Thoracic manifestations of tularaemia: a case series.

BACKGROUND: Tularaemia is a zoonotic disease caused by Francisella tularensis, a highly virulent bacterium that affects humans and small wild animals. It is transmitted through direct contact with infected animals or indirectly through contaminated soil, water or arthropod bites (e.g. ticks). Primary thoracic manifestations of tularaemia are infrequent and, therefore, a diagnostic challenge for clinicians. METHODS: We report six tularaemia cases with exclusively thoracic involvement diagnosed in a clinic for pulmonary diseases in Bavaria between 10/2020 and 02/2022. RESULTS: All patients lived or were active in rural areas, four reported a recent tick bite. All patients presented with thoracic lymphadenopathy and pulmonary tumours or consolidations; all underwent bronchoscopy with EBUS-TBNA of lymph nodes, three lung biopsies as well. Five patients showed inflammatory changes in the endobronchial mucosa. The main histological findings were necrotic epithelioid granulomas with remarkable granulocyte infiltration. All cases were identified by positive serology, five by PCR (here identification of F.t. ssp. Holarctica) from biopsy as well. As first-line therapy, oral ciprofloxacin was given (5/6); in 2/6 cases, a combination of quinolone-rifampicin was given. CONCLUSIONS: Pulmonary tularaemia may occur after tick bites and without extrathoracic manifestations. In patients who present with thoracic lymphadenopathy and pulmonary consolidations and who are exposed to increased outdoor activities, tularaemia should be included in the diagnostic pathway. Histologically, the presence of neutrophil-granulocyte infiltrations might help to distinguish tularaemia from other granulomatous infections, e.g. tuberculosis. The combination of quinolone-rifampicin rather than i.v. gentamicin reduced length of hospital stay in two patients.

Evaluation of corn hybrids for silage grown in different locations / Avaliação de híbridos de milho para silagem cultivados em diferentes locais

The aim of this study was to evaluate the yield, morphometric and chemical characteristics, and the digestibility of various corn hybrids cultivated in different locations for silage production. Four corn hybrids were grown: P2866H, P3456H, P30R50VYH and P4285YHR, in four locations, defined as farm A; B; C and D. The hybrid P4285YHR presented the highest plant and ear insertion heights (2.72m, 1.52m respectively), with a minimum registered height of 2.63 m and 1.42 m, for plant and ear insertion height, and for that reason it presented the highest yield of fresh biomass (78,089kg ha-1). The TND values showed trend very close to that observed in the DISMS of the whole-plant, with hybrid P3456H presenting the highest estimated value (68.74%), and the hybrid P4285YHR the lowest among them (65.25%). In general, lower fibrous carbohydrates and lignin content, higher fibrous carbohydrates content, together with satisfactory grains participation in the plant structure led to a greater dry matter digestibility. Hybrids with lower plant heights do not necessarily have lower dry biomass yields, but hybrids of greater height and with high stem and leaf participation tend to have a higher aFDN content and less dry matter digestibility.(AU)

O objetivo deste estudo foi avaliar o desempenho produtivo e as características morfométricas e químicas, além da digestibilidade de diferentes híbridos de milho cultivados em diferentes locais para produção de silagem. Foram cultivados quatro híbridos de milho: P2866H, P3456H, P30R50VYH e P4285YHR, em quatro locais, definidos como propriedades A; B; C e D. O híbrido P4285YHR apresentou as maiores alturas de planta e de inserção de espiga (2,72m, 1,52m, respectivamente), com altura mínima registrada, nos diferentes locais, de 2,63m e 1,42m, para altura de planta e inserção de espiga, e, por isso, apresentou o maior rendimento de biomassa fresca (78.089kg ha-1). Os valores calculados de NDT mostraram tendência muito próxima àquela observada na DISMS da planta inteira, tendo o híbrido P3456H apresentado o maior valor estimado (68,74%), e o híbrido P4285YHR o menor entre eles (65,25%). Em geral, menores concentrações de carboidratos fibrosos e lignina, maior teor de carboidratos fibrosos, juntamente com satisfatória participação de grãos na estrutura da planta, conduzem a uma maior digestibilidade da matéria seca. Híbridos com menores alturas de planta não necessariamente apresentam menores rendimentos de biomassa seca, mas híbridos de maior altura e com alta participação de colmo e folhas tendem a apresentar maior teor de aFDN e menor digestibilidade da matéria seca.(AU)

Effect of sealing on the feed out face of trench silos on the performance of confined calves / [Efeito da vedação na porção inicial de silos trincheiras sobre o desempenho de novilhos confinados]

This study aimed to evaluate the productive performance, dry matter intake, apparent digestibility and ingestive behavior of feedlot calves fed corn silage from the feed out face of trench silos with different types of sealing. The animals were divided into three treatments with four repetitions: Conventional seal - double-sided polyethylene of 110µm thickness; Double-sided seal - double-sided polyethylene of 200µm thickness; and Double seal - composed of double face polyethylene with a thickness of 80µm superimposed on a polyamide translucent vacuum film with a thickness of 20µm. The use of double face sealing provided 12.63% increase in average daily gain and improved food conversion by 0.62 percentage points. The apparent digestibility of the diet with double-face sealing system silage was 4.30% higher than the diet with double-face sealing silage and 11.00% higher than the diet with conventional sealing silage. It is recommended to use the double face sealing with 200µm polyethylene and double face sealing with 80µm thick polyethylene on top of a 20µm thick polyamide translucent vacuum film.(AU)

Objetivou-se avaliar o desempenho produtivo, o consumo de matéria seca, a digestibilidade aparente e o comportamento ingestivo de novilhos confinados, alimentados com silagem de milho da porção inicial de silos do tipo trincheira, conservada sob distintos tipos de vedação. Os animais foram divididos em três tratamentos, com quatro repetições: vedação convencional - polietileno tipo dupla face, com espessura de 110µm; vedação dupla face - polietileno tipo dupla face, com espessura de 200µm; e dupla vedação - polietileno tipo dupla face, com espessura de 80µm sobreposto a um filme vácuo translúcido de poliamida, com espessura de 20µm. O uso da vedação dupla face proporcionou incremento de 12,63% no ganho de peso médio diário e melhorou em 0,62 ponto percentual a conversão alimentar. A digestibilidade aparente da dieta com silagem do sistema de vedação dupla face foi 4,30% superior em relação à dieta com silagem da dupla vedação e 11,00% superior à dieta com silagem da vedação convencional. Recomenda-se a utilização tanto da vedação dupla face com polietileno de 200µm quanto da dupla vedação com polietileno tipo dupla face, com espessura de 80µm, sobreposto a um filme vácuo translúcido de poliamida com espessura de 20µm.(AU)

Production and nutritional quality of black oat forage grown in different population stands under a successive cutting regime / [Produção e qualidade nutricional da forragem de aveia-preta cultivada em diferentes estandes populacionais sob regime de cortes sucessivos]

The present study aimed to evaluate the agronomic productive and qualitative traits of forage of black oats grown in different stands of plants. The experimental design was a 2 x 2 factorial randomized complete block design consisting of four treatments, two plant stands (175 and 350 plants m2) associated with two successive cutting periods (vegetative and full vegetative) and four replications. The stand of plants did not influence the production of dry biomass; with 175 plants m2, we obtained a compensatory effect by the greater number of tillers m2-1 and/or tiller plant-1. The population stand influenced the chemical parameters, where 175 plants m2 resulted in forage with higher contents of hemicellulose and total digestible nutrients and a lower content of neutral detergent fiber. In the comparison between cuts, the first cut compared to the second presented higher values of crude protein (26.53%). It is recommended that the black oat be cultivated with a population stand of 175 plants m2 for generating an increase in the number of tillers m2-1 and tillers plant-1, in addition to improving the in situ dry matter digestibility of the whole plant, without causing reduction of production of dry biomass per unit area.(AU)

O presente trabalho objetivou avaliar as características agronômicas produtivas e qualitativas da forragem da aveia-preta submetida ao cultivo com diferentes estandes populacionais. O delineamento experimental foi de blocos ao acaso, em esquema fatorial 2 x 2, composto por quatro tratamentos, sendo dois estandes (175 e 350 plantas m2), associado a duas épocas de corte sucessivas (vegetativo e pleno vegetativo) e a quatro repetições. Os estandes populacionais não influenciaram a produção de biomassa seca, pois, com 175 plantas m2, obteve-se efeito compensatório por maior número de perfilhos m2-1 e/ou perfilho planta-1. O estande populacional influenciou os parâmetros bromatológicos, o qual, com 175 plantas m2, gerou produção de forragem com maiores teores de hemicelulose e de nutrientes digestíveis totais e um menor teor de fibra em detergente neutro. Na comparação entre os cortes, o primeiro corte, comparado ao segundo corte, apresentou maiores valores de proteína bruta (26,53%). Recomenda-se a aveia-preta cultivada com estande populacional de 175 plantas m2 por gerar aumento do número de perfilhos m2-1 e perfilhos planta-1, além de melhorar a digestibilidade in situ da matéria seca da planta inteira, sem causar redução de produção de biomassa seca por unidade de área.(AU)

Fiber composition and digestibility of fodder in different ryegrass fields submitted to different harvesting management systems / [Composição da fibra e digestibilidade da forragem de diferentes cultivares de azevém submetidos a diferentes sistemas de manejo de colheita]

This essay aims to evaluate the composition of fiber in neutral detergent, digestibility of plant components, as well as ruminal disappearance rate of fodder dry matter from five ryegrass fields submitted to different cut systems for the production of haylage. The experimental design was the randomized blocks one, at a 5 x 3 factorial scheme, with five cultivars (cv.) of ryegrass Lolium multiflorum (cv. Barjumbo, cv. BarHQ, cv. Ribeye, cv. Potro and cv. Willians) associated with three harvesting management systems: 1- single harvesting system at a pre-floral stage; 2 - double harvesting system, with a cut at vegetative stage and another at pre-floral stage; and 3 - triple harvesting system, with a cut at vegetative stage, a cut at full vegetative stage and a cut at pre-floral stage, with three repetitions each. Similarities were noticed on the results of fodder digestibility of different fields, however, cv. Potro presented a higher ruminal disappearance rate after 48 hours, with 69.27%. Generally, the harvesting management system with the increase of ryegrass cut frequency determined increments on the percentage of lignin and the reduction in the concentration of total nutrients and dry matter digestibility of the resulting hylage.(AU)

O objetivo do presente trabalho foi avaliar a composição da fibra em detergente neutro, digestibilidade dos componentes da planta, bem como a taxa de desaparecimento ruminal da matéria seca da forragem de cinco cultivares de azevém submetidos a diferentes sistemas de cortes para produção de silagem pré-secada. O delineamento experimental foi em blocos ao acaso,, em um fatorial 5 x 3, sendo cinco cultivares de azevém Lolium multiflorum (cv. Barjumbo, cv. BarHQ, cv. Ribeye, cv. Potro e cv. Willians) associados a três sistemas de manejo de colheita: 1 - sistema com única colheita no estádio de pré-florescimento; 2 - sistema com uma colheita no estádio vegetativo e outra no estádio de pré-florescimento; e 3 - sistema com uma colheita no estádio vegetativo, uma no estádio pleno vegetativo e outra no estádio de pré-florescimento, com três repetições cada. Notou-se similaridade entre os resultados de digestibilidade da forragem entre os cultivares, porém o cv. Potro apresentou a maior taxa de desaparecimento ruminal após 48 horas, com 69,27%. De maneira geral, o sistema de manejo de colheita mostrou que o aumento do número de cortes do azevém determinou incrementos nos teores de lignina e redução na concentração de nutrientes digestíveis totais e da digestibilidade da matéria seca nas silagens pré-secadas resultantes.(AU)

Yeast culture in the diet of feedlot steers: performance, carcass traits and feeding behavior / Cultura de leveduras na dieta de novilhos confinados: desempenho, características da carcaça e comportamento ingestivo

This study aimed to evaluate the performance, apparent digestibility of diet, ingestive behavior which occurred in two moments, carcass traits, being evaluated constituent and non-carcass components, and also the effect the yeast culture could promote in the peripheral temperature of rumen, hull and body temperature. The diets consisted of a constant ratio of 50% forage (maize silage) and 50% concentrate. Thirty-six steers, ½ Angus Nelore, with average age of 11 months and average initial body weight of 339.5±10kg were used in the experiment. The inclusion of yeast culture promoted a higher daily dry matter intake (8.83 vs 9.35kg day-1) and, consequently, a better daily weight gain (1,143 vs. 1,325kg day-1) in the initial feedlot phase, with no difference in other periods. The apparent digestibility of the diet containing yeast culture was higher than the control diet (69.69 versus 68.32%, respectively), and its use did not interfere with the feeding behavior of the animals. Based on our findings, supplementation with yeast culture may bring positive results in the initial feedlot phase.(AU)

O objetivo deste estudo foi avaliar o desempenho; a digestibilidade aparente da dieta; o comportamento oral ingestivo, o qual ocorreu em dois momentos, as características de carcaça, sendo avaliados componentes integrantes e não integrantes da carcaça; bem como o efeito que a cultura de leveduras pudesse promover perante a temperatura periférica de rúmen, casco e temperatura corpórea, sendo aferida por meio da temperatura retal. As dietas foram constituídas em uma constante relação de 50% de volumoso (silagem de milho) e 50% de concentrado. Utilizaram-se no experimento 36 novilhos, ½ sangue Angus Nelore, com idade média de 11 meses e peso vivo médio inicial de 339,5 ± 10kg. O uso de cultura de leveduras promoveu maior consumo diário de matéria seca (8,83 contra 9,35 kg dia-1) e consequentemente melhor ganho de peso diário (1,143 contra 1,325kg dia-1) na fase inicial do confinamento, não havendo diferença nos demais períodos. A digestibilidade aparente da dieta que continha cultura de leveduras foi superior à da dieta controle (69,69 contra 68,32%, respectivamente), e seu uso não interferiu no comportamento ingestivo dos animais. Com base nos resultados do presente estudo, a suplementação com cultura de leveduras pode trazer resultados positivos na fase inicial de confinamento.(AU)

Performance, carcass characteristics and ingestive behavior of steers fed with silages of different maize hybrids / Desempenho, características da carcaça e comportamento ingestivo de novilhos alimentados com silagens de diferentes híbridos de milho

The objective of this study was to evaluate the performance, carcass characteristics and ingestive behavior of feedlot steers fed with three maize hybrids: Maximus VIP3, Defender VIP and Feroz VIP. The experiment lasted 112 days, weighing animals four times, every 28 days. The experimental diets were formulated and constituted by maize silage and pelletized ration in a 50:50 ratio (dry basis). Regardless of the hybrid used, there was an increase in the intake of dry matter with the advance in feedlot evaluation period (9.15, 9.14, 9.35 and 9.59kg day-1, in the first, second, third and fourth weighing, respectively). The type of maize hybrid silage influenced weight gain of animals differently, with a final mean of 1.413kg for animals fed with Maximus VIP3, 1,375kg for those fed with Defender VIP and 1,184kg for those fed with Feroz VIP. The animals fed with Feroz VIP hybrid silage showed higher carcass gain efficiency and were more active in the number of times they went to the feeder. Although the three evaluated hybrids resulted in good animal performance, the carcass characteristics did not change; nevertheless, the hybrid Maximus VIP3 is recommended for its superior bromatological composition.(AU)

O objetivo deste trabalho foi avaliar desempenho, características da carcaça e comportamento ingestivo de novilhos terminados em confinamento alimentados com silagens dos híbridos de milho: Maximus VIP3, Defender VIP e Feroz VIP. O experimento teve duração de 112 dias, sendo quatro pesagens a cada 28 dias. As dietas experimentais foram formuladas e constituídas por silagem de milho e ração peletizada em proporção de 50:50, na base seca. Independentemente do híbrido utilizado, houve aumento conforme avanço na fase de terminação (9,15; 9,14; 9,35 e 9,59kg dia-1, na primeira, segunda, terceira e quarta pesagens, respectivamente). A distinção da silagem de milho determinou diferença no ganho de peso dos animais, com média final de 1,413kg para os animais tratados com Maximus VIP3, 1,375kg para os tratados com Defender VIP e 1,184 para aqueles alimentados com Feroz VIP. Os animais alimentados com silagem do híbrido Feroz VIP apresentaram maior eficiência de ganho de carcaça e foram mais ativos ao número de vezes em ir ao comedouro. Apesar dos três híbridos avaliados proporcionarem bons resultados relacionados ao desempenho animal, as características da carcaça não sofreram alterações; mesmo assim, recomenda-se o híbrido Maximus VIP3 por sua superioridade bromatológica.(AU)

Digestibilidade do amido e comportamento ingestivo de novilhos confinados sob efeito de doses de complexo enzimático em dietas de alta densidade energética / Digestibility of starch and ingestive behavior of feedlot steers by effect of enzymatic complex doses in high-energy diets

O objetivo do presente trabalho foi avaliar a conversão alimentar, a digestibilidade do amido, o comportamento ingestivo e o escore de sobras da dieta e de fezes de novilhos confinados, suplementados com doses do complexo enzimático (0; 2,5; 5,0 e 7,5g animal-1 dia-1) e alimentados com dieta constituída por 85% de grão de milho e 15% de núcleo proteico, vitamínico e mineral, na base seca, isenta de forragem. O delineamento experimental foi o de blocos ao acaso contendo quatro tratamentos e quatro repetições. Trinta e dois novilhos inteiros, ½ sangue Angus Nelore, com idade média de 12 meses e peso vivo médio inicial de 422kg, foram confinados por um período de 77 dias. Cada grama de inclusão de complexo enzimático melhorou a conversão alimentar em 0,1652%, reduziu a matéria seca das fezes em 0,4648% e o tempo de ingestão de água em 0,0068 horas dia-1. A máxima digestibilidade do amido foi alcançada na dose de 5,08g animal-1 dia-1. A inclusão progressiva do complexo enzimático à dieta de alta densidade energética promoveu melhoria na conversão alimentar, redução na matéria seca das fezes e diminuição do tempo de ingestão de água. A dose de 5g animal-1 dia-1 do complexo enzimático aumentou a digestibilidade do amido.(AU)

The objective was to evaluate the feed conversion, starch digestibility, ingestive behavior, diet leftover score and feces score of steers supplemented with doses of enzyme complex (0; 2.5; 5.0 and 7 .5g animal -1 day -1 ) fed with roughage-free diet composed of a mixture of 85% whole corn grain and 15% protein-mineral-vitamin mix, on a dry matter basis. A completely randomized block design was adopted, consisting of four treatments and four replicates. Thirty-two ½ Angus ½ Nellore crossbred steers at an average age of 12 months, with an average initial weight of 422kg, were kept in a feedlot for 77 days. Each gram of enzyme complex inclusion improved feed conversion in 0.1652%, decreased feces dry matter in 0,4648% and time of water intake in 0.0068 hours day -1 . The maximum starch digestibility was reached in the dose of 5,08g animal -1 day -1 . The gradual inclusion of enzyme complex promoted improvement in feed conversion, reduction in the dry matter of feces and redution in the time of water intake. The enzyme complex dose of 5.0g animal -1 day -1 increased the starch digestibility.(AU)

Cross-sectional increase of adherence to multidisciplinary tumor board decisions.

BACKGROUND: Cancer research has made great progress in the recent years. With the increasing number of options in diagnosis and therapy the implementation of tumorboards (TUBs) has become standard procedure in the treatment of cancer patients. Adherence tests on tumor board decisions are intended to enable quality assurance and enhancement for work in tumor boards in order to continuously optimize treatment options for cancer patients. METHODS: Subject of this study was the adherence of the recommendations made in three of 14 tumorboards, which take place weekly in the Center for Integrated Oncology (CIO) at the University Hospital Bonn. In total, therapy recommendations of 3815 patient cases were checked on their implementation. A classification into four groups has been made according to the degree of implementation. A second classification followed regarding the reasons for differences between the recommendation and the therapy which the patient actually received. RESULTS: The study showed that 80.1% of all recommendations in the three TUBs were implemented. 8.3% of all recommendations showed a deviance. Most important reasons for the deviances were patient wish (36.5%), patient death (26%) and doctoral decision, due to the patient's comorbidities or side effects of the treatment (24.1%).Interestingly, deviance in all three tumor boards in total significantly decreased over time. CONCLUSIONS: Aim of the study was to clarify the use of tumor boards and find approaches to make them more efficient. Based on the results efficiency might be optimized by increased consideration of patients` preferences, improved presentation of patient-related data, more detailed documentation and further structuring of the tumor board meetings.

Características produtivas e nutricionais do feno de trigo cultivado em dois níveis de adubação nitrogenada e estádios de colheita / Productive and nutritional characteristics of wheat hay cultivated in two nitrogen fertilization levels and harvest stages

O objetivo do presente trabalho foi avaliar a produção de fitomassa fresca e de fitomassa seca, assim como a composição física e bromatológica do feno do trigo cultivar BRS Umbu sob efeitos de dois níveis de adubação nitrogenada (120kg ha-1 e 180kg ha-1) e dois estádios fenológicos de colheita (pré-florescimento e grão farináceo). O delineamento experimental foi blocos ao acaso, em esquema fatorial 2x2, composto por quatro tratamentos com quatro repetições. Não houve interação (P>0,05) entre os níveis de adubação nitrogenada e os estádios fenológicos de colheita para todas as variáveis. A produção de fitomassa seca (P<0,05) nos estádios de grão farináceo e pré-florescimento foi de 10.171 e 4.982kg ha-1, respectivamente. A maior dose de N incrementou a produção de fitomassa seca em 775kg ha-1. Houve aumento da participação de espigas com o avanço do ciclo, apresentando-se 43,0% e 16,2% nos estádios grão farináceo e pré-florescimento, respectivamente. No estádio fenológico de pré-florescimento, a participação de folha verde foi superior (37,1% contra 9,8% da MS total). O feno colhido em estádio de grão farináceo apresentou menores teores de proteína bruta e fibra em detergente neutro. Os fenos produzidos apresentaram características distintas, o que permite seu uso em diferentes estratégias de alimentação de ruminantes.(AU)

The objective was to evaluate the production of the fresh and dry weight, physical and chemical composition of wheat hay, cv. BRS UMBU, under effects of two levels of nitrogen fertilization (120kg ha-1 and 180kg ha-1) and two harvest stages (pre-flowering and grain dough). The experimental design was randomized blocks in factorial 2X2, composed of four treatments with four replications. There was no interaction (p>0.05) between the levels of nitrogen fertilization and growth stages of harvest for all variables. The production of dry matter in the dough stage and pre-flowering were 10.171 and 4.982kg ha-1, respectively. The higher N rates increased the production of dry matter of 775kg ha-1. There was increased participation of spikes with the advancement of the cycle, presenting 43.0% and 16.2% in the dough stage and pre-flowering, respectively. In the growth stage of pre-flowering, the share of green leaf was higher (37.1% against 9.8% of the total MS). The hay harvested at dough stage had lower NDF and CP levels. Thus, each treatment presented favorable characteristics allowing its use in different strategies in ruminant nutrition.(AU)

Incidental Leydig Cell Tumor in Patient with Hormone Resistant Prostate Cancer.

We hereby present the case of a 55 years old patient with clinical diagnosis of high-risk prostate cancer T2bN1Mo Gleason 9 (4 + 5) treated with androgen deprivation therapy and external beam radiotherapy. Despite treatment, castration levels were not achieved and clinical progression was evidenced by the appearance of bone metastases and progression of PSA. After several hormonal treatments without any PSA or testosterone response, surgical castration was performed by bilateral orchiectomy. The pathology results showed an incidental Leydig cell tumor in the right testicle.

Molecular alterations in bone marrow mesenchymal stromal cells derived from acute myeloid leukemia patients.

The contribution of molecular alterations in bone marrow mesenchymal stromal cells (BM-MSC) to the pathogenesis of acute myeloid leukemia (AML) is poorly understood. Thus we assessed genome-wide genetic, transcriptional and epigenetic alterations in BM-MSC derived from AML patients (AML BM-MSC). Whole-exome sequencing (WES) of AML BM-MSC samples from 21 patients revealed a non-specific pattern of genetic alterations in the stromal compartment. The only mutation present in AML BM-MSC at serial time points of diagnosis, complete remission and relapse was a mutation in the PLEC gene encoding for cytoskeleton key player Plectin in one AML patient. Healthy donor controls did not carry genetic alterations as determined by WES. Transcriptional profiling using RNA sequencing revealed deregulation of proteoglycans and adhesion molecules as well as cytokines in AML BM-MSC. Moreover, KEGG pathway enrichment analysis unravelled deregulated metabolic pathways and endocytosis in both transcriptional and DNA methylation signatures in AML BM-MSC. Taken together, we report molecular alterations in AML BM-MSC suggesting global changes in the AML BM microenvironment. Extended investigations of these altered niche components may contribute to the design of niche-directed therapies in AML.

Non-Union in Upper Limb Fractures - Clinical Evaluation and Treatment Options.

Although non-unions in the upper limb are rare different treatment options of this challenging situation are still affected with up to 20% of failure rate due to current literature. Risk factors for delayed and non-union of fractures are mainly the size of the fracture gap and bone loss of open fractures or in primary surgery followed by other relevant internal and external factors. In the upper limb non-unions of long bones are described with up to 30% after operative intervention. Especially in the upper limb range of motion is limited in non-union cases and disables adjacent joints like the shoulder, elbow and wrist hence reducing the total activity level of affected patients. Beside careful investigation of the causes leading to the non-union a comprehensive treatment plan should be defined to achieve successful results. Treatment can be non-operative in several, selected cases, but in the majority of cases revision surgery is necessary to achieve osseous healing. Our own experience showed that non-union in the upper limb are rare and account for only 1.7% of all surgical managed upper limb fractures. Non-union of upper limb fractures occur most frequently in clavicle fractures followed by humeral fractures. Atrophic non-union is the most frequent reason for osseous non-union (57%) and osseous healing after revision surgery in non-unions is completed after a mean of 6.45 months. This article will give a brief overview of the genesis, clinical evaluation, treatment options and recommendations in upper limb non-unions according to the current literature. Key words: fracture, upper-limb, non-union, osteosynthesis, cancellous bone-graft.

Parâmetros nutricionais e estabilidade aeróbia de silagens de cereais de inverno submetidas a diferentes regimes de corte no estádio vegetativo / Cutting system in vegetative stage alters nutritional parameters and aerobic stability of Winter cereals silage

O uso de regimes de corte em estádio vegetativo para os cereais de inverno é interessante quando se busca intensificar a produção de alimento volumoso para ruminantes. No entanto, é necessário se averiguar o impacto desse manejo sobre as características das silagens resultantes. Dessa forma, o objetivo do experimento foi avaliar o valor nutricional e a estabilidade aeróbia de silagens de cereais de inverno, submetidas a regimes de corte no estádio vegetativo, prévio ao corte para ensilagem. Os cereais utilizados foram trigo (Triticum aestivum cv. BRS Gralha Azul), cevada (Hordeum vulgare cv. BRS Brau), aveia-branca (Avena sativa cv. URS Guará), aveia- preta (Avena strigosa cv. Embrapa 139) e triticale (X Triticosecale cv. IPR 11), associados a três regimes de corte: sem cortes prévios (silagem exclusiva); um corte; e com dois cortes em estádio vegetativo e subsequente produção de silagem. Na avaliação nutricional, a cevada apresentou valores baixos de FDA (311,7 e 375,3g kg de MS-1) e altos de NDT (569,2 e 533,4g kg de MS-1) para os sistemas com um e dois cortes, respectivamente. Na avaliação da estabilidade aeróbia, os materiais foram bastante estáveis após a abertura dos silos, com exceção da aveia-branca e da aveia-preta, no regime sem cortes. As silagens de triticale e de cevada apresentaram as maiores estabilidades nutricionais com o aumento no número de cortes.(AU)

The use of cutting regimes in vegetative stage for winter cereals is interesting when it seeks to intensify the forage production for ruminants. However, it is necessary to ascertain the impact of this management on the characteristics of the resulting silage. Thus, the aim of the experiment was to evaluate the nutritional quality and aerobic stability of winter cereal silages submitted to cutting regimes in vegetative stage, before ensiling. The materials used were: wheat (Triticum aestivum cv. BRS Gralha Azul); barley (Hordeum vulgare cv. BRS Brau); white oat (Avena sativa cv. URS Guará); black oat (Avena strigosa cv. Embrapa 139) and triticale (X Triticosecale cv IPR 11); associated with three management strategies: without previous cuts (Only silage), one cut and two cuts in vegetative and posterior silage making. Barley owned low values of ADF (311.7 and 375.3g kg de DM-1) and high TDN (569.2 and 533.4g kg de DM-1) for one and two-cut system, respectively. For aerobic stability, materials were quite stable after opening the silos, with the exception of black and white oat in management without cuts. Triticale and barley silage had the highest nutritional stability with the increase in the number of cuts.(AU)

Silencing of GATA3 defines a novel stem cell-like subgroup of ETP-ALL.

BACKGROUND: GATA3 is pivotal for the development of T lymphocytes. While its effects in later stages of T cell differentiation are well recognized, the role of GATA3 in the generation of early T cell precursors (ETP) has only recently been explored. As aberrant GATA3 mRNA expression has been linked to cancerogenesis, we investigated the role of GATA3 in early T cell precursor acute lymphoblastic leukemia (ETP-ALL). METHODS: We analyzed GATA3 mRNA expression by RT-PCR (n = 182) in adult patients with T-ALL. Of these, we identified 70 of 182 patients with ETP-ALL by immunophenotyping. DNA methylation was assessed genome wide (Illumina Infinium® HumanMethylation450 BeadChip platform) in 12 patients and GATA3-specifically by pyrosequencing in 70 patients with ETP-ALL. The mutational landscape of ETP-ALL with respect to GATA3 expression was investigated in 18 patients and validated by Sanger sequencing in 65 patients with ETP-ALL. Gene expression profiles (Affymetrix Human genome U133 Plus 2.0) of an independent cohort of adult T-ALL (n = 83) were used to identify ETP-ALL and investigate GATA3low and GATA3high expressing T-ALL patients. In addition, the ETP-ALL cell line PER-117 was investigated for cytotoxicity, apoptosis, GATA3 mRNA expression, DNA methylation, and global gene expression before and after treatment with decitabine. RESULTS: In our cohort of 70 ETP-ALL patients, 33 % (23/70) lacked GATA3 expression and were thus defined as GATA3low. DNA methylation analysis revealed a high degree of GATA3 CpG island methylation in GATA3low compared with GATA3high ETP-ALL patients (mean 46 vs. 21 %, p < 0.0001). Genome-wide expression profiling of GATA3low ETP-ALL exhibited enrichment of myeloid/lymphoid progenitor (MLP) and granulocyte/monocyte progenitor (GMP) genes, while T cell-specific signatures were downregulated compared to GATA3high ETP-ALL. Among others, FLT3 expression was upregulated and mutational analyses demonstrated a high rate (79 %) of FLT3 mutations. Hypomethylating agents induced reversal of GATA3 silencing, and gene expression profiling revealed downregulation of hematopoietic stem cell genes and upregulation of T cell differentiation. CONCLUSIONS: We propose GATA3low ETP-ALL as a novel stem cell-like leukemia with implications for the use of myeloid-derived therapies.

Predictors of Impaired Postpartum Renal Function in Women after Preeclampsia: Results of a Prospective Single Center Study.

Objective. The purpose of this prospective study was to investigate the predictive value of single prepartum findings combined with serum biomarkers sFlt-1 (soluble fms-like tyrosine kinase-1) and PlGF (placental growth factor) indicating severity of preeclampsia (PE) for occurrence and extent of impaired postpartum kidney function. Study Design. In this prospective, single center study 44 PE patients were compared to 39 healthy controls (similar in age and gestational age with singleton pregnancy) evaluated at time of delivery and at 6 months and 12 months postpartum. p values below 0.05 are considered statistically significant. Results. The majority of the PE patients had persistence of proteinuria (>120 mg/L after delivery) 6 months (p = 0.02) and 12 months postpartum (p < 0.0001) compared to controls. Also reduced GFR (glomerular filtration rate) persisted up to 6 months postpartum in PE patients compared to controls (p < 0.001). Prepartum sFlt-1 levels indeed correlated with impaired renal function parameters. Conclusion. A significant proportion of our PE patients had lower GFR levels and persistent proteinuria up to 12 months postpartum. Prepartum sFlt-1 is a trend-setting marker for impaired renal function postpartum, but it is not sufficient enough to predict renal impairment after PE. An evaluation of 24-month follow-up data is scheduled.

Capacidade produtiva e qualidade nutricional de gramíneas perenes submetidas a sistema contínuo de cortes / Productive capacity and nutritional quality of different perennial grasses submitted to a continued cuts system

O objetivo do trabalho foi avaliar a produtividade e as características bromatológicas dos estratos superior e inferior de gramíneas perenes em sistema contínuo de cortes. As cultivares avaliadas foram: Cynodon nlemfuensis Vanderyst cv. Estrela-roxa; Cynodon dactilon (L.) Pears cv. Coast-cross 1; Cynodon nlemfuensis Vanderyst cv. Tifton 68; Cynodon ssp. cv. Tifton 85; Cynodon dactilon sp. cv. Jiggs; Hemárthria altissima cv. Roxinha e Penissetum clandestinum cv. Quicuio. Todos os cortes foram realizados no momento em que cada cultivar alcançava 95% de interceptação luminosa. As cutivares Jiggs e Tifton 68, com 21.348 e 21.016kg ha-1, respectivamente, tiveram as maiores produções (P<0,05) de fitomassa seca acumulada. Na média geral dos cortes, o quarto corte apresentou a menor relação estrato superior:inferior em relação aos demais (P<0,05). Em relação ao estrato superior, a Tifton 85 apresentou o maior teor de PB, sendo superior estatisticamente (P<0,05) no primeiro, segundo e quarto cortes, enquanto no terceiro corte a Coast-cross apresentou o maior teor proteico. No geral, as cv. Jiggs e Tifton 68 apresentaram a maior produção de fitomassa acumulada. Já a cv. Tifton 85 foi responsável pelos maiores níveis de PB, enquanto os teores de carboidratos estruturais mantiveram padrão constante, tanto no estrato superior quanto inferior, em sistema de quatro cortes sucessivos.(AU)

The aim of this study was to evaluate the productivity and the bromatologic characteristics of the upper and lower strata of perennial grasses in four cut systems. The cultivars evaluated were: Cynodon nlemfuensis Vanderyst cv. Estrela Roxa; Cynodon dactilon (L.) Pears cv. Coast-cross 1; Cynodon nlemfuensis Vanderyst cv. Tifton-68; Cynodon ssp. cv. Tifton-85; Cynodon dactilon sp. cv. Jiggs; Hemárthria altissima cv. Roxinha, and Penissetum clandestinum cv. Quicuio. All cuts were made when each cv. reached 95% light interception. The cv. Jiggs and Tifton 68, with 21348 and 21016kg ha-1, respectively, were responsible for the higher yields (P<0.05) of accumulated dry biomass. The overall average of the cuts, the fourth cut had the lowest ratio upper stratum: lower compared to the others (P<0.05). Regarding the upper stratum, the cv. Tifton 85 had the highest CP content, statistically higher (P<0.05) in the first, second and fourth cut, while in the third cut the cv. Coast-cross had the highest protein content. In general, cv. Jiggs and Tifton 68 had the highest number of accumulated biomass. The cv. Tifton 85 was responsible for the higher levels of CP, whereas the levels of structural carbohydrates maintained a constant pattern, in both the upper and lower strata in four cut systems.(AU)