Robotic left hemicolectomy with intracorporeal anastomosis: Description of the technique and initial results.

AIM: The aim was to describe the robot-assisted intracorporeal anastomosis technique in left colon surgery (rLCS) and report the initial results. METHOD: The rLCS was performed in 25 consecutive patients, starting with a Pfannenstiel incision and introducing a prepared anvil. The robot was docked and the affected segment resected. Colotomy was performed and the anvil was introduced in the proximal segment. End-to-end anastomosis was performed and reinforced. An air-leak test was performed. RESULTS: The results varied in terms of patient's age, American Society of Anesthesiologists grade, weight and the technique performed. Most patients had cancer. There was no suture failure or mortality, and the mean hospital stay was 3 days. CONCLUSIONS: The rLCS is a safe, reproducible technique with good initial results. Prospective studies should be performed to demonstrate its advantages.

Risk-adjusted treatment selection and outcome of patients with acute cholecystitis.

PURPOSE: Age and comorbidities increase the surgical risk for patients with acute cholecystitis and impact on the initial treatment selection. The aim of this article is the implementation of objective risk criteria that may be used to select the most appropriate treatment. METHODS: We carried out a prospective cohort study of all patients who were admitted to the hospital with a diagnosis of acute cholecystitis during 2014. They were initially allocated to three different treatment groups according to cholecystitis grade, number of days from clinical onset, and surgical risk scores as follows: immediate surgery by sepsis (EmergS), early surgery (EarlyS), or medical treatment group (MedT). Differences in the outcomes between the treatment groups were evaluated using bivariate and logistic regression analyses. RESULTS: A total of 149 patients were admitted; 44 % were >80 years old and 40 % were American Society of Anesthesiologists (ASA) > II. The mortality rate of the series was 0 % in EarlyS, 17 % in MedT, and 19 % in EmergS. The mortality rate was significantly associated with a higher degree of cholecystitis, age, and worse score values in risk scales and Charlson index. Logistic regression identified that the only independent predictors of death at the time of admission were the degree of cholecystitis (OR 2.87, p = 0.018) and the Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) score (OR 1.14, p = 0.001). CONCLUSION: The evaluation for the initial treatment in acute cholecystitis should include a systematic determination of the degree of cholecystitis and a surgical risk assessment. Tokyo guideline recommendations should be reviewed.

Ephedrine for myasthenia gravis, neonatal myasthenia and the congenital myasthenic syndromes.

BACKGROUND: Myasthenia is a condition in which neuromuscular transmission is affected by antibodies against neuromuscular junction components (autoimmune myasthenia gravis, MG; and neonatal myasthenia gravis, NMG) or by defects in genes for neuromuscular junction proteins (congenital myasthenic syndromes, CMSs). Clinically, some individuals seem to benefit from treatment with ephedrine, but its effects and adverse effects have not been systematically evaluated. OBJECTIVES: To assess the effects and adverse effects of ephedrine in people with autoimmune MG, transient neonatal MG, and the congenital myasthenic syndromes. SEARCH METHODS: On 17 November 2014, we searched the Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. We also searched reference lists of articles, conference proceedings of relevant conferences, and prospective trial registers. In addition, we contacted manufacturers and researchers in the field. SELECTION CRITERIA: We considered randomised controlled trials (RCTs) and quasi-RCTs comparing ephedrine as a single or add-on treatment with any other active treatment, placebo, or no treatment in adults or children with autoimmune MG, NMG, or CMSs. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study design and quality, and extracted data. We contacted study authors for additional information. We collected information on adverse effects from included articles, and contacted authors. MAIN RESULTS: We found no RCTs or quasi-RCTs, and therefore could not establish the effect of ephedrine on MG, NMG and CMSs. We describe the results of 53 non-randomised studies narratively in the Discussion section, including observations of endurance, muscle strength and quality of life. Effects may differ depending on the type of myasthenia. Thirty-seven studies were in participants with CMS, five in participants with MG, and in 11 the precise form of myasthenia was unknown. We found no studies for NMG. Reported adverse effects included tachycardia, sleep disturbances, nervousness, and withdrawal symptoms. AUTHORS' CONCLUSIONS: There was no evidence available from RCTs or quasi-RCTs, but some observations from non-randomised studies are available. There is a need for more evidence from suitable forms of prospective RCTs, such as series of n-of-one RCTs, that use appropriate and validated outcome measures.

Profile of acute kidney injury in pediatric leptospirosis.

BACKGROUND/AIM: Leptospirosis is an emerging public health zoonotic disease driven by climate and environment. Reports on leptospirosis-induced acute kidney injury (AKI) in children are scant and lacking in detail. The main objective is to provide an accurate and comprehensive description of AKI in pediatric leptospirosis. METHODS: We reviewed records of children ≤ 18 years old referred to the Section of Pediatric Nephrology in a tertiary-level government hospital from January 2004 to December 2012. They presented with clinical manifestations of leptospirosis and a microscopic agglutination test (MAT) ≥ 1:400. Patients were stratified as oliguric and non-oliguric with the former having a urine output of <0.5 mL/kg/h. RESULTS: A total of 86 cases were included with 53 children (62%) presenting with oliguria during their confinement. Blood urea nitrogen (BUN) (p=0.04) and serum creatinine (p=0.01) levels were significantly more elevated in the oliguric subjects than the non-oliguric children upon hospital admission with a median estimated GFR (eGFR) of 9 and 11 mL/min per 1.73 m(2), respectively. Peritoneal dialysis (PD) was initiated in 19 (36%) patients in the oliguric group. Death occurred in 2 (4%) subjects with oliguric AKI. The most common pathologic serovars isolated were L. manilae (13%) and L. poi (13%). CONCLUSION: Anicteric oliguric AKI due to leptospirosis is more frequent and severe than non-oliguric kidney failure in the pediatric population.

Genetic Alterations of TRAF Proteins in Human Cancers.

The tumor necrosis factor receptor (TNF-R)-associated factor (TRAF) family of cytoplasmic adaptor proteins regulate the signal transduction pathways of a variety of receptors, including the TNF-R superfamily, Toll-like receptors (TLRs), NOD-like receptors (NLRs), RIG-I-like receptors (RLRs), and cytokine receptors. TRAF-dependent signaling pathways participate in a diverse array of important cellular processes, including the survival, proliferation, differentiation, and activation of different cell types. Many of these TRAF-dependent signaling pathways have been implicated in cancer pathogenesis. Here we analyze the current evidence of genetic alterations of TRAF molecules available from The Cancer Genome Atlas (TCGA) and the Catalog of Somatic Mutations in Cancer (COSMIC) as well as the published literature, including copy number variations and mutation landscape of TRAFs in various human cancers. Such analyses reveal that both gain- and loss-of-function genetic alterations of different TRAF proteins are commonly present in a number of human cancers. These include pancreatic cancer, meningioma, breast cancer, prostate cancer, lung cancer, liver cancer, head and neck cancer, stomach cancer, colon cancer, bladder cancer, uterine cancer, melanoma, sarcoma, and B cell malignancies, among others. Furthermore, we summarize the key in vivo and in vitro evidence that demonstrates the causal roles of genetic alterations of TRAF proteins in tumorigenesis within different cell types and organs. Taken together, the information presented in this review provides a rationale for the development of therapeutic strategies to manipulate TRAF proteins or TRAF-dependent signaling pathways in different human cancers by precision medicine.

Leadership mentoring in nursing research, career development and scholarly productivity: A systematic review.

BACKGROUND: Although nursing has been an academic discipline for decades, the infrastructure for nursing research in many countries is still fragile and struggling. Postdoctoral nurses have difficulties developing sustaining careers in nursing research due to lack of career opportunities. Considerable research has been conducted on leadership and mentoring in various areas of nursing. We aimed to systematically review the literature investigating leadership programs and mentoring for postdoctoral nurse researchers, as well as the influence of leadership and mentoring on research productivity, research career development, leadership knowledge and skills, the nurses' health and well-being, staff relationships, work culture and collaboration, salaries and postdoctoral nurses' experiences. METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was conducted. The electronic databases PubMed, CINAHL and EMBASE were searched without time limits for eligible studies up to January 2016. Reference lists of included articles were also searched manually and authors were contacted to inquire about other relevant papers. Two authors independently assessed eligibility of studies for inclusion. Titles and abstracts were matched with the inclusion criteria: studies investigating leadership and mentoring programs for postdoctoral nurses and leadership and mentoring influencing research productivity, and career development; and leadership knowledge and skills and other outcomes. The quality of the studies was appraised using the Centre for Evidence-Based Medicine for surveys, the Critical Appraisal Skill Program Qualitative Appraisal Checklist for qualitative studies, and a critical appraisal list for mixed methods studies. Any disagreements were resolved by consensus. Data were extracted by two reviewers. FINDINGS: We screened 1775 titles and abstracts, resulting in 15 studies, which included quantitative, descriptive, qualitative and mixed methods designs and involved 3855 postdoctoral nurses. Two studies presenting mentoring programs for postdoctoral nurses were identified. Other studies investigated the influence of mentoring on various outcomes. The findings showed a positive influence of mentoring on research productivity, including increase in publications and grant writing and research career development, improved leadership skills and knowledge. Furthermore, mentoring positively influenced nurses' health and well-being, staff relationships, work culture and collaboration. Postdoctoral nurses' experience of mentoring, mentorship, leadership and peer-support is essential in supporting ongoing research activity. CONCLUSION: Although there is a lack of studies with robust designs investigating leadership and mentoring programs, our results document some evidence of mentoring's influence on research productivity, career development and other outcomes of postdoctoral nurses.

Impact of Immunosuppression on the Metagenomic Composition of the Intestinal Microbiome: a Systems Biology Approach to Post-Transplant Diabetes.

Solid organ transplantation (SOT) outcomes have continued to improve, although long-term use of immunosuppressants can lead to complications such as diabetes, compromising post-transplant outcomes. In this study, we have characterized the intestinal microbiome (IM) composition at the metagenomic level in the context of hyperglycemia induced by immunosuppressants. Sprague-Dawley rats were subjected to doses of tacrolimus and sirolimus that reliably induce hyperglycemia and an insulin-resistant state. Subsequent exposure to probiotics resulted in reversal of hyperglycemia. 16S rRNA and metagenomic sequencing of stool were done to identify the bacterial genes and pathways enriched in immunosuppression. Bacterial diversity was significantly decreased in sirolimus-treated rats, with 9 taxa significantly less present in both immunosuppression groups: Roseburia, Oscillospira, Mollicutes, Rothia, Micrococcaceae, Actinomycetales and Staphylococcus. Following probiotics, these changes were reversed to baseline. At the metagenomic level, the balance of metabolism was shifted towards the catabolic side with an increase of genes involved in sucrose degradation, similar to diabetes. Conversely, the control rats had greater abundance of anabolic processes and genes involved in starch degradation. Immunosuppression leads to a more catabolic microbial profile, which may influence development of diabetes after SOT. Modulation of the microbiome with probiotics may help in minimizing adverse long-term effects of immunosuppression.

Endoscopic thoracic sympathectomy by clamping in the treatment of social phobia: the Monza experience.

AIM: Facial blushing represents the peculiar symptom in social phobia and is defined as the ''hallmark of embarrassment''. At present, endoscopic thoracic sympathectomy (ETS) is the technique only able to guarantee long-term results in the treatment of sympathetic disorders. The aim of our study was to evaluate results, complications and the true value of 52 ETSs by two-port approach with the use of endoclips in patients with isolated facial blushing or in association with hyperhidrosis. METHODS: A retrospective review of 52 subjects who underwent standard ETS by clamping between September 2002 and April 2005 was carried out. This surgical practice was performed in 26 cases (50%) for isolated facial blushing only and in other 26 cases (50%) for facial blushing associated to hyperhidrosis with changeable localizations. Under endoscopic guidance we operated an endoscopic sympathetic block (ESB) with interruption of the inter-ganglion trunk at the level of T2-T3 in 51 patients (98.07%). In 1 patient (1.92%) we performed a sympathetic block with the complete exclusion of T3 thoracic ganglion. RESULTS: There were no intra and postoperative deaths. The effect rate was excellent in all patients with early complications in one patient (1.92%) only. CONCLUSIONS: ETS by clamping is safe and effective. Patients referred an high satisfaction in terms of complications and quality of life; specific early and late diseases are negligible.

[Thoracic sympathetic block by clamping in the treatment of primary hyperhidrosis: indications and results in 281 patients]. / Interruzione del simpatico toracico mediante neurocompressione nel trattamento dell'iperidrosi primitiva. Indicazioni e risultati ottenuti in 281 pazienti.

AIM: Hyperhidrosis is a disabling troublesome characterized by excessive perspiration that produces a significant social and professional deficit for patients. It main involves the palmar sides of hands and feet, axillae, face and, with a lesser incidence, trunk and scalp. Thoracoscopic sympathectomy represents the best approach for this disorder. The aim of our prospective study is to assess the outcome, the safety and efficacy after thoracoscopic sympathetic block by clipping in the treatment of primary hyperhidrosis. METHODS: Between september 2002 and april 2005, 281 patients (117 female and 164 male, with a mean age of 28 years) underwent Endoscopic Thoracic Sympathectomy (ETS) to treat hyperhidrosis with palmar, axillar, facial and widespread localization. RESULTS: There were no deaths or major intra-operative problems. There was no conversion to open surgery. During intermediate and long-term follow up we obtained excellent results and few complications. In 3 patients (1.06%) we noted a major complication (Horner's Syndrome), but one patient only had the surgical operation reversed; compensatory sweating occurred in 61 individuals (21.7%). Gustatory sweating occurred in no patient. CONCLUSIONS: The clipping of the thoracic sympathetic chain is a reversible surgical technique considered safe and effective. Despite of an incidence of complications and/or compensatory sweating and according to our operatory results, we conclude that the sympathetic block by clamping is the elective treatment for hyperhidrosis.

Characterization of the effects induced on DNA in mouse and hamster cells by lithocholic acid.

Lithocholic acid (LCA) is a promoting agent in colon carcinogenesis. In this work we have tried to characterize the DNA alteration induced by LCA in cells grown in vitro and in nuclei. Confirming previous findings, a clear increase in elution rate was observed at both alkaline and neutral pH. The extent of the increase was very similar at the two pHs. However, an increased elution rate could be observed only when lysing the nuclei at high ionic strength and low detergent concentration (2 M NaCl + 0.2% N-lauroylsarcosine sodium salt). No effect could be observed when the nuclei were lysed with a high detergent concentration (2% sodium dodecyl sulfate). In addition, a slight effect could be observed using a method for the evaluation of DNA unwinding in alkali. After termination of the incubation with LCA, the DNA alteration observed with DNA elution disappeared very rapidly both in intact cells and nuclei, even when the incubation buffer was totally unsuitable for the repair of the type of DNA damage induced by typical genotoxic agents. The effect of LCA on DNA was apparently not mediated through an inhibition of topoisomerase II. Only the intact chromatin of nuclei was responsive, not the quasinaked DNA of nuclei lysed at high ionic strength. We advance the hypothesis that the increased alkaline and neutral elution rate observed with LCA could be independent of DNA fragmentation and related to changes in chromatin structure.

Advances in the FTU collective Thomson scattering system.

The new collective Thomson scattering diagnostic installed on the Frascati Tokamak Upgrade device started its first operations in 2014. The ongoing experiments investigate the presence of signals synchronous with rotating tearing mode islands, possibly due to parametric decay processes, and phenomena affecting electron cyclotron beam absorption or scattering measurements. The radiometric system, diagnostic layout, and data acquisition system were improved accordingly. The present status and near-term developments of the diagnostic are presented.

Changes of n-3 and n-6 fatty acids in plasma and circulating cells of normal subjects, after prolonged administration of 20:5 (EPA) and 22:6 (DHA) ethyl esters and prolonged washout.

Eight normal volunteers (four men and four women) were treated with 3 x 1 g capsules of n-3 fatty acid ethyl esters for a period of 18 weeks, followed by a 24 week washout. Fatty acids of plasma, platelets, monocytes and red blood cells were analyzed at 0, 6, 12 and 18 weeks of treatment and at 4, 14 and 24 weeks of washout. During treatment, accumulation of EPA in plasma and cells was almost maximal at 6 weeks, whereas that of DHA reached a peak at 18 weeks. Arachidonic acid declined somewhat at 12 weeks in plasma and more markedly at 18 weeks in red blood cells and monocytes. During washout, EPA returned rapidly toward pretreatment values in all compartments, but it remained significantly higher in plasma and platelets at the end of washout. DHA declined more slowly, maintaining higher than basal values in plasma and platelets and lower than basal in red blood cells, at the end of washout. Rebound increments of AA occurred in plasma. Finally, the plasma levels of AA, but not those of the n-3 fatty acids, were more markedly modified in males than in females. The presented results suggest interactions between circulating fatty acids in the different compartment after n-3 FA administration, and indicate that very long washouts are necessary for a complete recovery from the induced fatty acid modifications.

Current and best practices of genetic testing for maturity onset diabetes of the young: views of professional experts.

AIMS: Currently, many patients with maturity onset diabetes of the young (MODY) are undiagnosed or misdiagnosed with type 1 or 2 diabetes. This study aims to assess professional experts' views on factors which may influence the current practice of genetic testing for MODY and to explore next steps toward best practice. METHODS: Twelve semistructured interviews were conducted with professional experts. These experts included physicians with potential or actual experience with genetic testing for MODY, representatives of (para)medical professional associations and a staff member of a diabetes patients' organization. RESULTS: Participants differed in their valuation of genetic testing for MODY. While most considered the test useful, not all were convinced of its clinical utility. Other factors mentioned to influence current practice were: (perceived lack of) possibilities for treatment and prevention, patients' perspectives and perceived barriers, such as costs and a lack of knowledge and awareness. Participants agreed that guidelines would be helpful to facilitate expedient testing. CONCLUSIONS: This study identified next steps that should be taken to improve genetic diagnosis and care for patients with MODY. Besides the development of a consensus guideline, other suggestions included more education of healthcare professionals, a clearer allocation of responsibilities with regard to genetic testing for MODY and further research.

Prolonged inhibition of platelet aggregation after n-3 fatty acid ethyl ester ingestion by healthy volunteers.

This study addressed two questions: 1) whether a relatively low dose of n-3 fatty acid ethyl esters (n-3 FAs) administered to healthy volunteers for a prolonged period of time would exert beneficial effects on plasma lipids, platelet function, and thromboxane biosynthesis; and 2) whether a short-term loading treatment (6 wk) with 6 g n-3 FAs/d followed by 12 wk with 3 g/d results in more pronounced effects. After 6 wk treatment a reduction of plasma triglyceride concentration and an accumulation of EPA and DHA in plasma were observed. A longer period of treatment with n-3 FAs was necessary to affect platelet aggregation and thromboxane A2 biosynthesis. At 12 and 18 wk, platelet aggregation, thromboxane A2 formation, and the excretion of thromboxane metabolites in urine were reduced, particularly in subjects who received 6 g n-3 FAs/d during the initial 6 wk. After treatment ended, triglyceride and thromboxane A2 biosynthesis returned to baseline values within 4 wk, whereas platelet aggregation remained impaired for > or = 14 wk. The longlasting impairment in platelet aggregation was accompanied by the retention of n-3 FAs in platelet phospholipids.

Double-blind placebo-controlled trial of terazosin effect on blood pressure and urinary output of dopamine in hypertensive patients.

In a parallel, double-blind study, 12 untreated hypertensive patients received terazosin (2-4 mg/day for 4 weeks), and 12 received placebo during the same period. Systolic and diastolic blood pressure decreased significantly in the terazosin group, from 150 +/- 5.0 mmHg systolic and 99.6 +/- 2.0 diastolic before treatment, to 134.0 +/- 7.0 systolic and 85.6 +/- 3.0 mmHg diastolic at week 4 of treatment. No significant blood pressure changes occurred in the placebo group. Blood pressure decrease showed a positive correlation (r = .62 and r = .52 for systolic and diastolic blood pressure, respectively) with the patient's age (P less than .05). Total plasma cholesterol decreased 18% in the terazosin group (P less than .05) and 9% in the placebo group (P greater than .05). Urinary dopamine excretion decreased significantly from 692.8 +/- 180.0 to 330.5 +/- 52.0 micrograms/24 hours in the terazosin group (P less than .05) and showed a nonsignificant increase in the placebo group. Compared with 22 age- and sex-matched healthy volunteers, urinary dopamine excretion in the hypertensive group before treatment was not statistically different (779.3 +/- 83.1 micrograms/24 hours). Dopamine excretion was higher in untreated hypertensive men and in male healthy volunteers compared with women. The decrease of urinary dopamine excretion observed under terazosin treatment could be due to a decrease of kidney dopamine synthesis or release induced by blood pressure reduction, or secondarily to the blockade of kidney alpha 1-receptors, modulating dopamine excretion. No significant changes were observed in urinary excretion of noradrenaline and adrenaline.

Intratracheal administration of pulmonary vasodilator agents.

We compared intravenous and intratracheal administration of histamine (0.4 and 1.6 micrograms/kg, respectively) and nitroglycerin (5.0 and 20.0 micrograms/kg, respectively) in seven hypoxemic 2 week old lambs, during right lung only perfusion, to see if intratracheal administration could limit their vasodilator action to the pulmonary vessels. The hemodynamic variables: pulmonary artery pressure (Ppa), left atrial pressure (Pla), pulmonary blood flow per kilogram (Q/kg), and aortic pressure (Pao) were measured at baseline and in each experimental state, then pulmonary vascular resistance (PVR) and systemic vascular input resistance (SVR) were determined. We found that intravenous histamine showed some pulmonary vasodilator selectivity in that it caused a 19% decrease of Ppa from baseline (P less than 0.002), a 23% decrease of PVR from baseline (P less than 0.002), and an 8% decrease of SVR from baseline (P less than 0.05). Intratracheal histamine produced smaller effects, decreasing Ppa by 11% from baseline (P less than 0.02), and PVR by 14% from baseline (P less than 0.02), while SVR was unaffected. Intravenous nitroglycerin decreased cardiac output by 16% from baseline (P less than 0.02), and also decreased SVR by 8% while producing a small increase in PVR. Intratracheal nitroglycerin caused a similar 17% (P less than 0.01) decrease in cardiac output, and again an increased PVR but a decreased SVR. This study confirms that histamine has some intrinsic pulmonary vasodilator selectivity. Furthermore, the data suggest that intratracheal administration may accentuate pulmonary selectivity by lessening systemic effects. Nitroglycerin, on the other hand, had untoward hemodynamic effects in the presence of hypoxia.

DNA damage in mouse and rat liver by caprolactam and benzoin, evaluated with three different methods.

Benzoin and caprolactam were examined for their capability of inducing alkaline DNA fragmentation in mouse and rat liver DNA after treatment in vivo. Three different methods were used. With the alkaline elution technique we measured an effect presumably related to the conformation of the DNA coil. With a viscometric and a fluorometric unwinding method we measured an effect presumably related to the number of unwinding points in DNA. For both compounds only the alkaline elution technique was clearly positive. The results suggest that both caprolactam and benzoin can induce an important change in the conformation of the DNA coil without inducing true breaks in DNA.

Hematocolpos in double vagina associated with uterus didelphus: US and MR findings.

The malformative syndrome of double vagina in association with uterus didelphus and kidney agenesis is a rare condition, often asymptomatic: if this condition is accompanied by imperforated obstructed hemivagina, the clinical manifestations depend on the presence of hematocolpos. MRI plays an important role for diagnosis because it allows to characterize the nature of the lesion and to evaluate the anatomical details of the uterine malformation. The authors describe this complex genital malformation and discuss the main US and MRI features.

Blood pressure, serum lipids, and fatty acids in populations on a lake-fish diet or on a vegetarian diet in Tanzania.

Major risk factors for coronary heart disease were assessed in two populations of Tanzania, one on a fish diet (FD) living along the coast of Lake Nyasa, and the other, mainly on a vegetarian diet (VD), living in a farming area. Lower blood pressure values were found in the FD subjects (n = 618) vs. VD (n = 618) (systolic blood pressure, SBP, 120 +/- 15 vs. 135 +/- 20, P < 0.01; diastolic blood pressure, DBP, 70 +/- 9 vs. 78 +/- 11, P < 0.01, respectively). In an FD subgroup (n = 61), total cholesterol (TC) (122 vs. 136 mg/dL, P < 0.01); triglycerides (TG) (82 vs. 105 mg/dL, P < 0.01); and lipoprotein (a) [Lp(a)] (19.9 +/- 18.4 vs. 32.3 +/- 22.4, P < 0.001) were lower than in a VD subgroup (n = 55). Serum fatty acids (FA) in the FD subgroup were as follows: eicosapentaenoic acid (EPA) (20:5) 2.48 vs. 0.72%, docosahexaenoic acid (DHA) (22:6) 5.93 vs. 1.49%, vs. the VD, respectively. Arachidonic acid (AA) (20:4n-6) also was higher in the FD vs. the VD group (9.85 vs. 8.30%, P < 0.05), whereas 18:2n-6 was about double (23.97 and 14.85%) in VD vs. FD. The peculiar serum FA pattern in FD reflected the FA of dietary fish. In fact, in four main species of lake fish, DHA was 8-19%, higher than EPA (1.8-4.2%), in contrast with the situation in cold-water fish, and AA was 5.8-8%, higher than in cold-water fish. The data, obtained in populations strictly on natural, unprocessed, low-fat diets, show that a diet based on freshwater fish results in lower BP, serum TC, TG, and Lp(a), and suggests that serum AA is not reduced when the major dietary n-3 is DNA rather than EPA.