[Precise diagnosis and management of anaphylaxis based on phenotypes and endotypes]

Anaphylaxis is the most severe allergic reaction, demanding immediate management by health care providers, which is currently underdiagnosed and undertreated in China. In addition to the classic IgE-mediated pathway, non-IgE dependent pathway has also been extensively studied in the pathogenesis of anaphylaxis. Recently, the atypical symptoms induced by widespread used monoclonal antibodies and biologics have been reported. The goal of this article is to recognize the phenotypes (triggers and presentation) and understand its characteristics through endotypes (mechanisms) of anaphylaxis. Ultimately, the aim is to help allergists and health care providers guide a precision approach to diagnose and manage of anaphylaxis.

[Prevention and long-term management of anaphylaxis in children]

Anaphylaxis is increasingly in children. Foods are the most common triggers. Anaphylaxis is currently undernotified, underdiagnosed, and undertreated in China. Recurrence of anaphylaxis has been recorded in one-third of cases, thus it is essential to prevent recurrence in long-term personalized management of anaphylaxis. Here it reviews the avoidance of triggers and cofactors/risk factors,long-term management of anaphylaxis. This article aims to increase awareness of anaphylaxis in children in order to improve management and prevention of recurrences.

[Effect of fluid resuscitation guided by pulse contour cardiac output monitoring technology on organ function in extremely severe burn patients]

Objective: To investigate the effect of fluid resuscitation guided by pulse contour cardiac output (PiCCO) monitoring technology on the organ function in extremely severe burn patients. Methods: From May 2015 to March 2019, 52 patients with extremely severe burn hospitalized in Tongren Hospital of Wuhan University & Wuhan Third Hospital, meeting the inclusion criteria, were recruited to conduct a prospectively randomized control study. The patients were divided into PiCCO monitoring rehydration group (25 cases, 17 males and 8 females) and traditional rehydration group (27 cases, 20 males and 7 females) according to the random number table, with the ages of (47±9) and (49±8) years respectively. After admission, all the patients were rehydrated according to the rehydration formula of the Third Military Medical University during shock stage. In traditional rehydration group, fluid resuscitation of the patients was performed by monitoring the traditional shock indicators such as urine volume and central venous pressure, while PiCCO monitoring was performed in patients in PiCCO monitoring rehydration group, and the global end-diastolic volume index combined with the other relevant indicators of PiCCO monitoring were used to guide rehydration on the basis of the monitoring indicators of traditional rehydration group. The rehydration coefficients and urine volumes per kilogram of body weight per hour during the first and second 24 h post injury were compared between the two groups, which were compared with the corresponding rehydration scheme value of the Third Military Medical University (hereinafter referred to as the scheme value) at the same time. The total rehydration volumes within post injury hour (PIH) 8 and during the first and second 24 h post injury, the urine volumes per hour during the first and second 24 h post injury, and the levels of creatinine, urea nitrogen, lactate clearance rate, procalcitonin, creatine kinase isoenzyme (CK-MB) in blood and mean arterial pressure (MAP) on post injury day (PID) 1, 2, and 3 were measured. The incidence of complications, the application case number of mechanical ventilation, and the mechanical ventilation time within PID 28 were analyzed. Data were statistically analyzed with analysis of variance for repeated measurement, t test, Bonferroni correction, Mann-Whitney U test, chi-square test, and Fisher's exact probability method test. Results: During the second 24 h post injury, the rehydration coefficient of patients in traditional rehydration group was significantly higher than the scheme value (t=5.120, P<0.01). During the first and second 24 h post injury, the rehydration coefficients of patients in PiCCO monitoring rehydration group were significantly higher than the scheme values (t=3.655, 10.894, P<0.01) and those in traditional rehydration group (t=3.172, 2.363, P<0.05 or P<0.01). Within PIH 8, the total rehydration volumes of patients between the two groups were similar. During the first and second 24 h post injury, the total rehydration volumes of patients in PiCCO monitoring rehydration group were significantly higher than those in traditional rehydration group (t=4.428, 3.665, P<0.01). During the first and second 24 h post injury, the urine volumes per kilogram of body weight per hour of patients in traditional rehydration group were significantly higher than the schema values (t=4.293, 6.362, P<0.01), and the urine volumes per kilogram body weight per hour of patients in PiCCO monitoring rehydration group were significantly higher than the schema values (t=6.461, 8.234, P<0.01). The urine volumes per kilogram of body weight per hour and urine volumes per hour of patients in PiCCO monitoring rehydration group during the second 24 h post injury were significantly higher than those in traditional rehydration group (t=2.849, 3.644, P<0.05 or P<0.01). The creatinine levels of patients between the two groups on PID 1, 2, and 3 were similar. The urea nitrogen levels of patients in PiCCO monitoring rehydration group on PID 1, 2, and 3 were (6.8±1.5), (5.6±1.4), (4.4±1.4) mmol/L respectively, which were significantly lower than (8.6±1.8), (6.6±1.5), (5.5±1.4) mmol/L in traditional rehydration group (t=3.817, 2.511, 2.903, P<0.05 or P<0.01). The lactate clearance rates of patients in PiCCO monitoring rehydration group on PID 1, 2, and 3 were significantly higher than those in traditional rehydration group (t=2.516, 4.540, 3.130, P<0.05 or P<0.01). The procalcitonin levels of patients in PiCCO monitoring rehydration group on PID 2 and 3 were significantly lower than those in traditional rehydration group (Z=-2.491, -2.903, P<0.05). The CK-MB level of patients in PiCCO monitoring rehydration group on PID 3 was (35±10) U/L, which was significantly lower than (51±16) U/L in traditional rehydration group (t=4.556, P<0.01). The MAP levels of patients between the two groups on PID 1, 2, and 3 were similar. Within PID 28, the incidence of complications of patients in traditional rehydration group was significantly higher than that in PiCCO monitoring rehydration group (χ(2)=4.995, P<0.05), and the application case number of mechanical ventilation and the mechanical ventilation time of patients between the two groups were similar. Conclusions: The use of PiCCO monitoring technology to guide the early fluid resuscitation of extremely severe burn patients is beneficial for accurate determination of the fluid volume required by the patients and reduction of organ injury caused by improper rehydration.

Radiographic horizontal gaze deviation in the setting of acute PICA territory ischemia: A potential mimic of large vessel occlusion

PURPOSE

Horizontal gaze deviation (HGD) is a predictor of acute large vessel occlusion (LVO) and helps to expedite the triage of patients to CTA and endovascular-capable sites. Patients with acute cerebellar ischemia, particularly involving the PICA territory, can also exhibit HGD.

MATERIALS AND METHODS

We reviewed 2260 CTA stroke assessment cases between January 2016 and May 2020. Forty-six patients with CTA-proven acute PICA occlusions were identified and compared with 114 patients with acute LVO (ICA, M1, and M1/2). Both clinical and radiographic HGD were examined. The degree of radiographic HGD was measured for each patient. Site of ischemia was confirmed on subsequent MRI.

RESULTS

Of the 46 patients with acute PICA occlusions, 20 (43.5%) patients had radiographic (+) HGD with either ipsilateral or contralateral gaze deviation, 6 of whom (13.0%) displayed clinical HGD. Of the 114 patients with LVO (control group), 72 (63.2%) patients had radiographic (+) HGD, all ipsilateral, 49 of whom (68.0%) displayed clinical HGD. The mean degree of HGD between PICA and LVO were 30.0° vs. 22.9°, respectively, p < 0.001; AUC = 0.68.

CONCLUSION

Patients with acute PICA occlusion can exhibit either ipsilateral or contralateral HGD and a higher degree of HGD than LVO occlusion on NECT. In hyperacute stroke, the presence of radiographic HGD > 30° in the absence of ischemic changes in the MCA territory should prompt clinicians to closely evaluate for features of early ischemic changes in the cerebellar hemispheres that suggest acute PICA occlusion.

[Experience in the treatment of burn patients combined with inhalation injury during the epidemic of coronavirus disease 2019]

Objective: To introduce the experience in treating burn patients with inhalation injury during the epidemic of coronavirus disease 2019 (COVID-19). Methods: Six burn patients combined with inhalation injury were hospitalized in Department of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital from February 1 to March 1 in 2020 during the high-incidence period of COVID-19, including 4 males and 2 females, aged 21-63 years, admitted at 2-4 hours after burns, with total burn areas of 1%-20% total body surface area (TBSA) and full-thickness burn areas of 1%-12% TBSA. Among them, 1 case had severe inhalation injury, 2 cases had mild inhalation injury, and 3 cases had moderate inhalation injury. The body temperatures of the patients were normal at the time of admission, with no fever or cough in the past 2 weeks. At admission, chest CT of one patient showed double lower lobes and left upper lobes had multiple slices and slightly high-density shadow of nodules. Chest CT of two patients showed thickening of bilateral lung texture, and the chest CT of remaining patients were normal. After admission, 6 patients were given routine treatment, the medical staffs paid attention to the protection and screened for COVID-19 according to the diagnosis and treatment plan of COVID-19. On post injury day (PID) 1, 3, 6, and 9, vein blood of patients were collected for determination of white blood cell (WBC) count, neutrophil, lymphocyte absolute value, and level of procalcitonin (PCT). Nucleic acid of novel coronavirus was detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction on PID 3 and 6. The temperatures of patients were recorded after admission. The results of chest CT within one week after injury and the prognosis of the patients were recorded. Measurement data distributed normally were expressed as x±s, and measurement data distributed abnormally were expressed as M(P(25), P(75)). Results: (1) On PID 1, 3, 6, and 9, WBC counts of patients were respectively (19.8±3.8)×10(9)/L, (17.2±3.4)×10(9)/L, (13.3±3.1)×10(9)/L, and (11.1±1.6)×10(9)/L, neutrophils of patients were respectively 0.919±0.019, 0.899±0.011, 0.855±0.034, and 0.811±0.035, absolute values of lymphocytes of patients were respectively (0.65±0.18)×10(9)/L, (0.65±0.24)×10(9)/L, (0.91±0.34)×10(9)/L, and (1.23±0.42)×10(9)/L, and PCT values of patients were respectively 0.49 (0.36, 1.64), 0.39 (0.26, 0.73), 0.28 (0.18, 0.33), and 0.12 (0.11, 0.20) ng/mL. The values of WBC and neutrophils of patients were higher than the normal value, showing a downward trend. The absolute values of lymphocyte of patients returned to the normal value from PID 6. The PCT values of patients were higher than the normal value. (2) Nucleic acid test results of novel coronavirus of 6 patients were negative on PID 3 and 6. The temperatures of 6 patients ranged from 36.5 to 38.6 ℃. The typical imaging features of COVID-19 were not found in 6 patients within 1 week after injury by chest CT. After treatment for 14-32 days, 6 patients were cured and discharged. Conclusions: During COVID-19 pandemic, burn patients combined with inhalation injury should be treated under condition of good protection for doctors and nurses. Meanwhile, virus should be actively screened to reduce the risk of COVID-19 infection among doctors and patients.

Hypovascular pancreas head adenocarcinoma: CT texture analysis for assessment of resection margin status and high-risk features

OBJECTIVES

To determine if CT texture analysis features are associated with hypovascular pancreas head adenocarcinoma (PHA) postoperative margin status, nodal status, grade, lymphovascular invasion (LVI), and perineural invasion (PNI).

METHODS

This Research Ethics Board-approved retrospective cohort study included 131 consecutive patients with resected PHA. Tumors were segmented on preoperative contrast-enhanced CT. Tumor diameter and texture analysis features including mean, minimum and maximum Hounsfield units, standard deviation, skewness, kurtosis, and entropy and gray-level co-occurrence matrix (GLCM) features correlation and dissimilarity were extracted. Two-sample t test and logistic regression were used to compare parameters for prediction of margin status, nodal status, grade, LVI, and PNI. Diagnostic accuracy was assessed using receiver operating characteristic curves and Youden method was used to establish cutpoints.

RESULTS

Margin status was associated with GLCM correlation (p = 0.012) and dissimilarity (p = 0.003); nodal status was associated with standard deviation (p = 0.026) and entropy (p = 0.031); grade was associated with kurtosis (p = 0.031); LVI was associated with standard deviation (p = 0.047), entropy (p = 0.026), and GLCM correlation (p = 0.033) and dissimilarity (p = 0.011). No associations were found for PNI (p > 0.05). Logistic regression yielded an area under the curve of 0.70 for nodal disease, 0.70 for LVI, 0.68 for grade, and 0.65 for margin status. Optimal sensitivity/specificity was as follows: nodal disease 73%/72%, LVI 72%/65%, grade 55%/83%, and margin status 63%/66%.

CONCLUSIONS

CT texture analysis features demonstrate fair diagnostic accuracy for assessment of hypovascular PHA nodal disease, LVI, grade, and postoperative margin status. Additional research is rapidly needed to identify these high-risk features with better accuracy.

KEY POINTS

• CT texture analysis features are associated with pancreas head adenocarcinoma postoperative margin status which may help inform treatment decisions as a negative resection margin is required for cure. • CT texture analysis features are associated with pancreas head adenocarcinoma nodal disease, a poor prognostic feature. • Indicators of more aggressive pancreas head adenocarcinoma biology including tumor grade and LVI can be diagnosed using CT texture analysis with fair accuracy.

[Retrospective study of fiberoptic bronchoscopy airway lavage in the treatment of extremely severe burn patients with severe inhalation injury]

Objective: To explore the clinical effects of fiberoptic bronchoscopy airway lavage (FBAL) in the treatment of extremely severe burn patients with severe inhalation injury. Methods: From January 2015 to January 2019, 47 extremely severe burn patients with severe inhalation injury who were hospitalized in Tongren Hospital of Wuhan University & Wuhan Third Hospital, meeting the inclusion criteria, were recruited in this retrospective cohort study. According to whether or not they were treated with FBAL, the patients were divided into fiberoptic bronchoscopy group (23 cases, 19 males and 4 females) and routine group (24 cases, 20 males and 4 females), with the age of (44±11) and (49±9) years, and the admission time of 4 (3, 4) h and 4 (3, 5) h respectively. The patients in routine group were given routine comprehensive treatment, and the patients in fiberoptic bronchoscopy group were treated with FBAL on the basis of routine comprehensive treatment. The pH value, arterial partial pressure of oxygen (PaO(2)), arterial partial pressure of carbon dioxide (PaCO(2)), arterial oxygen saturation (SaO(2)), oxygenation index, white blood cell count (WBC), neutrophils, blood lactic acid, and procalcitonin (PCT) at admission and on post injury day (PID) 3, 5, 7, and 10, the time of mechanical ventilation, the day of intensive care unit (ICU) stay, the incidence of complications and death within PID 28 were compared between the two study groups. The occurrences of bronchospasm and asphyxia of patients in fiberoptic bronchoscopy group were monitored. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, Bonferroni correction, chi-square test, and Fisher's exact probability test. Results: (1) At admission, the values of pH, PaO(2), PaCO(2), SaO(2), and oxygenation index of patients in the two groups were similar (Z=-0.118, -0.320, -0.362, -2.416, -0.234, P>0.05). On PID 3, 5, 7, and 10, the values of pH, PaO(2), SaO(2), and oxygenation index of patients in fiberoptic bronchoscopy group were significantly higher than those of routine group (Z(3 d)=-4.711, -4.161, -5.525, -2.661; Z(5 d)=-3.489, -4.678, -5.875, -3.599; Z(7 d)=-5.104, -4.619, -5.876, -4.844; Z(10 d)=-4.026, -5.698, -5.877, -4.716; P<0.05 or P<0.01). The PaCO(2) values of patients in fiberoptic bronchoscopy group were significantly lower than those of routine group (Z=-2.895, -3.162, -3.407, -2.831, P<0.05 or P<0.01). (2) At admission and on PID 3, 5, and 7, the values of WBC, blood lactic acid, and PCT of patients in the two groups were similar (Z=-0.830, -0.915, -0.458, -0.648, -1.714, -1.479; -0.330, -0.128, -1.766, -0.494, -1.396, -1.522, P>0.05). On PID 10, the values of WBC, blood lactic acid, and PCT of patients in fiberoptic bronchoscopy group were significantly lower than those of routine group (Z=-3.502, -2.630, -2.662, P<0.05 or P<0.01). At admission, the value of neutrophils of patients in fiberoptic bronchoscopy group was 0.887 (0.862, 0.912), which was similar to 0.887 (0.856, 0.897) in routine group (Z=-0.404, P>0.05). On PID 3, 5, 7, and 10, the values of neutrophils of patients in fiberoptic bronchoscopy group were respectively 0.848 (0.802, 0.867), 0.831 (0.815, 0.849), 0.798 (0.771, 0.849), 0.796 (0.751, 0.869), which were significantly lower than those of routine group [0.882 (0.820, 0.906), 0.871 (0.835, 0.903), 0.845 (0.819, 0.905), 0.881 (0.819, 0.916), Z=-2.756, -2.810, -2.618, -3.033, P<0.05]. (3) The time of mechanical ventilation and the days of ICU stay of patients were shorter in fiberoptic bronchoscopy group than those in routine group (Z=-2.199, t=2.368, P<0.05). Within PID 28, the number of patients with complications was significantly less in fiberoptic bronchoscopy group than in routine group (χ(2)=5.436, P<0.05), while the incidence of death within PID 28 in fiberoptic bronchoscopy group was similar to that of routine group (P>0.05). The airway lavage procedures of patients in fiberoptic bronchoscopy group went well with no bronchospasm or asphyxia occurred. Conclusions: FBAL is effective in treating extremely severe burn patients combined with severe inhalation injury. It can improve the oxygenation status of the lung, reduce the systemic inflammatory reaction of patients, shorten the time of mechanical ventilation and ICU stay, and reduce the incidence of complications.

[Clinical significance of pulse contour cardiac output monitoring technology in guiding fluid replacement during shock stage of extensive burn]

Objective: To explore the guiding significance of pulse contour cardiac output (PiCCO) monitoring technology in the treatment of fluid replacement during shock stage of extensive burn in clinic. Methods: Sixty-five patients with extensive burn hospitalized in our unit from January 2014 to December 2018, conforming to the inclusion criteria, were recruited to conduct a prospective controlled research. According to the order of admission, 35 odd-numbered patients and 30 even-numbered patients were enrolled in routine rehydration group (25 males and 10 females) and PiCCO monitoring rehydration group (21 males and 9 females) respectively, with the age of (48±9) and (44±8) years respectively. All patients of the two groups were rehydrated according to the rehydration formula of the Third Military Medical University during shock stage. The rehydration speed was adjusted in routine rehydration group according to the general indexes of shock such as central venous pressure, mean arterial pressure, heart rate, respiratory rate, urine volume, and clinical symptoms of patients. PiCCO monitoring was performed in patients of PiCCO monitoring rehydration group, and the global end-diastolic volume index combined with the other relevant indicators of PiCCO were used to guide rehydration on the basis of the monitoring indicators of routine rehydration group. The heart rates and positive fluid balance volumes at post injury hour (PIH) 8, 16, 24, 32, 40, 48, 56, 64, and 72, the diuretic dosage at PIH 48 and 72, the total fluid replacement volumes, urine volumes, blood lactic acid, platelet count, and hematocrit at PIH 24, 48, and 72, the length of intensive care unit (ICU) stay, and the incidence of complications and death within 28 days after injury were compared between patients in the two groups. Data were processed with analysis of variance for repeated measurement, t test, Bonferroni correction, Mann-Whitney U test, chi-square test, and Fisher's exact probability test. Results: The heart rates of patients in the two groups were similar at PIH 8, 16, 24, 32, 40, 48, and 56 (t=0.775, 1.388, 2.511, 2.203, 1.654, 2.303, 1.808, P>0.05), and the heart rates of patients in PiCCO monitoring rehydration group at PIH 64 and 72 were obviously lower than those of routine rehydration group (t=3.229, 3.357, P<0.05 or P<0.01). The positive fluid balance volumes of patients in the two groups were similar at PIH 8, 16, 40, and 56 (t=0.768, 1.670, 2.134, 2.791, P>0.05), and the positive fluid balance volumes of patients in PiCCO monitoring rehydration group at PIH 24, 32, 48, 64, and 72 were obviously less than those of routine rehydration group (t=3.364, 4.047, 2.930, 2.950, 2.976, P<0.05 or P<0.01). The amount of diuretics used by patients in the two groups was similar at PIH 48 and 72 (Z=-0.697, -1.239, P>0.05). The total fluid replacement volumes of patients in PiCCO monitoring rehydration group at PIH 24, 48, and 72 were (13 864±4 241), (9 532±2 272), and (8 480±2 180) mL, respectively, obviously more than those in routine rehydration group [(10 388±2 445), (8 095±1 720), and (7 059±1 297) mL, respectively, t=-3.970, -2.848, -3.137, P<0.05 or P<0.01]. The urine volumes of patients in the two groups at PIH 24 were close (t=-1.027, P>0.05). The urine volumes of patients in PiCCO monitoring rehydration group at PIH 48 and 72 were (3 051±702) and (3 202±624) mL respectively, obviously more than those in routine rehydration group [(2 401±588) and (2 582±624) mL respectively, t=-4.062, -4.001, P<0.01]. The levels of blood lactate acid of patients in PiCCO monitoring rehydration group at PIH 24, 48, and 72 were obviously lower than those in routine rehydration group (t=4.758, 6.101, 3.938, P<0.01). At PIH 24 and 48, the values of the platelet count of patients in PiCCO monitoring rehydration group were obviously higher than those in routine rehydration group (t=-2.853, -2.499, P<0.05), and the values of hematocrit of patients in PiCCO monitoring rehydration group were obviously lower than those in routine rehydration group (t=2.698, 4.167, P<0.05 or P<0.01). Both the platelet count and hematocrit of patients in the two groups were similar at PIH 72 (t=-1.363, 0.476, P>0.05). The length of ICU stay of patients in PiCCO monitoring rehydration group was obviously shorter than that of routine rehydration group (t=2.184, P<0.05). Within 28 days after injury, the incidence of complications of patients in routine rehydration group was obviously higher than that in PiCCO monitoring rehydration group (P<0.05), while the mortality rate of patients in routine rehydration group was similar to that in PiCCO monitoring rehydration group (P>0.05). Conclusions: The application of PiCCO monitoring technology in monitoring fluid replacement in patients with extensive burn can quickly correct shock, reduce the occurrence of organ complications caused by improper fluid replacement, and shorten the length of ICU stay, which is of great significance in guiding the treatment of burn shock.

Magnetic Resonance Elastography to Assess Fibrosis in Kidney Allografts

BACKGROUND AND OBJECTIVES

Fibrosis is a major cause of kidney allograft injury. Currently, the only means of assessing allograft fibrosis is by biopsy, an invasive procedure that samples <1% of the kidney. We examined whether magnetic resonance elastography, an imaging-based measure of organ stiffness, could noninvasively estimate allograft fibrosis and predict progression of allograft dysfunction.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Kidney allograft recipients >1 year post-transplant undergoing an allograft biopsy first underwent free-breathing, flow-compensated magnetic resonance elastography on a 3.0-T magnetic resonance imaging scanner. Each patient had serial eGFR measurements after the elastography scan for a follow-up period of up to 1 year. The mean stiffness value of the kidney allograft was compared with both the histopathologic Banff fibrosis score and the rate of eGFR change during the follow-up period.

RESULTS

Sixteen patients who underwent magnetic resonance elastography and biopsy were studied (mean age: 54±9 years old). Whole-kidney mean stiffness ranged between 3.5 and 7.3 kPa. Whole-kidney stiffness correlated with biopsy-derived Banff fibrosis score (Spearman rho =0.67; P<0.01). Stiffness was heterogeneously distributed within each kidney, providing a possible explanation for the lack of a stronger stiffness-fibrosis correlation. We also found negative correlations between whole-kidney stiffness and both baseline eGFR (Spearman rho =-0.65; P<0.01) and eGFR change over time (Spearman rho =-0.70; P<0.01). Irrespective of the baseline eGFR, increased kidney stiffness was associated with a greater eGFR decline (regression r2=0.48; P=0.03).

CONCLUSIONS

Given the limitations of allograft biopsy, our pilot study suggests the potential for magnetic resonance elastography as a novel noninvasive measure of whole-allograft fibrosis burden that may predict future changes in kidney function. Future studies exploring the utility and accuracy of magnetic resonance elastography are needed.

Effects of Water-misting Sprays with Forced Ventilation after Transport during Summer on Meat Quality, Stress Parameters, Glycolytic Potential and Microstructures of Muscle in Broilers

Effects of water-misting sprays with forced ventilation after transport during summer on meat quality, stress parameters, glycolytic potential and microstructures of muscle in broilers were investigated. A total of 105 mixed-sex Arbor Acres broilers were divided into three treatment groups: i) 45-min transport without rest (T group), ii) 45-min transport with 1-h rest (TR group), iii) 45-min transport with 15-min water-misting sprays with forced ventilation and 45-min rest (TWFR group). The results showed the TWFR group significantly increased (p<0.05) initial muscle pH (pHi) and ultimate pH (pHu) and significantly reduced L* (p<0.05), drip loss, cook loss, creatine kinase, lactate dehydrogenase activity, plasma glucose content, lactate and glycolytic potential when compared with other groups. Microstructure of the muscle from TWFR group broilers under light microscopy showed smaller intercellular spaces among muscle fibers and bundles compared with T group. In conclusion this study indicated water-misting sprays with forced ventilation after transport could relieve the stress caused by transport under high temperature, which was favorable for the broilers' welfare. Furthermore, water-misting sprays with forced ventilation after transport slowed down the postmortem glycolysis rate and inhibited the occurrence of PSE-like meat in broilers. Although rest after transport could also improve the meat quality, the effect was not as significant as water-misting sprays with forced ventilation after transport.

The effect of transportation of broilers during summer on the expression of heat shock protein 70, postmortem metabolism and meat quality

The objective of this study was to determine the effects of different transport times on broilers during summer on stress, meat quality, and early postmortem muscle metabolites. Arbor Acres broiler chickens (n = 105) were randomly categorized into 5 treatments: unstressed control, 0.5 h, 1 h, 2 h, and 4 h transport. Each treatment consisted of 3 replicates with 7 birds each. All birds (except the control group) were transported according to a designed protocol. With the extension of transport time, the activities of plasma creatine kinase (CK) and lactate dehydrogenase (LDH) gradually increased. The content of heat shock protein 70 (Hsp70) did not change significantly during 0.5 h transport compared to the control group, but was significantly higher (P < 0.05) at 1 h or more of transport time. Also, transport times of 2 h or more resulted in a death rate of 20%-33% of broilers. We found that the breast meat in the 0.5 h transport group had significantly (P < 0.05) higher L* values, drip loss, cooking loss, AMP/ATP ratio, and phosphorylation of AMP-activated protein kinase (p-AMPK). In addition, pH24h was lower compared to the control group, increasing the likelihood of pale, soft, and exudative (PSE)-like meat. However, no significant variations were found in meat color, drip loss, or cooking loss in other transport groups compared to the control group under the condition of this study. Muscle glycogen content decreased with time of transportation. There were significant correlations among p-AMPK and meat quality (P < 0.05). These results indicate that preslaughter transport during summer may cause severe physiological and biochemical changes of broilers. Further investigations studying the deeper relationship between biological indicators and meat quality according to the similar transport conditions would provide a better understanding of the effect of transport duration on meat quality.

Impact of cytogenetics in patients with relapsed or refractory multiple myeloma treated with bortezomib: Adverse effect of 1q21 gains

We investigated the influence of genetic risk factors on the clinical response to bortezomib in 85 relapsed/refractory multiple myeloma (MM) patients. Interphase cytoplasmic fluorescence in situ hybridization (cIg-FISH) detected del(13q), del(17p), del(1p21), t(4;14), and 1q21 gain in 38%, 22%, 26%, 18% and 39% of evaluable cases. Forty-nine patients (49%) responded to bortezomib with median progression free (PFS) and overall survivals (OS) of 5.0 and 12.6 months, respectively. Patients with 1q21 gain had a significantly shorter OS (5.3 months vs. 24.6 months, p=0.0006) and PFS (2.3 months vs. 7.3 months, p=0.003) than patients without such abnormality. There was no significant difference in response rate, response duration, PFS or OS for any of the other genetic risk factors tested. Multivariate analysis confirmed that 1q21 gain is an independent risk factor for PFS (p=0.03) and OS (p=0.009) of bortezomib-treated relapsed/refractory myeloma.