Quality assessment of Clinical Practice Guidelines (CPG) for the diagnosis and treatment of inflammatory bowel disease using the AGREE II instrument: a systematic review.

BACKGROUND: The incidence and diagnosis of inflammatory bowel disease (IBD) has increased considerably in recent years. Many clinical practice guidelines (CPG) have been developed for the management of this disease across different clinical contexts, however, little evidence exists on their methodological quality. Therefore, we aimed to systematically evaluate the quality of CPGs for the diagnosis and treatment of IBD using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. METHODS: We identified CPGs by searching databases (MEDLINE - PubMed, EMBASE, CINAHL, LILACS) and other sources of gray literature on January 2022. We included guidelines with specific recommendations for the diagnosis and treatment of IBD and evaluated them with the AGREE II instrument to assess their methodological quality. Six independent reviewers assessed the quality of the guidelines and resolved conflicts by consensus. We assessed the degree of agreement using the intraclass correlation coefficient (ICC) and change in quality over time was appraised in two periods: from 2012 to 2017 and from 2018 to 2022. RESULTS: We analyzed and evaluated 26 CPGs that met the inclusion criteria. The overall agreement among reviewers was moderate (ICC: 0.74; 95% CI 0.36 - 0.89). The mean scores of the AGREE II domains were: "Scope and purpose" 84.51%, "Stakeholder involvement" 60.90%, "Rigor of development" 69.95%, "Clarity of presentation" 85.58%, "Applicability" 26.60%, and "Editorial independence" 62.02%. No changes in quality were found over time. CONCLUSIONS: The quality of the CPGs evaluated was generally good, with a large majority of the assessed guidelines being "recommended" and "recommended with modifications"; despite this, there is still room for improvement, especially in terms of stakeholder involvement and applicability. Efforts to develop high quality CPGs for IBD need to be further optimized.

Metformin inhibits human spermatozoa motility and signalling pathways mediated by protein kinase A and tyrosine phosphorylation without affecting mitochondrial function.

Metformin is a leading antidiabetic drug that is used worldwide in the treatment of diabetes mellitus. This biguanide exerts metabolic and pleiotropic effects in somatic cells, although its invitro actions on human spermatozoa remain unknown. The present study investigated the effects of metformin on human sperm function. Human spermatozoa were incubated in the presence or absence of 10mM metformin for 8 or 20h, and motility was measured by computer-aided sperm analysis (CASA); other parameters were evaluated by flow cytometry. Metformin significantly reduced the percentage of motile, progressive and rapid spermatozoa and significantly decreased sperm velocity. Metformin did not affect viability, mitochondrial membrane potential (MMP) or mitochondrial superoxide anion generation of human spermatozoa at any time studied. However, metformin clearly inhibited the protein kinase (PK) A pathway and protein tyrosine phosphorylation at 8 and 20h, key regulatory pathways for correct sperm function. In summary, metformin treatment of human spermatozoa had a detrimental effect on motility and inhibited essential sperm signalling pathways, namely PKA and protein tyrosine phosphorylation, without affecting physiological parameters (viability, MMP, mitochondrial superoxide anion generation). Given the growing clinical use of metformin in different pathologies in addition to diabetes, this study highlights an adverse effect of metformin on spermatozoa and its relevance in terms of human fertility in patients who potentially could be treated with metformin in the future.

Metformin blocks mitochondrial membrane potential and inhibits sperm motility in fresh and refrigerated boar spermatozoa.

Metformin is clinically used to treat diabetes. Given its role-impacting metabolism, metformin has been also added to semen cryopreservation media showing specie-dependent effects. We aimed to investigate metformin effects in both fresh (38.5°C for 2, 24 hr) and refrigerated (17°C for 10 days) boar spermatozoa. Metformin (2 hr) does not affect fresh sperm viability, membrane lipid organization nor acrosome integrity. However, metformin (24 hr) blocks sperm ΔΨm and significantly reduces % motile spermatozoa (65%), % progressive spermatozoa (50%), % rapid (100%), velocities VCL (69%), VSL (86%), VAP (78%) and motility coefficients. Metformin-including extender does not modify sperm viability, membrane lipid organization or acrosome integrity. Furthermore, it significantly reduces high ΔΨ-population spermatozoa at refrigeration day 4. Metformin also significantly reduces sperm motility during refrigeration. Summarizing, metformin inhibits both boar sperm ΔΨ and motility in any sperm condition studied: fresh and refrigerated. These findings dissuade metformin as an additive to improve boar sperm quality.

The effect of feed composition on anaerobic co-digestion of animal-processing by-products.

Four streams and their mixtures have been considered for anaerobic co-digestion, all of them generated during pig carcasses processing or in related industrial activities: meat flour (MF), process water (PW), pig manure (PM) and glycerin (GL). Biochemical methane potential assays were conducted at 37 °C to evaluate the effects of the substrate mix ratio on methane generation and process behavior. The results show that the co-digestion of these products favors the anaerobic fermentation process when limiting the amount of meat flour in the mixture to co-digest, which should not exceed 10%. The ratio of other tested substrates is less critical, because different mixtures reach similar values of methane generation. The presence in the mixture of process water contributes to a quick start of the digester, something very interesting when operating an industrial reactor. The analysis of the fraction digested reveals that the four analyzed streams can be, a priori, suitable for agronomic valorization once digested.

Closing system-wide yield gaps to increase food production and mitigate GHGs among mixed crop-livestock smallholders in Sub-Saharan Africa.

In this study we estimate yield gaps for mixed crop-livestock smallholder farmers in seven Sub-Saharan African sites covering six countries (Kenya, Tanzania, Uganda, Ethiopia, Senegal and Burkina Faso). We also assess their potential to increase food production and reduce the GHG emission intensity of their products, as a result of closing these yield gaps. We use stochastic frontier analysis to construct separate production frontiers for each site, based on 2012 survey data prepared by the International Livestock Research Institute for the Climate Change, Agriculture and Food Security program. Instead of relying on theoretically optimal yields-a common approach in yield gap assessments-our yield gaps are based on observed differences in technical efficiency among farms within each site. Sizeable yield gaps were estimated to be present in all of the sites. Expressed as potential percentage increases in outputs, the average site-based yield gaps ranged from 28 to 167% for livestock products and from 16 to 209% for crop products. The emission intensities of both livestock and crop products registered substantial falls as a consequence of closing yield gaps. The relationships between farm attributes and technical efficiency were also assessed to help inform policy makers about where best to target capacity building efforts. We found a strong and statistically significant relationship between market participation and performance across most sites. We also identified an efficiency dividend associated with the closer integration of crop and livestock enterprises. Overall, this study reveals that there are large yield gaps and that substantial benefits for food production and environmental performance are possible through closing these gaps, without the need for new technology.

AMPK up-activation reduces motility and regulates other functions of boar spermatozoa.

We recently demonstrated that AMPK inhibition in spermatozoa regulates motility, plasma membrane organization, acrosome integrity and mitochondrial membrane potential. As AMPK activity varies in different energy conditions induced by sperm environment, this work investigates the functional effects of AMPK activation in boar spermatozoa. Spermatozoa were incubated under non-stimulating (TBM) or Ca(2+) and [Formula: see text]-stimulating (TCM) media in the presence/absence of AMPK activator, A769662, for different times. AMPK activity, evaluated as Thr(172) phosphorylation by western blot, is effectively increased by A769662 in spermatozoa. AMPK activation significantly reduces the percentage of motile spermatozoa under Ca(2+) and/or [Formula: see text]-stimulating conditions. Moreover, AMPK activation in spermatozoa incubated in TBM or TCM significantly reduces curvilinear VCL, straight-line VSL and average VAP velocities, which subsequently lead to a significant decrease in the percentage of rapid spermatozoa (VAP > 80 µm/s). The effect of AMPK activation on motility is intensified by the absence of BSA in the incubation medium. AMPK activation for a short time prevents the decline in cell viability and in the sperm population displaying high mitochondrial membrane potential which is induced by Ca(2+) and [Formula: see text]. Sustained (24 h) AMPK activation under TBM or TCM significantly increases both lipid disorganization and phosphatidylserine externalization in the sperm plasma membrane, and diminishes the acrosome membrane integrity. In summary, AMPK activation modifies essential sperm processes such as motility, viability, mitochondrial membrane potential, acrosome membrane integrity, and organization and fluidity of plasma membrane. As these spermatozoa processes are required under different environmental conditions when transiting through the female reproductive tract to achieve fertilization, we conclude that balanced levels of AMPK activity are essential for regulating sperm function.

Effects of exposure to 17-alpha-ethynylestradiol on sperm quality of tench (Tinca tinca).

Alterations of sperm quality were studied in tench (Tinca tinca) exposed to sub-lethal doses of 17-alpha-ethynylestradiol-EE2-(50, 100 and 500µg/kg t.w) under semi-static conditions for 30 days. Thus, different biomarkers of sperm quality were assessed: concentration and volume of ejaculate, total number of spermatozoa, percentage of motile spermatozoa, sperm motility and percentage of live and dead spermatozoa. Sperm motility was examined by computer-assisted image analysis and the viability of spermatozoa was assessed through flow cytometry. The most relevant alterations observed were significant reductions in the reproductive parameters such as testicular somatic index, spermatozoa concentration, straight line velocity, curvilinear velocity, average path velocity and wobble in tench exposed to 50µg/kg t.w of EE2. Our study about the effects of EE2 on the sperm quality in tench provides new evidences which strengthen the fact that this synthetic estrogen is included in the list of non-monotonic dose response compounds in animal studies.

Bipolar disorder in the elderly: a cohort study comparing older and younger patients.

OBJECTIVE: The purpose of this study was to analyze differences in clinical and socio-demographic characteristics between older and younger bipolar outpatients paying special attention to depressive symptoms in a large, naturalistic cohort. METHOD: Five hundred and ninety-three DSM-IV-TR bipolar outpatients were enrolled. Clinical characteristics were assessed according to DSM-IV-TR (SCID-I). Subjects were categorized into two groups according to current age (older OBD: age > 65 years; younger-YBD: age < 65 years). RESULTS: About 80% of patients were younger (N = 470), and a fifth were older (N = 123), with a mean age of 77.30 years in OBD. Older patients were more likely to be married, not qualified, bipolar II, with depressive polarity of first episode, higher age at illness onset, higher age at first hospitalization. They were more likely to present with depressive predominant polarity, with lifetime history of catatonic, psychotic and melancholic features, age at illness onset >40 years, as well as suffering from more medical comorbidities when compared to younger bipolars. CONCLUSION: The clinical presentation of bipolar disorder in late life would be defined more frequently by melancholic depressive features and a predominantly depressive polarity. These results suggest that treatment strategies for elderly bipolar patients should focus in the prevention of depressive episodes.

The impact of repeated manic episodes and executive dysfunction on work adjustment in bipolar disorder.

The aim of this study was to study the clinical and neurocognitive variables that best explain poor work adjustment in a sample of bipolar I euthymic patients. Eighty-five euthymic patients at the Hospital Clinic of Barcelona were assessed for this study by means of a comprehensive neuropsychological battery and a work-focused interview to determine work adjustment. Clinical and sociodemographic variables were also collected. Direct logistic regression was performed to assess the impact of demographic, clinical and neuropsychological variables on the likelihood of presenting poor work adjustment. The model that best fitted contained five variables (Hamilton Depression Rating scores, number of manic episodes, number of perseverative errors in the Wisconsin Card Sorting Test (WCST), number of depressive episodes and Trail Making Test-part B). However, only two out of these variables made a unique statistically significant contribution to the model, which were number of manic episodes (OR 1.401; CI 1.05-1.86; p = 0.021) and number of perseverative errors in the WCST (OR 1.062; CI 1.00-1.12; p = 0.044). The model explained up to 36 % of the variance in work adjustment. This study highlights the role of manic relapses and neurocognitive impairment, specifically the role of executive function, in work adjustment.

Milk production and enteric methane emissions by dairy cows grazing fertilized perennial ryegrass pasture with or without inclusion of white clover.

An experiment was undertaken to investigate the effect of white clover inclusion in grass swards (GWc) compared with grass-only (GO) swards receiving high nitrogen fertilization and subjected to frequent and tight grazing on herbage and dairy cow productivity and enteric methane (CH4) emissions. Thirty cows were allocated to graze either a GO or GWc sward (n=15) from April 17 to October 31, 2011. Fresh herbage [16 kg of dry matter (DM)/cow] and 1 kg of concentrate/cow were offered daily. Herbage DM intake (DMI) was estimated on 3 occasions (May, July, and September) during which 17 kg of DM/cow per day was offered (and concentrate supplementation was withdrawn). In September, an additional 5 cows were added to each sward treatment (n=20) and individual CH4 emissions were estimated using the sulfur hexafluoride (SF6) technique. Annual clover proportion (± SE) in the GWc swards was 0.20 ± 0.011. Swards had similar pregrazing herbage mass (1,800 ± 96 kg of DM/ha) and herbage production (13,110 ± 80 kg of DM/ha). The GWc swards tended to have lower DM and NDF contents but greater CP content than GO swards, but only significant differences were observed in the last part of the grazing season. Cows had similar milk and milk solids yields (19.4 ± 0.59 and 1.49 ± 0.049 kg/d, respectively) and similar milk composition. Cows also had similar DMI in the 3 measurement periods (16.0 ± 0.70 kg DM/cow per d). Similar sward and animal performance was observed during the CH4 estimation period, but GWc swards had 7.4% less NDF than GO swards. Cows had similar daily and per-unit-of-output CH4 emissions (357.1 ± 13.6g of CH4/cow per day, 26.3 ± 1.14 g of CH4/kg of milk, and 312.3 ± 11.5 g of CH4/kg of milk solids) but cows grazing GWc swards had 11.9% lower CH4 emissions per unit of feed intake than cows grazing GO swards due to the numerically lower CH4 per cow per day and a tendency for the GWc cows to have greater DMI compared with the GO cows. As a conclusion, under the conditions of this study, sward clover content in the GWc swards was not sufficient to improve overall sward herbage production and quality, or dairy cow productivity. Although GWc cows had a tendency to consume more and emitted less CH4 per unit of feed intake than GO cows, no difference was observed in daily or per-unit-of-output CH4 emissions.

Gastrointestinal tract size, total-tract digestibility, and rumen microflora in different dairy cow genotypes.

The superior milk production efficiency of Jersey (JE) and Jersey × Holstein-Friesian (JE × HF) cows compared with Holstein-Friesian (HF) has been widely published. The biological differences among dairy cow genotypes, which could contribute to the milk production efficiency differences, have not been as widely studied however. A series of component studies were conducted using cows sourced from a longer-term genotype comparison study (JE, JE × HF, and HF). The objectives were to (1) determine if differences exist among genotypes regarding gastrointestinal tract (GIT) weight, (2) assess and quantify whether the genotypes tested differ in their ability to digest perennial ryegrass, and (3) examine the relative abundance of specific rumen microbial populations potentially relating to feed digestibility. Over 3 yr, the GIT weight was obtained from 33 HF, 35 JE, and 27 JE × HF nonlactating cows postslaughter. During the dry period the cows were offered a perennial ryegrass silage diet at maintenance level. The unadjusted GIT weight was heavier for the HF than for JE and JE × HF. When expressed as a proportion of body weight (BW), JE and JE × HF had a heavier GIT weight than HF. In vivo digestibility was evaluated on 16 each of JE, JE × HF, and HF lactating dairy cows. Cows were individually stalled, allowing for the total collection of feces and were offered freshly cut grass twice daily. During this time, daily milk yield, BW, and dry matter intake (DMI) were greater for HF and JE × HF than for JE; milk fat and protein concentration ranked oppositely. Daily milk solids yield did not differ among the 3 genotypes. Intake capacity, expressed as DMI per BW, tended to be different among treatments, with JE having the greatest DMI per BW, HF the lowest, and JE × HF being intermediate. Production efficiency, expressed as milk solids per DMI, was higher for JE than HF and JE × HF. Digestive efficiency, expressed as digestibility of dry matter, organic matter, N, neutral detergent fiber, and acid detergent fiber, was higher for JE than HF. In grazing cows (n=15 per genotype) samples of rumen fluid, collected using a transesophageal sampling device, were analyzed to determine the relative abundance of rumen microbial populations of cellulolytic bacteria, protozoa, and fungi. These are critically important for fermentation of feed into short-chain fatty acids. A decrease was observed in the relative abundance of Ruminococcus flavefaciens in the JE rumen compared with HF and JE × HF. We can deduce from this study that the JE genotype has greater digestibility and a different rumen microbial population than HF. Jersey and JE × HF cows had a proportionally greater GIT weight than HF. These differences are likely to contribute to the production efficiency differences among genotypes previously reported.

Influence of gonadotrophin-induced first oestrus on gilt fertility.

The aim of this study was to determine the association between the oestrous response of pre-pubertal gilts to gonadotrophin injection or boar exposure and their subsequent farrowing rate and litter size. At 154 days of age, randomly selected pre-pubertal gilts received an intramuscular injection of 400 IU equine chorionic gonadotrophin plus 200 IU human chorionic gonadotrophin (PG600(®) ; Merck Animal Health; n = 181). From the remaining pool of animals not treated with hormones, the first gilts showing signs of oestrus were selected to act as controls (n = 201). Boar exposure began at 155 days of age for both groups, and gilts were bred at a weight of approximately 130 kg. Comparisons were made between PG600(®) -treated gilts exhibiting oestrus or not within 7 days post-injection (early and late responders, respectively) and control gilts exhibiting oestrus or not within 30 days after beginning of boar exposure (select and non-select control gilts, respectively). By 162 days, oestrus was detected in 67.5% of PG600(®) -treated gilts compared with 5.7% of control gilts (p < 0.0001). The proportion of animals observed in oestrus at least three times before breeding was greater for select control gilts compared with early and late responder PG600(®) -treated gilts (p ≤ 0.001). There were no significant differences in farrowing rate and litter size between the four treatment groups. These data indicate that PG600(®) is an effective tool to induce an earlier oestrus in gilts, that subsequent farrowing rate and born alive litter size compare favourably to that of select gilts and that gilts failing to respond promptly to hormonal stimulation do not exhibit compromised fertility.

Evaluation of Intergovernmental Panel on Climate Change (IPCC) equations to predict enteric methane emission from lactating cows fed Mediterranean diets.

The study aimed to evaluate Intergovernmental Panel on Climate Change (IPCC) Tier 2 (2006 and 2019) to predict enteric CH4 emissions from lactating cows fed Mediterranean diets. The effects of the CH4 conversion factor (Ym; CH4 energy loss as a percentage of gross energy intake) and digestible energy (DE) of the diet were evaluated as model predictors. A data set was created using individual observations derived from 3 in vivo studies on lactating dairy cows housed in respiration chambers and fed diets typical of the Mediterranean region based on silages and hays. Five models using different Ym and DE were evaluated following a Tier 2 approach: (1) average values of Ym (6.5%) and DE (70%) from IPCC (2006); (2) average value of Ym (5.7%) and DE (70.0%) from IPCC (2019; 1YM); (3) Ym = 5.7% and DE measured in vivo (1YMIV); (4) Ym = 5.7 or 6.0%, depending on dietary NDF, and DE = 70% (2YM); and (5) Ym = 5.7 or 6.0%, depending on dietary NDF, and DE measured in vivo (2YMIV). Finally, a Tier 2 model for Mediterranean diets (MED) was derived from the Italian data set (Ym = 5.58%; DE = 69.9% for silage-based diets and 64.8% for hay-based diets) and validated on an independent data set of cows fed Mediterranean diets. The most accurate models tested were 2YMIV, 2YM, and 1YMIV with predictions of 384, 377, and 377 (g of CH4/d), respectively, versus the in vivo value of 381. The most precise model was 1YM (slope bias = 1.88%; r = 0.63). Overall, 1YM showed the highest concordance correlation coefficient value (0.579), followed by 1YMIV (0.569). Cross-validation on an independent data set of cows fed Mediterranean diets (corn silage and alfalfa hay) resulted in concordance correlation coefficient of 0.492 and 0.485 for 1YM and MED, respectively. The prediction of MED (397) was more accurate than 1YM (405) in comparison with the corresponding in vivo value of 396 g of CH4/d. The results of this study showed that the average values proposed by IPCC (2019) can adequately predict CH4 emissions from cows fed typical Mediterranean diets. However, the use of specific factors for the Mediterranean area, such as DE, improved the accuracy of the models.

Biochemical methane potential (BMP) of agro-food wastes from the Cider Region (Spain).

An inventory of agro-food industry organic waste streams with a high potential for biogas transformation was studied in a logistically viable area (Cider Region, Asturias, Spain). Three industries were selected as the most viable ones: livestock, dairy and beverage. The potential for methane production from six wastes (beverage waste, BW; milled apple waste, MA; milk waste, MK; yogurt waste, YG; fats and oils from dairy wastewater treatment, F&O and cattle manure, CM) at five different substrate:inoculum ratios (0.25, 0.50, 0.75, 1.00 and 1.50) was evaluated in laboratory batch assays. Obtained methane yields ranged from 202-549 mL STP CH(4)·g VS waste(-1), and the methane content in biogas ranged from 58-76%. The ultimate practical biochemical methane potentials were slightly affected by the substrate:inoculum ratio. The estimation of the regional fluxes of waste and methane potentials suggests anaerobic digestion as a sustainable solution for the valorization of the organic wastes generated in this Region.

Evaluation of pre-treatment processes for increasing biodegradability of agro-food wastes.

Anaerobic digestion (AD) technology can be employed for treating sewage sludge, livestock waste or food waste. Generally, the hydrolysis stage is the rate-limiting step of the AD processes for solid waste degradation. Therefore, physical, chemical and biological pre-treatment methods or their combination are required, in order to reduce the rate of such a limiting step. In this study, four methods (mechanical shredding, acid hydrolysis, alkaline hydrolysis and sonication) were tested to improve methane production and anaerobic biodegradability of different agro-food wastes and their mixtures. The kinetics of anaerobic degradation and methane production ofpre-treated individual wastes and selected mixtures were investigated with batch tests. Sonication at lower frequencies (37 kHz) proved to give the best results with methane productivity enhancements of over 100% in the case of pig manure and in the range of 10-47% for the other wastes assayed. Furthermore, the ultimate methane production was proportional, in all the cases, to the specific energy input applied (Es). Sonication can, thus, enhance waste digestion and the rate and quantity of biogas generated. The behaviour of the other pre-treatments under the conditions assayed is not significant. Only a slight enhancement of biogas production (around 10%) was detected for whey and waste activated sludge (WAS) after mechanical shredding. The lack of effectiveness of chemical pre-treatments (acid and alkaline hydrolysis) can be justified by the inhibition of the methanogenic process due to the presence of high concentrations of sodium (up to 8 g l(-1) in some tests). Only in the case of WAS did the acid hydrolysis considerably increase the biodegradability of the sample (79%), because in this case no inhibition by sodium took place. Some hints of a synergistic effect have been observed when co-digestion of the mixtures was performed.

Influence of cavitation, pelleting, extrusion and torrefaction petreatments on anaerobic biodegradability of barley straw and vine shoots.

When dealing with lignocellulosic biomass in anaerobic digestion, a pretreatment stage is always required to open the structure of the material, facilitating its degradation. Numerous methods have been developed to pretreat lignocellulosic biomass. Four of them: cavitation, pelleting, extrusion and torrefaction have been comparatively studied in this paper as ways to improve the production of methane by anaerobic digestion of two different feedstocks: barley straw and vine shoots. Additionally, how the selected pretreatments and the nature of the feedstock influence the formation of individual volatile fatty acids was examined. Cavitation was revealed as the most efficient pretreatment, increasing 240% and 360% the methane production for barley straw and vine shoots, respectively, although in absolute terms, barley straw has higher production rate and yield than vine shoots. Torrefaction carried out at 180 °C increased methane production, 81% for straw and 25% for vine shoots, while the process at higher temperatures (220 °C) negatively affected biogas production from both feedstocks. Finally, volatile fatty acids accumulation seems to neutralize any potential positive effects of densification pretreatments.

Prostatic artery embolization treatment for patients with benign prostatic hyperplasia who are permanent urinary catheter users ineligible for de-obstructive surgery.

INTRODUCTION: Benign prostatic hyperplasia is considered the most frequent cause of lower urinary tract symptoms. Urinary catheterization is the emergency treatment for patients with urinary retention and surgery is indicated in patients refractory to medical treatment. There is a group of people with important comorbidities that make them ineligible for surgery. Prostatic arterial embolization (PAE) could be presented as a safe and effective alternative to achieve bladder emptying and spontaneous urination, thus avoiding permanent urinary catheterization in patients with significant comorbidities that represent a contraindication for surgery. In this retrospective study, we evaluated the efficacy of PAE in patients with permanent urinary catheterization who are ineligible for surgical treatment. MATERIAL AND METHODS: Retrospective study of 26 patients with permanent urinary catheter who underwent prostatic embolization. Demographic and clinical data (age, use of anticoagulation, prostate volume, length of hospital stay, unilateral or bilateral embolization), Charlson comorbidity index evaluation and Clavien-Dindo classification for procedural complications were reviewed. Successful removal of permanent urinary catheter was analyzed at one month after the procedure. RESULTS: A total of 26 patients were included in the review. The median age was 85 years with a median prostate volume of 90 mL. A Charlson comorbidity score above 7 was obtained in 88.5% of the subjects. Only one patient had one Clavien-Dindo III complication. Of the 26 subjects, 17 (65.4%) had spontaneous micturition and a postvoid residual lower than 100 mL at one month post procedure. Overall, catheter removal was achieved in 19 out of 26 subjects (73.1%). CONCLUSION: PAE is a safe and effective treatment for patients with permanent urinary catheterization who are ineligible for surgical treatment.

Effect of recovery period of mixture pasture on cattle behaviour, pasture biomass production and pasture nutritional value.

Pasture management that considers pasture growth dynamics remains an open question. Conceptually, such management must allow for grazing only after the recuperation of the pasture between two separate timely grazing periods when pasture reaches optimum recovery, as per the first law of Voisin's rational grazing system. The optimum recovery period not only implies a pasture with better nutritional value and higher biomass yield but one that also reduces the production of enteric methane (CH4) to improve the grazing efficiency of cattle. Therefore, this study aimed to evaluate three different recovery periods (RP) of mixed grasses on the grazing behaviour of heifers, as well as herbage selectivity, herbage yield and nutritional value, in vitro degradability and CH4 production. Based on these criteria, three pasture RPs of 24 (RP24), 35 (RP3) and 46 (RP46) days were evaluated in six blocks using a randomized block design. At each predetermined RP, samples of the pasture were taken before the animals were allowed to graze. Right after collecting the pasture samples, heifers accessed the pasture during 4 h consecutively for grazing simulation and behavioural observations. We also measured the bite rate of each animal. The pasture growing for 24 days had the highest biomass production, best nutritional value, best efficiency of in vitro CH4 relative emission (ml) per DM degraded (g) and bite rate of the three RPs. Heifers all selected their herbage, irrespective of RP, but with different nutritional value and higher in vitro degradability. However, this did not change the production of in vitro CH4. Considering the growth conditions of the area where the study was performed, we recommend the shorter RP24 as the most suitable during the summer season. The study's findings support the idea of management intervention to increase the quality of grazing systems.

Erythropoietin pharmacology.

Anaemia is a frequent complication in cancer patients and may be multifactorial in origin. Treatment with recombinant human erythropoietin (rHuEPO) is an alternative to red blood cell transfusion. The evidence from clinical trials has established that patients with chemotherapy-induced anaemia with a haemoglobin concentration below 10 g/dl benefit from epoetin therapy. The native glycoprotein hormone consists of 165 amino acids with three N-glycosylation and one O-glycosylation sites. Epoetin and darbepoetin bind to the EPO receptor to induce intracellular signalling by the same intracellular molecules as native EPO. There are some differences in the glycosylation pattern which lead to variations in the pharmacokinetics and pharmacodynamics profiles. Pharmacokinetic and therapeutic studies have examined the use of rHuEPO administered intravenously and subcutaneously and there is accumulating evidence that the latter route has several advantages in cancer patients. After subcutaneous administration, the bioavailability of epoetin is about 20-30% and has a plasma half-life of >24 h. Darbepoetin has a longer half-life after subcutaneous administration of 48 h. The general recommendations are based on evidence from trials in which epoetin was administered 150 U/kg thrice weekly. The recommended initial dose for darbepoetin alpha is 2.25 mug/kg per week. The most serious adverse effects are hypertension, bleeding and increased risk of thrombotic complications. Caution is advised when used in patients who are at high risk for thromboembolic events. In the management of anaemic cancer patients, physicians should closely follow the National Comprehensive Cancer Network (NCCN) and American Society of Clinical Oncology (ASCO)/American Society of Hematology (ASH) guidelines.

Long term testing of Microbial Fuel Cells: Comparison of different anode materials.

This paper focuses on the long term operation and testing of three Microbial Fuel Cells (MFC) having three different anode materials: commercial carbon felt (C-FELT), polyaniline-deposited carbon felt (C-PANI) and carbon-coated Berl saddles (C-SADDLES). A mixed consortium from seawater was used as inoculum and acetate was used as substrate. Tests were conducted for four months under 1000Ω external load. The maximum power generation was obtained by C-SADDLES (102mWm(-2)) followed by C-FELT and C-PANI, respectively. A similar trend was obtained with the evaluation of electrical energy produced: C-SADDLES (2222J), C-PANI (2183J) and C-FELT (2114J). However, the performance of C-PANI decreased over time, most evidently due to degradation or deactivation of deposited polyaniline by the microorganisms' activity. These results provide evidence that the three-dimensional structure, C-SADDLES, offers excellent biocompatibility, high specific surface area, high conductivity and most importantly these properties are maintained for a long period of time.