Dopamine agonist serum concentrations and impulse control disorders in Parkinson's disease.

BACKGROUND AND PURPOSE: Impulse control disorders (ICDs) are common among Parkinson's disease patients using dopamine agonists. We wanted to determine whether ICD patients have higher dopamine agonist serum concentrations than those without any sign of ICD. METHODS: Patients who used either pramipexole or ropinirole depot once daily were screened for ICDs using the validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale. Those who scored above the cut-off for one or more of the four defined ICDs (gambling, compulsive sexual behavior, compulsive shopping, and binge-eating) were compared in a case-control study to patients who scored zero points (no evidence of ICD) on the same items. They were examined clinically and evaluated using relevant scales. Three blood samples were taken on the same day: before daily dose, and then 6 and 12 h later. RESULTS: Forty-six patients were included: 19 ICD-positive and 27 controls. Ropinirole serum concentrations 6 h after daily intake (Cmax ) were higher in the case group compared to the control group, as was the daily ropinirole dosage. No differences were observed in serum concentrations, dosage or total drug exposure for pramipexole. Disease duration and length of dopamine agonist treatment was significantly longer among ICD patients for ropinirole, but not for pramipexole. CONCLUSIONS: The use of pramipexole may in itself confer high ICD risk, whereas ICDs among ropinirole users depend more on serum concentration and drug exposure. The pharmacokinetic properties of ropinirole make it challenging to predict its effects on patients, which supports the need for therapeutic drug monitoring to reduce risk of ICD.

Age and healthy lifestyle behavior's disparities and similarities on knowledge of myocardial infarction symptoms and risk factors among public and outpatients in a resource-limited setting, cross-sectional study in greater Gaborone, Botswana.

OBJECTIVES: In this cross-sectional study from Botswana, we investigated knowledge of myocardial infarction (MI) symptoms and risk factors among the general public and outpatients with MI risk factors based on age and lifestyle behaviors, in addition to assessing associations with sociodemographic and MI risk factors. METHOD: Open-ended questionnaires about 8 MI symptoms and 10 risk factors, were administered by research assistants to a representative selection of outpatients (n = 525) and the public (n = 2248). Weight and height were measured in all participants and BMI was calculated. Knowledge scores were compared between the two groups. We examined whether sociodemographic and MI risk factors had impact on the scores. Analyses were further adjusted for lifestyle behavior (smoking status, dietary status and physical activities). RESULTS: The valid response rate was 97.9% comprising 97.8% for the public (n = 2199) and 98.1% for outpatients (n = 515). Public respondents (35.2 ± 12.3 years) were younger than outpatients (38.5 ± 12.6 years). The public comprised 56.9% females while outpatients 54.6%. In general, outpatients had higher knowledge of MI symptoms than the public, with mean scores ± SD of 3.49 ± 2.84 vs 2.80 ± 2.54. Outpatients also had higher knowledge score of MI risk factors than the public, with mean scores, 5.33 ± 3.22 vs 3.82 ± 3.07. For MI symptoms, outpatients were more aware than the public for chest pains among all ages, for arm pain/ numbness, neck/ jaw pain radiating to/ from chest, and feeling sick or looking pallor on the skin among those aged 35-49 years. Among both the public and outpatients, lower knowledge of both MI symptoms and risk factors was associated with primary education, not residing/working together, history of hypertension, no history of heart disease/stroke, and obesity. There were similarities and disparities on MI knowledge among respondents with various numbers of healthy lifestyle behaviours. CONCLUSION: Results call for urgent educational campaigns on awareness and knowledge of MI and using strategies based on age and lifestyle behavior.

Changes in Infection Prevention Practices and Occurrence of Skin Symptoms among Healthcare Workers, Cleaners and Day-care Workers in Norway during the COVID-19 Pandemic.

The COVID-19 pandemic has resulted in increased attention on infection prevention measures. This study aims to assess whether changes in hand hygiene procedures, use of personal protective equipment and moisturizers during the first year of the COVID-19 pandemic were associated with changes in the occurrence of skin symptoms among healthcare workers, cleaners, and day-care workers. A total of 602 participants (40%) responded to an electronic questionnaire, including questions on previous and current occupational exposure and skin problems. Increased frequency of hand washing, use of hand disinfectants, use of disposable gloves and moisturizers were all associated with an increased symptom score on the hands, wrists, forearms. Participants who increased their use of masks or respirators had a higher risk of facial skin symptoms, compared with those with non-increased occupational exposure. In conclusion, a change of behaviour among healthcare workers, cleaners and day-care workers during the first year of the COVID-19 pandemic, with an increase in occupational exposures and use of moisturizers, was associated with higher occurrence of facial skin symptoms and symptoms on the hands, wrists and forearms.

The surgical anatomy of a (robot-assisted) minimally invasive transcervical esophagectomy.

BACKGROUND: Transcervical esophagectomy allows for esophagectomy through transcervical access and bypasses the thoracic cavity, thereby eliminating single lung ventilation. A challenging surgical approach demands thorough understanding of the encountered anatomy. This study aims to provide a comprehensive overview of surgical anatomy encountered during the (robot-assisted) minimally invasive transcervical esophagectomy (RACE and MICE). METHODS: To assess the surgical anatomy of the lower neck and mediastinum, MR images were made of a body donor after, which it was sliced at 24-µm intervals with a cryomacrotome. Images were made every 3 slices resulting in 3.200 images of which a digital 3D multiplanar reconstruction was made. For macroscopic verification, microscopic slices were made and stained every 5 mm (Mallory-Cason). Schematic drawings were made of the 3D reconstruction to demonstrate the course of essential anatomical structures in the operation field and identify anatomical landmarks. RESULTS: Surgical anatomy 'boxes' of three levels (superior thoracic aperture, upper mediastinum, subcarinal) were created. Four landmarks were identified: (i) the course of the thoracic duct in the mediastinum; (ii) the course of the left recurrent laryngeal nerve; (iii) the crossing of the azygos vein right and dorsal of the esophagus; and (iv) the position of the aortic arch, the pulmonary arteries, and veins. CONCLUSIONS: The presented 3D reconstruction of unmanipulated human anatomy and schematic 3D 'boxes' provide a comprehensive overview of the surgical anatomy during the RACE or MICE. Our findings provide a useful tool to aid surgeons in learning the complex anatomy of the mediastinum and the exploration of new surgical approaches such as the RACE or MICE.

Public and outpatients' awareness of calling emergency medical services immediately by acute stroke in an upper middle-income country: a cross-sectional questionnaire study in greater Gaborone, Botswana.

OBJECTIVES: In this cross-sectional study from Botswana, we investigated awareness of calling emergency medical services (EMS) and seeking immediate medical assistance by acute stroke among stroke risk outpatients and public. METHOD: Closed-ended questionnaires on awareness of calling EMS and seeking immediate medical assistance by acute stroke, were administered by research assistants to a representative selection of outpatients and public. RESULTS: The response rate was 96.0% (93.0% for public (2013) and 96.6% for outpatients (795)). Public respondents had mean age of 36.1 ± 14.5 years (age range 18-90 years) and 54.5% were females, while outpatients had mean age of 37.4 ± 12.7 years (age range 18-80 years) and 58.1% were females. Awareness of calling EMS (78.3%), and of seeking immediate medical assistance (93.1%) by stroke attack was adequate. For calling EMS by acute stroke, outpatients had higher awareness than the public (p < 0.05) among those with unhealthy diet (90.9% vs 71.1%), family history of both stroke and heart diseases (90.7% vs 61.2%), no history of psychiatric diseases (93.2% vs 76.0%) and sedentary lifestyle (87.5% vs 74.8%). Predictors of low awareness of both calling EMS and seeking immediate medical assistance were no medical insurance, residing/working together, history of psychiatric diseases, and normal weight. Male gender, ≥50 years age, primary education, family history of both stroke and heart diseases, current smoking, no history of HIV/AIDS, and light physical activity were predictors of low awareness of need for calling EMS. CONCLUSION: Results call for educational campaigns on awareness of calling EMS and seeking immediate medical assistance among those with high risk factor levels.

Nutrient digestibility and endogenous protein losses in the foregut and small intestine of weaned dairy calves fed calf starters with conventional or enzyme-treated soybean meal.

The aims of this experiment were (1) to compare the effects of a soybean meal with an enzymatic treatment (ESBM) to reduce the concentration of antinutritional factors versus a standard soybean meal (SBM) on foregut and small intestine digestion in weaned dairy calves and (2) to estimate the endogenous losses of crude protein (CP) in the small intestine. Our hypothesis was that a diet containing ESBM instead of SBM would improve ruminal and small intestine digestion and absorption of nutrients. A T-cannula was placed in the duodenum, and a second T-cannula was installed in the distal ileum of 12 Holstein calves at approximately 3 wk of age. Calves were weaned on d 42, and on d 50 they were assigned randomly to a quadruplicated 3 × 3 Latin square with 10-d periods. Digesta samples were collected on d 7 and 8 from the ileum and d 9 and 10 from the duodenum. The diets were fed for ad libitum intake and consisted of a calf starter (CS) of 20% CP with SBM as the main source of protein (CTRL), and an isonitrogenous CS with an ESBM instead of SBM (ENZT). A third diet with a low content of CP (10%) and no soy protein was fed to estimate endogenous N losses and digestibilities of test ingredients. Flows and digestibilities of nutrients were compared between CTRL and ENZT and their test ingredients (SBM vs. ESBM, respectively). Duodenal net flows of CP and total AA as well as ruminal microbial protein synthesis per kilogram of digested CP were greater, and flow of nonprotein N and CP true (corrected by endogenous and microbial flows) foregut digestibility were lower with ENZT than CTRL. The apparent small intestine digestibilities of CP and total AA were greater for ESBM than SBM, but there were no differences between the CTRL and ENZT diets. We observed no differences in digestibilities at the duodenum or ileum of starch or NDF, but true small intestine digestibilities of CP and all AA were greater with ENZT than CTRL. Total endogenous protein losses in the small intestine estimated from calves fed the low-CP with no soy protein diet were 37 ± 1.5 g of CP and 29 ± 1.4 g of AA/kg of DMI. These values may be considered the basal endogenous losses as they are similar to values obtained with the regression method, which estimates N losses when dietary N is null. Our results indicated that the inclusion of an ESBM improved the efficiency of ruminal microbial protein synthesis per digested kilogram of organic matter and CP, and increased CP and AA absorption in the small intestine despite a greater proportion of undigested dietary protein entering the duodenum.

Sex Differences and Tumor Blood Flow from Dynamic Susceptibility Contrast MRI Are Associated with Treatment Response after Chemoradiation and Long-term Survival in Rectal Cancer.

Background MRI is the standard tool for rectal cancer staging. However, more precise diagnostic tests that can assess biologic tumor features decisive for treatment outcome are necessary. Tumor perfusion and hypoxia are two important features; however, no reference methods that measure these exist in clinical use. Purpose To assess the potential predictive and prognostic value of MRI-assessed rectal cancer perfusion, as a surrogate measure of hypoxia, for local treatment response and survival. Materials and Methods In this prospective observational cohort study, 94 study participants were enrolled from October 2013 to December 2017 (ClinicalTrials.gov: NCT01816607). Participants had histologically confirmed rectal cancer and underwent routine diagnostic MRI, an extended diffusion-weighted sequence, and a multiecho dynamic contrast agent-based sequence. Predictive and prognostic values of dynamic contrast-enhanced, dynamic susceptibility contrast (DSC), and intravoxel incoherent motion MRI were investigated with response to neoadjuvant treatment, progression-free survival, and overall survival as end points. Secondary objectives investigated potential sex differences in MRI parameters and relationship with lymph node stage. Statistical methods used were Cox regression, Student t test, and Mann-Whitney U test. Results A total of 94 study participants (mean age, 64 years ± 11 [standard deviation]; 61 men) were evaluated. Baseline tumor blood flow from DSC MRI was lower in patients who had poor local tumor response to neoadjuvant treatment (96 mL/min/100 g ± 33 for ypT2-4, 120 mL/min/100 g ± 21 for ypT0-1; P = .01), shorter progression-free survival (hazard ratio = 0.97; 95% confidence interval: 0.96, 0.98; P < .001), and shorter overall survival (hazard ratio = 0.98; 95% confidence interval: 0.98, 0.99; P < .001). Women had higher blood flow (125 mL/min/100 g ± 27) than men (74 mL/min/100 g ± 26, P < .001) at stage 4. Volume transfer constant and plasma volume from dynamic contrast-enhanced MRI as well as ΔR2* peak and area under the curve for 30 and 60 seconds from DSC MRI were associated with local malignant lymph nodes (pN status). Median area under the curve for 30 seconds was 0.09 arbitrary units (au) ± 0.03 for pN1-2 and 0.19 au ± 0.12 for pN0 (P = .001). Conclusion Low tumor blood flow from dynamic susceptibility contrast MRI was associated with poor treatment response in study participants with rectal cancer. © RSNA, 2020 Online supplemental material is available for this article.

Short communication: A pilot study to describe duodenal and ileal flows of nutrients and to estimate small intestine endogenous protein losses in weaned calves.

The aims of this pilot study were (1) to evaluate the effect of an ileal and duodenal cannulation surgery on body weight and dry matter intake, (2) to estimate endogenous losses of crude protein (CP) and AA in the small intestine, and (3) to describe duodenal and ileal flows of nutrients in weaned dairy calves. Three Holstein male calves were fitted at 7 wk of life with a T-cannula at the terminal ileum and another cannula at the proximal duodenum. On wk 14 of life, calves were randomly assigned to a single 3 × 3 Latin square with 10-d periods. The 3 diets were fed ad libitum and consisted of a control calf starter (CS) with conventional soybean meal (SBM) as the main source of protein (CTRL), an isonitrogenous (20% CP) CS with an enzyme-treated SBM as the main source of protein (ENZT), and a CS with low content of CP (10%) and no soy protein (LOCP). Flows and digestibilities of nutrients were compared between the soy-based high-protein diets (HICP) and LOCP, and between CTRL and ENZT. Final data were only available from 2 calves per diet (n = 2) because cannulas from 1 calf became inoperative after the first collection period. Duodenal flows of CP, total AA, nonprotein nitrogen, microbial N, and fatty acids, as well as apparent duodenal digestibility of starch, were greater for HICP than for LOCP, indicating a greater foregut microbial activity and digestion. The apparent ileal digestibility (AID) of organic matter, CP, and total AA were greater for HICP than for LOCP. Duodenal net flow of CP was greater for ENZT than for CTRL, but flow of AA was not different. On the other hand, duodenal flow of microbial N was greater, and flows of nonprotein N and starch were lower for the ENZT diet, suggesting a more efficient microbial activity in the rumen. Even though CTRL had a greater AID when compared with ENZT, the AID of CP and AA were greater for enzyme-treated SBM than for SBM. Endogenous losses in the small intestine per kilogram of duodenal dry matter flow were 47 ± 15 and 37 ± 12 g/d, and the true ileal digestibilities for the HICP diets were 86 ± 0.1 and 87 ± 0.1% for CP and AA, respectively. An optimal supply of CP and the inclusion of an enzyme-treated SBM improved the efficiency of microbial digestion and increased AA absorption. Although further research with greater biological replication is needed, our results indicate that there is potential to improve digestion and absorption of proteins through dietary strategies in young weaned calves.

Ileal digestibility and endogenous protein losses of milk replacers based on whey proteins alone or with an enzyme-treated soybean meal in young dairy calves.

Our objective was to measure and compare apparent ileal digestibility, standard ileal digestibility, and true ileal digestibility of crude protein (CP) and amino acids (AA) in milk replacers (MR) containing all milk proteins (WPC) or with 50% of the CP provided by an enzyme-treated soybean meal (ESBM). A T-cannula was placed in the ileum of 9 Holstein calves (8 males and 1 freemartin female) at approximately 15 d of age. After 2 wk postsurgery, calves were randomly assigned to a 3 × 3 replicated Latin square with 5-d periods. Calves were fed twice daily at a rate of 2% (dry matter) of body weight (1.25 kg/d on average), reconstituted to 15% solids, and adjusted weekly. No starter was offered to minimize rumen development. Digesta samples were collected continuously during 12 h on d 4 and 5 of each period. Basal endogenous losses of AA and CP were estimated by feeding an N-free MR to each calf during 1 period. Total endogenous losses (basal + specific; ENDtotal) were estimated by multivariate regression of the chi-squared distances between digesta and reference protein AA profiles. Ileal digesta pH with the ESBM diet was lower than that with the WPC diet. According to the piecewise nonlinear model of pH fluctuation, digesta pH during ESBM decreased more slowly after feeding and reached its nadir later than with the WPC diet. Diet did not affect average daily gain, but calves on the ESBM diet showed a bigger increment of withers height and lower mean fecal scores. The basal endogenous losses of AA and CP were 13.9 ± 1.1 and 22.4 ± 1.1 g/kg of dry matter intake, respectively. The estimated ENDtotal of AA and CP was higher with ESBM than with WPC. Accordingly, apparent ileal digestibility and standard ileal digestibility of most AA, CP, and total AA were lower or tended to be lower with ESBM. However, true ileal digestibility did not differ between diets for CP and all AA except Ala and Ile, which were greater with WPC, and Arg, which tended to be greater with ESBM. In agreement with the estimated differences in ENDtotal, we found that flows of digesta DNA and crude mucin were greater with ESBM. Substitution of 50% of the protein from whey with enzymatically treated soybean meal did not affect major nutrient digestibility or calf growth and even improved fecal consistency. Adjusting digestibilities of CP and AA in MR by endogenous protein losses is crucial when comparing bioavailability of alternative proteins and milk proteins.

Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction.

RATIONALE: Cleaning tasks may imply exposure to chemical agents with potential harmful effects to the respiratory system, and increased risk of asthma and respiratory symptoms among professional cleaners and in persons cleaning at home has been reported. Long-term consequences of cleaning agents on respiratory health are, however, not well described. OBJECTIVES: This study aimed to investigate long-term effects of occupational cleaning and cleaning at home on lung function decline and airway obstruction. METHODS: The European Community Respiratory Health Survey (ECRHS) investigated a multicenter population-based cohort at three time points over 20 years. A total of 6,235 participants with at least one lung function measurement from 22 study centers, who in ECRHS II responded to questionnaire modules concerning cleaning activities between ECRHS I and ECRHS II, were included. The data were analyzed with mixed linear models adjusting for potential confounders. MEASUREMENTS AND MAIN RESULTS: As compared with women not engaged in cleaning (ΔFEV1 = -18.5 ml/yr), FEV1 declined more rapidly in women responsible for cleaning at home (-22.1; P = 0.01) and occupational cleaners (-22.4; P = 0.03). The same was found for decline in FVC (ΔFVC = -8.8 ml/yr; -13.1, P = 0.02; and -15.9, P = 0.002; respectively). Both cleaning sprays and other cleaning agents were associated with accelerated FEV1 decline (-22.0, P = 0.04; and -22.9, P = 0.004; respectively). Cleaning was not significantly associated with lung function decline in men or with FEV1/FVC decline or airway obstruction. CONCLUSIONS: Women cleaning at home or working as occupational cleaners had accelerated decline in lung function, suggesting that exposures related to cleaning activities may constitute a risk to long-term respiratory health.

Technical note: Establishment of an ileal cannulation technique in preweaning calves and use of a piecewise regression approach to evaluate effects on growth and pH fluctuation of ileal digesta.

Digestibilities of nutrients, especially protein, are crucial characteristics of milk replacers in a calf-rearing program. Endogenous synthesis of proteins and microbial fermentation in the large intestine alter apparent total-tract digestibility of AA. Therefore, collection of digesta samples at the end of the ileum is the only method to estimate true small intestinal digestibility of AA. The aim of this work was to evaluate the effectiveness of inserting a T-cannula into the distal ileum of preweaning calves for use in digestibility studies. A second objective was to evaluate the use of a "broken-line" statistical model to compare treatment effects on calf growth and digesta pH. A T-cannula was surgically installed in the terminal ileum of 2 calves approximately 5 cm anterior to the ileocecal junction at 15 d of age, and 2 paired noncannulated calves were used as controls. Cannulation did not affect mean body weight (BW), average daily gain, milk and water intakes, and body frame dimensions. However, final BW (89.2 vs. 94.6 kg) was lower and starter intake (0.06 vs. 0.21 kg/d) tended to be decreased in cannulated calves compared with control calves. No effects on health scores, rectal temperature, or the odds of incurring diarrhea or being medicated were observed. Flow of digesta (46.4 ± 0.04 g/h) increased linearly after feeding, whereas there was a quadratic effect of time on digesta pH, with the nadir at approximately 8.5 h postfeeding. The broken-line model successfully fitted daily fluctuations of pH and allowed us to detect differences in growth slopes between cannulated and control calves. Despite the expected negative effect on BW, we conclude that this technique permitted sampling of representative ileal digesta while allowing satisfactory growth and health of the calves.

[Aggressive B­cell lymphomas : Recommendations from the German Panel of Reference Pathologists in the Competence Network on Malignant Lymphomas on diagnostic procedures according to the current WHO classification, update 2017]. / Aggressive B­Zell-Lymphome : Empfehlungen des Deutschen Panels der Referenzpathologen im Kompetenznetz Maligne Lymphome e. V. zum diagnostischen Vorgehen nach der aktuellen WHO-Klassifikation, Update 2017.

The update of the 4th edition of the WHO classification for hematopoietic neoplasms introduces changes in the field of mature aggressive B­cell lymphomas that are relevant to diagnostic pathologists. In daily practice, the question arises of which analysis should be performed when diagnosing the most common lymphoma entity, diffuse large B­cell lymphoma. We discuss the importance of the cell of origin, the analysis of MYC translocations, and the delineation of the new WHO entities of high-grade B­cell lymphomas.

[Revised version of the 4th edition of the WHO classification of malignant lymphomas : What is new?] / Revidierte Fassung der 4. Ausgabe der WHO-Klassifikation maligner Lymphome : Was ist neu?

After 8 years, the WHO has now published the updated version of the 4th edition of the classification of hematopoietic and lymphoid tumors. This update provides a conceptual rewrite of existing entities as well as some new provisional entities and categories, particularly among the aggressive B­cell lymphomas. Important new diagnostic categories include the high-grade B­cell lymphomas, the large B­cell lymphoma with IRF4 rearrangement, and the Burkitt-like lymphoma with 11q aberrations. Of particular importance, new concepts concerning the taxonomy and classification of early lymphoid lesions or precursor lesions are included, such as the in situ follicular neoplasia or the in situ mantle cell neoplasia. In addition, the concept of indolent lymphoproliferations, such as breast-implant-associated anaplastic large cell lymphoma and the indolent T­cell lymphoproliferative disorder of the gastrointestinal tract, has been strengthened. Finally, diagnostic criteria for existing lymphoma entities have been refined.

Less periprosthetic bone loss following the anterolateral approach to the hip compared with the direct lateral approach.

Background and purpose - The loss of bone mineral in the proximal femur following hip arthroplasty may increase the fracture risk around uncemented stems. We hypothesized that the surgical approach to the hip might influence bone mineral changes around the femoral stem in patients with a femoral neck fracture (FNF). Patients and methods - This was a pre-specified subgroup analysis (n = 51) of an ongoing randomized trial (n = 120) in patients with FNF. Participants were allocated to an uncemented hemiarthroplasty inserted through a direct lateral (Hardinge) approach or an anterolateral (modified Watson-Jones) approach. The 51 patients (mean age 83 (70-90) years, 33 women) were measured by dual-energy X-ray absorptiometry (DXA) to assess changes in periprosthetic bone mineral density (BMD). Results - The mean change in total BMD differed between groups at 12 months in favor of the anterolateral group (4.8%, 95% CI 0.0-9.6; p = 0.05). DXA at 3 months displayed BMD loss in the proximal Gruen zones in the lateral group compared with the anterolateral group. Zone 1 (-5.0% vs. 2.7%), zone 2 (-4.3% vs. 4.1%), zone 6 (-6.5% vs. 0.0%) and zone 7 (-11% vs. -2.4%, all p < 0.05). Interpretation - DXA measurements in this study indicate that surgical approach to the hip influences periprosthetic BMD. Clinical implications remain uncertain. Our conclusions should be interpreted with caution as we did not perform adjustments for multiple tests, possibly leading to inflation of false-positive findings.

Fully robotic da Vinci Ivor-Lewis esophagectomy in four-arm technique-problems and solutions.

The aim of this technical note is a step-by-step description of a fully robotic abdominothoracic esophagectomy with an intrathoracic esophagogastrostomy. We report on our technique and short-term results of 75 patients undergoing an Ivor-Lewis esophagectomy using a fully robotic 4-arm approach in the abdominal and thoracic phase with a hand-sewn intrathoracic anastomosis. There are several important steps and differences to consider compared to the conventional minimal invasive approach (patient's positioning, anaesthesiological set up, port placement, gastric conduit pull up, technique of esophagostrostomy). Mean operative time was 392 minutes (240-610) with a 94% R0 resection status. Conversion to open procedure occurred in 2 (2.6%) in the abdominal, and 14 (18.2%) in the thoracic phase. Main reasons for conversion were problems during the lifting of the gastric conduit and difficulties in the construction of the esophagogastrostomy. The rate dropped during the last 20 patients (1/20 (10%). Our results suggest that the reported technique is safe and feasible. It satisfies the oncological principles and provides the advantages of robotic assisted minimal invasive surgery.

Prevalence of, and work-related risk factors for, hand eczema in a Norwegian general population (The HUNT Study).

BACKGROUND: Chemical exposures at work and at home may cause hand eczema. However, this has been scarcely described for Norway. OBJECTIVES: To investigate the prevalence of, and occupational risk factors for, hand eczema in Norway. METHODS: Among 50 805 respondents (aged ≥20 years) to the third Nord-Trøndelag Health Study (HUNT3), 5757 persons reported ever having hand eczema, and 4206 answered a hand eczema questionnaire. RESULTS: The lifetime prevalences of hand eczema were 8.4% in men and 13.8% in women (p < 0.001), with onset at age ≤10 years in 24% (men) and 20% (women), and onset at age ≥30 years in 37% (men) and 25% (women) (p < 0.001). Work-related hand eczema affected 4.8% of the population, and was most frequently associated with health/social work (29%) and occupational cleaning (20%) in women, and with farming (26%) and industrial occupations (27%) in men. Cleaning detergents (75%) and other chemicals (36%) were the most common exacerbating factors. CONCLUSIONS: The prevalence of hand eczema was 11.3%, and that of work-related hand eczema was 4.8%. Hand eczema was more common in women than in men, but with a later onset in men. Cleaning detergents were the most common aggravating factors. A large proportion of the Nord-Trøndelag population is employed in farming, providing the possibility to identify farming as an important risk factor for hand eczema.

Clinical, pathological and genetic features of follicular lymphoma grade 3A: a joint analysis of the German low-grade and high-grade lymphoma study groups GLSG and DSHNHL.

BACKGROUND: Histologically, follicular lymphoma (FL) grades 1, 2 and 3A are composed of two distinct cell types, centroblasts and centrocytes. FL grade 3B is composed only of centroblasts and has been shown to differ in immunophenotype and genetics from FL that contain centrocytes. We aimed to understand the pathogenetic and clinical relation between FL grade 3A to FL grade 1/2 on the one hand and FL grade 3B on the other hand. PATIENTS AND METHODS: Trial patients with long-term follow-up and diagnosis of FL grade 3 were selected and samples underwent a second central pathological review using a multiple-observer approach to assess grading. RESULTS: Interobserver variability for diagnosing FL grade 3 was high. FL grade 3A frequently harbored areas of FL grade 1/2 within the same tissue specimen. FL grade 3B rarely coexisted with grade 1/2 or 3A, suggesting divergent pathogenesis. There was no statistically significant difference in outcome between 47 cases of FL grade 3A and 14 cases of grade 3B. Compared with grade 1/2 FL, both groups showed longer progression-free survival without late events, especially after immunochemotherapy; this outcome difference was retained after adjustment for clinical prognostic factors. The subgroup of FL grade 3A with an additional FL grade 1/2 component or a translocation t(14;18) showed a poorer outcome. In contrast, the FL grade 3A lacking t(14;18) and of localized stage resembled the pediatric type of FL and showed a very good outcome. FL3 with MYC breaks showed a poor outcome. CONCLUSIONS: The results suggest that first-line immunochemotherapy might allow long-lasting remissions in a subgroup of FL grade 3A similar to diffuse large B-cell lymphoma. Within FL3A, prognostic subgroups can be identified by analyzing for coexisting FL1/2 and MYC breaks.

Effects of Post-harvest Storage Duration and Variety on Nutrient Digestibility and Energy Content Wheat in Finishing Pigs.

This study was conducted to investigate the effects of post-harvest storage duration and wheat variety on the digestibility and energy content of new season wheat fed to finishing pigs. Two wheat varieties (Shi and Zhong) were harvested in 2013 and stored in the warehouse of the Fengning Pig Experimental Base at China Agricultural University for 3, 6, 9, or 12 mo. For each storage period, 12 barrows were placed in metabolism crates and allotted to diets containing 1 of the 2 wheat varieties in a randomized complete block design. The experimental diets contained 97.34% wheat and 2.66% of a vitamin and trace mineral premix. With an extension of storage duration from 3 mo to 12 mo, the gross energy (GE) and crude protein (CP) of the wheat decreased by 2.0% and 12.01%, respectively, while the concentration of neutral detergent fiber (NDF), acid detergent fiber (ADF) and starch content increased by 30.26%, 19.08%, and 2.46%, respectively. Total non-starch polysaccharide, total arabinose, total xylose and total mannose contents decreased by 46.27%, 45.80%, 41.71%, and 75.66%, respectively. However, there were no significant differences in the chemical composition between the two wheat varieties with the exception of ADF which was approximately 13.37% lower in Shi. With an extension of storage duration from 3 mo to 12 mo, the digestible energy (DE), metabolizable energy (ME) content and the apparent total tract digestibility of GE, CP, dry matter, organic matter, ether extract, ADF and metabolizability of energy in wheat decreased linearly (p<0.01) by 5.74%, 7.60%, 3.75%, 3.88%, 3.50%, 2.47%, 26.22%, 27.62%, and 3.94%, respectively. But the digestibility of NDF changed quadratically (p<0.01). There was an interaction between wheat variety and storage time for CP digestibility (p<0.05), such that the CP digestibility of variety Zhong was stable during 9 mo of storage, while the CP digestibility of variety Shi decreased (p<0.05). In conclusion, the GE, DE, and ME of wheat was stable during the first 3 to 6 mo of post-harvest storage, and decreased during the following 6 to 12 mo of storage under the conditions of this study.

- invited review - calcium digestibility and metabolism in pigs.

Calcium (Ca) and phosphorus (P) are minerals that have important physiological functions in the body. For formulation of diets for pigs, it is necessary to consider an appropriate Ca:P ratio for an adequate absorption and utilization of both minerals. Although both minerals are important, much more research has been conducted on P digestibility than on Ca digestibility. Therefore, this review focuses on aspects that are important for the digestibility of Ca. Only values for apparent total tract digestibility (ATTD) of Ca have been reported in pigs, whereas values for both ATTD and standardized total tract digestibility (STTD) of P in feed ingredients have been reported. To be able to determine STTD values for Ca it is necessary to determine basal endogenous losses of Ca. Although most Ca is absorbed in the small intestine, there are indications that Ca may also be absorbed in the colon under some circumstances, but more research to verify the extent of Ca absorption in different parts of the intestinal tract is needed. Most P in plant ingredients is usually bound to phytate. Therefore, plant ingredients have low digestibility of P due to a lack of phytase secretion by pigs. During the last 2 decades, inclusion of microbial phytase in swine diets has improved P digestibility. However, it has been reported that a high inclusion of Ca reduces the efficacy of microbial phytase. It is possible that formation of insoluble calcium-phytate complexes, or Ca-P complexes, not only may affect the efficacy of phytase, but also the digestibility of P and Ca. Therefore, Ca, P, phytate, and phytase interactions are aspects that need to be considered in Ca digestibility studies.