenylalanine, lysine and valine (p < .001-p < .05), and lower of methionine (p < .001) were detected in Iberian pigs, whereas phenylalanine, leucine, lysine, threonine and methionine concentration decreased and arginine increased (p < .001-p < .05) when pigs were fed DL diet. Genotype and lysine deficiency effects were moderate in the AA composition of protein of biceps femoris muscle. The results show that AA proportions in protein of carcass and longissimus muscle can be influenced by pig genotype and conditions of lysine shortage. The biceps femoris muscle, with different functional and metabolic properties, shows more constant AA composition than longissimus, which seem to prevail independent from genotype or nutritional challenges.

Trace metals in striped dolphins (Stenella coeruleoalba) stranded along the Murcia coastline, Mediterranean Sea, during the period 2009-2015

Mercury (Hg), cadmium (Cd), lead (Pb), selenium (Se) and arsenic (As) concentrations in internal tissues of 72 striped dolphins (Stenella coeruleoalba) from Murcia Region (Mediterranean coastline) have been investigated for the first time. Hg showed the highest concentration, followed by Se, Cd, As and Pb. In general, the levels of metal found in this study were similar to those described in similar studies in the Mediterranean Sea. However, in some adult specimens, Hg liver concentrations were related with toxic effects in cetacean. A significant correlation was observed with age, likewise between Se and Hg and Cd in tissues, which agree with detoxify effect attributed to Se through inert complex formation. Molar ratio Hg:Se in liver was close to 1:1 in some specimens, which would indicate overload of the Hg-Se detoxify function and compromised health. These results could contribute to a better knowledge of the distribution of these persistent pollutants in the Mediterranean Sea.

Composition and Antioxidant Properties of Spanish Extra Virgin Olive Oil Regarding Cultivar, Harvest Year and Crop Stage

The health benefits of extra virgin olive oil (EVOO) are related to its chemical composition and the presence of bioactive compounds with antioxidant properties. The aim of this study was to evaluate antioxidant compounds (pigments, coenzyme Q₁₀ (CoQ₁₀) and phenolic compounds) and antioxidant properties of EVOO from the same region comparing different cultivars (Hojiblanca and Arbequina), harvest year and crop stage. Antioxidant properties of oils were studied before and after a gastrointestinal digestion process, by in vitro assays (DPPH, ABTS and FRAP) and antioxidant markers in Caco-2 cells (reactive oxygen species production). The content of bioactive compounds measured was significantly affected by cultivar and harvest year (except for carotenoids) and by the crop stage (except for coenzyme Q₁₀). Higher amounts of coenzyme Q₁₀ were observed in Hojiblanca than in Arbequina EVOO. Total phenol content and antioxidant properties were also different depending on cultivar and harvest year and the in vitro digestion process strongly improved antioxidant marker values. Antioxidant potential in bioaccessible fractions was mainly related to the content of coenzyme Q₁₀ and phenolic compounds in EVOO. Chemometric analysis showed that the oils were clearly classified by cultivars, harvest and crop stage, according to the chemical composition and antioxidant activity analyzed in the present study.

Targeting enhancer switching overcomes non-genetic drug resistance in acute myeloid leukaemia

Non-genetic drug resistance is increasingly recognised in various cancers. Molecular insights into this process are lacking and it is unknown whether stable non-genetic resistance can be overcome. Using single cell RNA-sequencing of paired drug naïve and resistant AML patient samples and cellular barcoding in a unique mouse model of non-genetic resistance, here we demonstrate that transcriptional plasticity drives stable epigenetic resistance. With a CRISPR-Cas9 screen we identify regulators of enhancer function as important modulators of the resistant cell state. We show that inhibition of Lsd1 (Kdm1a) is able to overcome stable epigenetic resistance by facilitating the binding of the pioneer factor, Pu.1 and cofactor, Irf8, to nucleate new enhancers that regulate the expression of key survival genes. This enhancer switching results in the re-distribution of transcriptional co-activators, including Brd4, and provides the opportunity to disable their activity and overcome epigenetic resistance. Together these findings highlight key principles to help counteract non-genetic drug resistance.

Portal drained-viscera heat production and net flux of volatile fatty acids in Iberian pigs fed acorn

The aim of the present study was to determine the portal-drained viscera (PDV) heat production (HP) and net PDV flux of volatile fatty acids (VFA: acetic, propionic and butyric acids) in Iberian pigs (34-kg bodyweight) fed with acorn from evergreen oak, and to ascertain whether there is an effect of acorn feeding over time. In addition, potential contribution of both parameters to the energy budget of the animal was calculated. The following two sampling periods were conducted with six gilts: after 1 day (I) and after 1 week (II) of acorn feeding. Postprandial PDV HP was 29% greater (P &lt; 0.01) in Sampling period II than in Sampling period I, but net PDV flux of VFA was only slightly greater (5%, P &gt; 0.1). Potential proportional contribution of VFA to the whole HP was almost identical in both sampling periods (0.057, on average), representing 0.109 (on average) of the metabolisable energy requirements for maintenance. Pigs adapted for 1 week to an acorn diet had increased PDV HP without an increase in the net PDV flux of VFA, indicating that, apparently, nutrients other than VFA were responsible for the increased PDV HP.

Total Pancreatectomy and Islet Autotransplantation Following Treated Hepatitis C Infection

Hepatic parenchymal disease, including chronic viral hepatitis, has traditionally been considered a relative contraindication to islet transplantation as the islets are infused into the recipient’s liver. We present a case study of a patient with treated chronic hepatitis C infection (HCV) who safely received an autologous islet transplant following total pancreatectomy with excellent clinical outcomes. The patient was a 60-year-old woman diagnosed with debilitating abdominal pain secondary to chronic pancreatitis and with preserved islet function. She had previously been treated >10 years prior to surgical evaluation with interferon monotherapy for 1 year that led to sustained virologic response, including at the time of surgical evaluation for total pancreatectomy and islet autotransplantation (TPIAT). She underwent comprehensive preoperative evaluation of the liver, including liver biopsy, which showed no significant portal inflammation or fibrosis. Following a multidisciplinary meeting and discussion of the potential risks for the patient, the decision was made to proceed with TPIAT. The patient underwent a standard total pancreatectomy, and an autologous islet dose of 6638 islet equivalents/kg body weight was infused into the liver via the portal vein. Portal vein pressure was monitored throughout the infusion with a transient peak pressure of 27 cm H₂O (basal pressure of 14 cm H₂O) and final pressure of 23 cm H₂0 at 10 min post-infusion. Aside from a transient transaminitis, liver enzymes were normal at the time of hospital discharge. At greater than 1 year of follow-up, the patient has improved quality of life, with reduction in narcotic analgesia, remains insulin independent (with normal islet function), and has normal liver function. This case illustrates that islet autotransplant into the liver can be safely performed and suggests that carefully selected patients with liver disease may be eligible for TPIAT.

Verbal fluency tests: Normative data for Spanish-speaking pediatric population

OBJECTIVE

To generate normative data for the phonological and semantic verbal fluency tests (VFT) in Spanish-speaking pediatric populations.

METHOD

The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the VFT as part of a larger neuropsychological battery. Scores for letters F, A, S, and animals and fruit categories were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses.

RESULTS

The final multiple linear regression models showed main effects for age on all scores, such that scores increased linearly as a function of age. Age2 had a significant effect in Chile (animals), Cuba (A letter, fruits), Ecuador (animals, fruits), Honduras (F letter), Mexico (animals, fruits), Peru (fruits), and Spain (S letters, animals, fruits). Models showed an effect for MLPE in Chile (A letters, animals, fruits), Ecuador (S letter, animals, fruits), Guatelama (F, S letter, animals), Honduras (animals), Mexico (F, A, S letters, animals, fruits), Puerto Rico (A, letters, animals), and Spain (all scores). Sex scores were found significant in Chile (animals), Ecuador (A letter, fruits), Mexico (F letter, fruits), Paraguay (F, A, S letters, fruits), Puerto Rico (F letter, animals, fruits), and Spain (F letter, fruits).

CONCLUSIONS

This is the largest multi-national Spanish speaking-pediatric normative study in the world, and as such it will allow neuropsychologists from these countries to have a more accurate way to interpret the phonological and semantic VFT in pediatric populations.

Trail Making Test: Normative data for the Latin American Spanish-speaking pediatric population

OBJECTIVE

To generate normative data for the Trail Making Test (TMT) in Spanish-speaking pediatric populations.

METHOD

The sample consisted of 3,337 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the TMT as part of a larger neuropsychological battery. The TMT-A and TMT-B scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses.

RESULTS

The final multiple linear regression models showed main effects for age on both scores, such that as children needed less time to complete the test while they become older. TMT-A scores were affected by age2 for all countries except, Cuba, Guatemala, and Puerto. TMT-B scores were affected by age2 for all countries except, Guatemala and Puerto Rico. Models indicated that children whose parent(s) had a MLPE >12 years of education needed less time to complete the test compared to children whose parent(s) had a MLPE ≤12 years for Mexico and Paraguay in TMT-A scores; and Ecuador, Mexico, Paraguay, and Spain for TMT-B scores. Sex affected TMT-A scores for Chile, Cuba, Mexico, and Peru, in that boys needed less time to complete the test than girls. Sex did not affect TMT-B scores.

CONCLUSIONS

This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate approach to interpret the TMT in pediatric populations.

Peabody Picture Vocabulary Test-III: Normative data for Spanish-speaking pediatric population

OBJECTIVE

To generate normative data for the Peabody Picture Vocabulary Test-III (PPVT-III) in Spanish-speaking pediatric populations.

METHOD

The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Honduras, Guatemala, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the PPVT-III as part of a larger neuropsychological battery. PPVT-III scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses.

RESULTS

The final multiple linear regression models showed main effects for age in all countries, such that scores increased linearly as a function of age. In addition, age2 had a significant effect in all countries, except Guatemala and Paraguay. Models showed that children whose parent(s) had a MLPE >12 years obtained higher scores compared to children whose parent(s) had a MLPE ≤12 years in all countries, except for Cuba, Peru, and Puerto Rico. Sex affected scores for Chile, Ecuador, Guatemala, Mexico, and Spain.

CONCLUSIONS

This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate interpretation of the PPVT-III when used in pediatric populations.

Modified Wisconsin Card Sorting Test (M-WCST): Normative data for Spanish-speaking pediatric population

OBJECTIVE

To generate normative data for the Modified Wisconsin Card Sorting Test (M-WCST) in Spanish-speaking pediatric populations.

METHOD

The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the M-WCST as part of a larger neuropsychological battery. Number of categories, perseverative errors, and total error scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses.

RESULTS

The final multiple linear regression models indicated main effects for age on all scores, such that the number of categories correct increased and total number of perseverative errors and total number of errors decrease linearly as a function of age. Age2 had a significant effect in Chile, Cuba, Ecuador, and Spain for numbers of categories; a significant effect for number of perseverative errors in Chile, Cuba, Mexico, and Spain; and a significant effect for number of total errors in Chile, Cuba, Peru, and Spain. Models showed an effect for MLPE in Cuba (total errors), Ecuador (categories and total errors), Mexico (all scores), Paraguay (perseverative errors and total error), and Spain (categories and total errors). Sex affected number of total errors for Ecuador.

CONCLUSIONS

This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate way to interpret the M-WCST with pediatric populations.

Concentration Endurance Test (d2): Normative data for Spanish-speaking pediatric population

OBJECTIVE

To generate normative data for the Concentration Endurance Test (d2) in Spanish-speaking pediatric populations.

METHOD

The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the d2 test as part of a larger neuropsychological battery. The Total number of items processed (TN), Total number of correct responses (CR), Total performance (TP), and Concentration performance (CP) scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses.

RESULTS

The final multiple linear regression models showed main effects for age on all scores, such that scores increased linearly as a function of age. TN scores were affected by age2 for Guatemala and Puerto Rico; CR scores were affected by age2 for Mexico; TP scores were affected by age2 for Chile, Mexico, Puerto Rico, and Spain; and CP scores for Mexico and Spain. Models indicated that children whose parents had a MLPE >12 years obtained higher scores compared to children whose parents had a MLPE≤12 years for Mexico and Spain in all scores, and Puerto Rico for TN, CR, and TP, and Guatemala and Paraguay for CP scores. Sex affect the scores for Ecuador and Honduras (CP scores).

CONCLUSIONS

This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate approach to interpret the d2 test in pediatric populations.

Índices productivos y características de la canal de cerdos Ibéricos inmunocastrados o castrados quirúrgicamente y alimentados con dietas de diferente concentración proteica. Resultados preliminares

La inmunocastración ha resultado una estrategia útil en el cerdo para prevenir el olor sexual en la carne. En trabajos previos se indica que los cerdos inmunocastrados (IC) pueden presentar mejores índices productivos que los castrados quirúrgicamente (SC). Además de las ventajas en bienestar animal que conlleva esta práctica, la mejora en producción puede tener interés en razas como la Ibérica, con capacidad de crecimiento limitada. El objetivo de este estudio ha sido examinar los efectos de la inmunocastración sobre los índices productivos del cerdo Ibérico, el uso de la proteína en la dieta y las características de la canal, en animales alimentados con dietas de diferente concentración proteica. Se utilizaron 27 animales de tres sexos (machos IC, machos SC, y hembras IC) alimentados con 3 dietas isoenergéticas (160, 140 y 120 g PB/kg materia seca), con tres animales por cada combinación de tratamientos. Los animales se vacunaron contra la hormona liberadora de gonadotropina a los 4,3 (40 kg) y 6 meses de edad (70-80 kg). Los tratamientos se ofrecieron a los animales, que permanecieron alojados individualmente, desde los 40 a los 100 kg de peso. Se realizaron ensayos de digestibilidad y balance de N a los 50 y 90 kg de peso. A los 100 kg se sacrificaron los animales. Los resultados preliminares indican que los machos IC tuvieron un ritmo de crecimiento superior (803 vs 706 and 696 g/d, para machos IC, machos SC y hembras IC, respectivamente; P < 0.001) y mejores índices productivos que el resto de grupos (P < 0.01). Los machos IC presentaron mayor longitud de la canal y pesos relativos en la mayoría de los componentes magros de la canal, así como menor peso relativo de canal y panceta que el resto de grupos. No se apreciaron diferencias en los parámetros estudiados debidas a la concentración proteica de la dieta. Necesitamos profundizar en el posible papel que pueda jugar la inmunocastación en el crecimiento magro del cerdo Ibérico en futuros trabajos.

Bases nutricionales para la alimentación proteica del cerdo Ibérico puro

En este trabajo de revisión describimos los resultados obtenidos en una serie de experimentos realizados con el objetivo de evaluar la utilización de la proteína dietética por el cerdo Ibérico en distintas fases de su ciclo productivo. Se describen ensayos nutricionales basados en diseños dosis/respuesta, en los que se han empleado tratamientos isoenergéticos con distinta concentración de proteína –con idéntica composición en aminoácidos siguiendo el concepto de proteína ideal-, así como ensayos ensayos metabólicos comparativos con razas porcinas magras. Los resultados obtenidos indican que la capacidad de la raza Ibérica para depositar proteína corporal es limitada en comparación con la descrita para razas porcinas convencionales en etapas similares de crecimiento. Asimismo, sugieren la necesidad de utilizar dietas con concentración de proteína sensiblemente inferior a la utilizada para razas convencionales, de acuerdo a esta limitación metabólica del animal. Estudios de carácter básico han puesto de manifiesto algunas peculiaridades metabólicas que dan lugar a un crecimiento limitado en proteína y tejido magro. Resumimos la información obtenida en varios experimentos y aportamos recomendaciones sobre la concentración y composición de la proteína en las dietas destinadas a la alimentación del cerdo Ibérico puro, en distintas fases de su ciclo productivo. Un adecuado manejo nutricional, particularmente el aporte proteico, mejora la eficiencia de utilización de este nutriente y da lugar a beneficios de carácter ambiental, económico y de bienestar animal.

Differences on meat colour and composition between ‘Landrace × Large White’ and ‘Iberian’ pigs under identical nutritional and management conditions

In pig production, factors such as nutritional system and genotype affect quality characteristics of meat. This study was aimed to evaluate differences in nutritional composition and colour of meat between Iberian (IB) and Landrace × Large White (LLW) pigs reared under identical nutrition and management conditions. Nutrient composition, mineral content, fatty acid profile and instrumental colour of two muscles (longissimus thoracis and biceps femoris) were examined at two growing stages (50- and 115-kg weight). Significant differences were found in relation to genotype. IB muscles contained higher amounts of intramuscular fat, dry matter, monounsaturated fatty acids, iron and zinc, and were redder (higher a* value) and with less colour saturation (lower hue angle), than those from LLW pigs. Significant relationships between colour coordinates with the mineral content and the lipid profile of muscles were found: redness was mainly linked to iron, zinc and monounsaturated fatty acids levels, whereas yellowness was positively related with copper, polyunsaturated fatty acids and linoleic acid level. The results of the present study support that muscles from the IB pig genotype have special characteristics, which may enhance the overall quality of meat compared with conventional or high-lean porcine breeds, even under identical management system, due to its particular fat composition and colour attributes.

Similar effects of lysine deficiency in muscle biochemical characteristics of fatty and lean piglets

The main objective of this work was to investigate the effects of feeding Lys-deficient diets on muscle biochemical characteristics, particularly intramuscular fat concentration and fatty acid profile, in a fatty (Iberian) and a conventional pig genotype (Landrace × Large White [LDW]) maintained in identical experimental conditions. Performance and plasma metabolite changes were also monitored. Twenty-eight barrows of 10 kg initial BW, 14 of Iberian and 14 of LDW breed, were randomly assigned to each of 2 experimental diets in a 2 × 2 factorial arrangement (2 breeds × 2 diets). Seven pigs were allocated to each treatment combination. Diets (isonitrogenous and isoenergetic; 200 g CP/kg DM and 14.7 MJ ME) based on barley, corn, corn gluten meal, and soybean meal, with identical composition, except for their Lys content (10.9 g/kg for the diet adequate in Lys and 5.2 g/kg for the diet deficient in Lys), were assayed. Pigs were housed in individual 2 m pens and fed at 85% of ad libitum intake of the Iberian genotype, of greater intake capacity. Daily feed allowance was based on BW individually measured each week. At 25 kg BW, pigs were slaughtered by exsanguination after electrical stunning. Blood samples were taken and longissimus dorsi and biceps femoris muscles were rapidly dissected and stored frozen prior to analysis. Performance was reduced in both pig breeds when fed Lys-deficient diets, particularly in LDW pigs (breed × diet interaction, < 0.05). Intramuscular fat content increased in longissimus dorsi of Iberian ( < 0.05) and in biceps femoris of both pig genotypes ( < 0.01) when fed Lys-deficient diets. Oleic acid increased ( < 0.05) and PUFA acid decreased ( < 0.01) in longissiumus dorsi and biceps femoris of pigs of both genotypes fed Lys-deficient diets. The proportion of oxidative fibers ( < 0.001) and free carnitine content ( < 0.05) increased in longissimus dorsi of both pigs types fed Lys-deficient diets. Plasma creatinine was greater in LDW pigs compared with Iberian pigs ( < 0.01). Urea and total cholesterol increased in pigs consuming Lys-deficient diets ( < 0.01). The plasma free carnitine concentration was higher in Iberian pigs than in LDW pigs ( < 0.059). No changes in plasma carnitine status due to dietary Lys supply were detected. Feeding Lys-deficient diets could be a suitable strategy for increasing intramuscular fat content in fatty and lean pigs.

PathOS: a decision support system for reporting high throughput sequencing of cancers in clinical diagnostic laboratories

Background

The increasing affordability of DNA sequencing has allowed it to be widely deployed in pathology laboratories. However, this has exposed many issues with the analysis and reporting of variants for clinical diagnostic use. Implementing a high-throughput sequencing (NGS) clinical reporting system requires a diverse combination of capabilities, statistical methods to identify variants, global variant databases, a validated bioinformatics pipeline, an auditable laboratory workflow, reproducible clinical assays and quality control monitoring throughout. These capabilities must be packaged in software that integrates the disparate components into a useable system.

Results

To meet these needs, we developed a web-based application, PathOS, which takes variant data from a patient sample through to a clinical report. PathOS has been used operationally in the Peter MacCallum Cancer Centre for two years for the analysis, curation and reporting of genetic tests for cancer patients, as well as the curation of large-scale research studies. PathOS has also been deployed in cloud environments allowing multiple institutions to use separate, secure and customisable instances of the system. Increasingly, the bottleneck of variant curation is limiting the adoption of clinical sequencing for molecular diagnostics. PathOS is focused on providing clinical variant curators and pathology laboratories with a decision support system needed for personalised medicine. While the genesis of PathOS has been within cancer molecular diagnostics, the system is applicable to NGS clinical reporting generally.

Conclusions

The widespread availability of genomic sequencers has highlighted the limited availability of software to support clinical decision-making in molecular pathology. PathOS is a system that has been developed and refined in a hospital laboratory context to meet the needs of clinical diagnostics. The software is available as a set of Docker images and source code at https://github.com/PapenfussLab/PathOS.

Electronic supplementary material

The online version of this article (doi:10.1186/s13073-017-0427-z) contains supplementary material, which is available to authorized users.

Effects of dietary protein-to-energy ratio on rate of growth, protein deposition and tissue composition of pure Iberian boars prior to extensive production

Thirty entire male Iberian (IB) pigs of 12 kg initial BW were used to study the effects of dietary protein-to-energy ratio on performance, body protein accretion, and tissue composition. Two nutritional regimes were supplied at 3 stages of growth (Phase I, from 12 to 30 kg BW; Phase II, from 30 to 45 kg BW; and Phase III, from 45 to 100 kg BW): the first regime (RefP/E) was formulated to provide optimum protein-to-energy ratios for castrated IB pigs at several stages of growth from 10 to 100 kg BW; the second (IncP/E), for which an overall increase of 2.5 g digestible protein/MJ ME was provided, would allow an increased potential for lean tissue growth presumably well above that expected for the entire male of an obese pig breed. The pigs were surgically castrated at 45 kg BW and slaughtered at about 100 kg BW. In Phases I and II, in which feed was provided ad libitum, no significant differences between dietary treatments in ADG (580 ± 10 and 740 ± 11 g, on average, respectively), G:F (0.475 ± 0.004 and 0.362 ± 0.005, on average, respectively), and gain:ME intake ratio (37.8 ± 0.4 and 26.1 ± 0.4 g/MJ, on average, respectively) were found ( > 0.05). After surgical castration, for the entire fattening period (Phase III), ADFI was fixed and highly restricted. A lower gain:ME intake ratio (14.0 vs. 15.1 g/MJ; < 0.01) was obtained when the diet with the highest digestible protein:ME ratio was offered (IncP/E). With this regime, body protein accretion significantly improved in the IB boar growing from 12 to 45 kg BW, irrespective of the stage of growth, although the amount of protein accreted was notably enhanced at the later stage (75 vs. 85 g/d in Phase I [ < 0.05] and 110.5 vs. 151 g/d in Phase II [ < 0.001]). However, the efficiency of utilization of dietary N remained unchanged irrespective of the diet fed ( > 0.05). In contrast, in the fattening stage, similar daily rates of N retention ( > 0.05) were found, in spite of the observed differences in digestible N intake ( < 0.001). We concluded that the protein (lysine) requirements of the IB boar growing from 12 to 30 kg BW and from 30 to 45 kg BW are met with the supply of 11.5 and 10.2 g digestible protein of ideal AA pattern/MJ ME (0.80 and 0.71 g digestible lysine/MJ ME), respectively. As surgical castration is programmed to be abandoned in European Union by 1 January 2018, this information will be important for the efficient production of the immunologically castrated IB pig, at the earlier stages of growth.

Portal-drained viscera heat production in Iberian pigs fed betaine- and conjugated linoleic acid-supplemented diets

BACKGROUND

Betaine and conjugated linoleic acid (CLA) may alter growth and body composition in pigs, although their mode of action is not well understood. Portal-drained viscera (PDV) have a disproportionate influence with respect to their masses, and this may affect the productivity of more profitable tissues. The objective of this study was to determine if the use of betaine and/or CLA in the diet affects PDV heat production.

RESULTS

Postprandial portal blood flow (PBF) was greater (19.0%, P = 0.004) for control compared with the other three diets. The lowest (P < 0.001) value for postprandial PDV O₂ consumption corresponded to betaine + CLA followed by betaine and CLA diets (32.7, 25.4 and 17.7% respectively with respect to control diet). Postprandial PDV heat production was greater (26.4%, P < 0.001) for control with respect to the other three diets, with the minimum value corresponding to betaine + CLA (34.1% lower than control).

CONCLUSION

Supplementation with betaine and/or CLA reduced the PBF, O₂ consumption and therefore PDV heat production with respect to control diet. This effect was more pronounced when betaine and CLA were supplemented together, potentially increasing the energy availability for other body tissues. © 2016 Society of Chemical Industry.

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.

CONCLUSIONS

Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.

An estimation of the protein requirements of Iberian x Duroc 50:50 crossbred growing pigs

The effects of dietary protein content on the rates of gain and protein deposition were studied in Iberian (IB) × Duroc (DU) 50:50 barrows at 2 stages of growth [10.6 ± 0.2 (n = 28) and 60.0 ± 0.4 (n = 24) kg initial BW]. Two feeding, digestibility, and N-balance trials were performed. At each stage of growth, they were allocated in individual pens and given restrictedly (at 0.9 × ad libitum intake) one of 4 pelleted diets of similar energy concentration (13.8 to 14.5 MJ ME/kg DM), formulated to provide 4 different (ideal) CP contents (236, 223, 208, and 184 g CP/kg DM in the first trial, and 204, 180, 143, and 114 g CP/kg DM in the second trial). Feed allowance was offered in 2 daily equal meals. The average concentration of Lys was 6.59 ± 0.13 g /100 g CP for all diets. Whatever the stage of growth, average daily BW gain and gain to feed ratio were unchanged by increases in dietary CP content (477 ± 7 and 1,088 ± 20 g, and 0.475 ± 0.027 and 0.340 ± 0.113, respectively, in the first and second trial). In pigs growing from 10 to 27 kg BW, the average rate of N retention increased linearly (P < 0.01) on increasing the protein content in the diet up to a break point, so a linear-plateau dose response was observed. Pigs fed diets providing 208 to 236 g/kg DM did not differ in rate of protein deposition (PD). A maximum value of 87 (13.93 g N retained × 6.25) g PD/d was obtained when the diet supplied at least 208 g CP/kg DM. The broken-line regression analysis estimated dietary CP requirements at 211 g ideal CP (15.2 g total Lys)/kg DM. In the fattening pigs, there was a quadratic response (P < 0.01) in the rate of N retention as dietary CP content increased. Maximum N retention (18.7 g/d) was estimated from the first derivative of the function that relates the observed N retained (g/d) and dietary CP content (g/kg DM). This maximum value would be obtained by feeding a diet containing 185 g ideal CP (13.3 g total Lys)/kg DM and represents the maximum capacity of the IB × DU 50:50 pigs for protein accretion (i.e., 117 g PD/d). Consequently, cross breeding of IB dams with Duroc sires alters the metabolic response to dietary CP supply by increasing the potential of the crossbred to accrete protein and by modifying the pattern of PD response with BW.

The development, feasibility and acceptability of an Internet-based STI-HIV prevention intervention for young Chilean women

BACKGROUND

Young Chilean women between 18 and 24 years of age are at high risk of contracting sexually transmitted infection (STI) and human immunodeficiency virus (HIV). The literature shows a shortage of STI-HIV prevention interventions focused on this specific high-risk population and a unique set of barriers to receiving prevention messages. Internet-based interventions are promising for delivering STI-HIV prevention interventions and avoiding barriers to services.

AIMS

The study aimed to develop a culturally informed Internet-based STI-HIV prevention intervention for Chilean women between 18 and 24 years of age, to investigate its feasibility and acceptability, and to compile recommendations on what would make the intervention more acceptable and feasible for these women.

METHODS

The development of the Internet intervention was facilitated by a process that featured consultation with content and technology experts. A pre-post test design was used to test the acceptability and feasibility of the intervention with 40 young Chilean women between 18 and 24 years of age.

RESULTS

The intervention website consisted of four modules of content and activities that support learning. The intervention was feasible and acceptable for young Chilean women between 18 and 24 years of age.

DISCUSSION AND CONCLUSION

This study demonstrated the value of engaging multiple expert panels to develop culturally informed and technology-based interventions. The results of this study support the feasibility and acceptability of conducting an Internet-based intervention with multiple sessions, yielding high participation rates in a population in which there are barriers to discussion of STI-HIV prevention and sex-related content.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The outcomes have implications for nursing education and clinical practice and they can be used for the legal and judicial systems to promote or reinforce policies that encourage STI-HIV prevention strategies among women.