Relation between body composition and severe diarrhea in patients treated with preoperative chemoradiation with capecitabine for rectal cancer: a single-centre cohort study.

BACKGROUND: Chemoradiation with capecitabine followed by surgery is standard care for locally advanced rectal cancer (LARC). Severe diarrhea is considered a dose-limiting toxicity of adding capecitabine to radiation therapy. The aim of this study was to describe the risk factors and the impact of body composition on severe diarrhea in patients with LARC during preoperative chemoradiation with capecitabine. METHODS: A single centre retrospective cohort study was conducted in a tertiary referral centre. All patients treated with preoperative chemoradiation with capecitabine for LARC from 2009 to 2015 were included. Patients with locally recurrent rectal cancer who received chemoradiation for the first time were included as well. Logistic regression analyses were performed to identify risk factors for severe diarrhea. RESULTS: A total of 746 patients were included. Median age was 64 years (interquartile range 57-71) and 477 patients (64%) were male. All patients received a radiation dosage of 25 × 2 Gy during a period of five weeks with either concomitant capecitabine administered on radiation days or continuously during radiotherapy. In this cohort 70 patients (9%) developed severe diarrhea. In multivariable logistic regression analyses female sex (OR: 4.42, 95% CI 2.54-7.91) and age ≥ 65 (OR: 3.25, 95% CI 1.85-5.87) were the only risk factors for severe diarrhea. CONCLUSIONS: Female patients and patients aged sixty-five or older had an increased risk of developing severe diarrhea during preoperative chemoradiation therapy with capecitabine. No relation was found between body composition and severe diarrhea.

Sponge: effect on the form of reef corals.

The sponge, Mycale laevis, when encrusting the lower surfaces of flattened reef corals, induces marked peripheral folding of the host colonies. This relationship, though facultative, has advantages for both associates. The sponge has a continually enlarging substrate that is free from competitive sessile forms. The coral may benefit from an increased feeding efficiency as a result of water currents produced by the sponge and it is protected from invasion by boring forms, notably clionid sponges.

Recent brachiopod-coralline sponge communities and their paleoecological significance.

Brachiopods and coralline sponges are the dominant taxa of a series of parallel pantropical communities found in cryptic habitats of Recent coral reefs, where these organisms may cover almost the entire available surface area. It is suggested that the continued survival and success of these and other groups of considerable paleontological importance resulted from their occupation of cryptic reef habitats after competition with more rapidly growing hermatypic corals in the Middle Jurassic when scleractinian reefs first appeared.

Hyperhomocysteinemia and traditional cardiovascular disease risk factors in end-stage renal disease patients on dialysis: a case-control study.

Hyperhomocysteinemia occurs frequently in end-stage renal disease (ESRD), but its prevalence in comparison with traditional cardiovascular disease (CVD) risk factors is unknown. Fasting total plasma homocysteine, potential determinants of plasma homocysteine (i.e., plasma B-vitamins and serine), total and HDL cholesterol, glucose, and creatinine, were determined in 24 ESRD patients on dialysis, and 24 age, gender, and race matched Framingham Offspring Study controls with normal renal function. Presence of clinical CVD and CVD risk factors was established by standardized methods. Mean plasma homocysteine was markedly higher in the ESRD patients versus controls (22.7 vs. 9.5 mumol/l). ESRD patients were 33 times more likely than controls to have hyperhomocysteinemia (> 15.8 mumol/l) (95% confidence interval, 5.7-189.6). Hyperhomocysteinemia persisted in the ESRD patients despite normal to supernormal B-vitamin status. Plasma serine levels below the tenth percentile of the control distribution were found in 75% of the ESRD patients. Oral serine supplementation caused a 37% increase in mean plasma serine, but had no effect on plasma homocysteine in four ESRD patients with supernormal plasma folate, low plasma serine, and hyperhomocysteinemia. Given its unusually high prevalence, improved management of hyperhomocysteinemia might reduce CVD sequelae in ESRD.

Comparative and functional morphology of the stomach in the adult and newborn pigmy hippopotamus (Choeropsis liberiensis).

Examination of the topographical anatomy of the stomach complex and intestinal tract of an adult male and a newborn female pigmy hippopotamus (Choeropsis liberiensis) shows that the stomach consists of four chambers, the first three constituting the proventriculus and the fourth the glandular stomach. The proventriculus is made up of a visceral and parietal blind sac opening into a connecting chamber, which in turn opens into the glandular compartment. The walls of the proventricular chambers are covered with villi and non-glandular mucous membrane. The significant difference between the animals is that whereas the connecting chamber of the adult stomach lies transversely deep in the cranial part of the abdomen and connects with the glandular chamber on the right side, that of the newborn lies almost vertically and connects ventrally with the glandular compartment situated on the floor of the abdomen. A groove which in the adult runs more or less horizontally from the cardia through the visceral sac and connecting chambers is aligned almost vertically in the newborn. In the adult the connecting chamber is the largest compartment, but in the neonate the visceral blind sac and the glandular compartment are proportionally larger. Functional aspects of these anatomical differences are discussed in relation to suckling behavior.(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanical properties of the tendinous equine interosseus muscle are affected by in vivo transducer implantation.

Liquid metal strain gauges (LMSGs) were implanted in the tendinous interosseous muscle, also called suspensory ligament (SL), in the forelimbs of 6 ponies in order to quantify in vivo strains and forces. Kinematics and ground reaction forces were recorded simultaneously with LMSG signals at the walk and the trot prior to implantation, and 3 and 4 days thereafter. The ponies were euthanised and tensile and failure tests were performed on the instrumented tendons and on the tendons of the contra lateral limb, which were instrumented post mortem. The origo-insertional (OI) strain of the SL was computed from pre- and post-operative kinematics, using a 2D geometrical model. The LMSG-recorded peak strain of the SL was 5.4+/-0.9% at the walk and 9.1+/-1.3% at the trot. Failure occurred at 15.4+/-2.1% (mean+/-S.D.). The LMSG strain was higher than the simultaneously recorded OI strain 0.5+/-0.7% strain at the walk and 2.2+/-1.1% strain at the trot. Post-operative OI strains were only slightly higher than pre-operative values. Failure strains of in vivo instrumented SLs were 2.0+/-1.2% strain higher, and failure forces were slightly lower, than those of the contra lateral SLs that were instrumented post mortem. SL strains appeared to be considerably higher than those found in earlier acute experiments. Differences between in vivo LMSG and OI strains, supported by lower failure strains comparing in vivo and post mortem instrumented SLs, revealed that local changes in tendon mechanical properties occurred within 3 to 4 days after transducer implantation. Therefore, measurements of normal physiological tendon strains should be performed as soon as possible after transducer implantation.

Supplemental arginine and ornithine do not affect splenocyte proliferation in surgically treated rats.

The present study was designed to determine whether arginine or ornithine supplementation enhanced immune responsiveness in surgically stressed rats. Young rats (130 to 150 g; n = 72) were fed one of three nonpurified diets: control, arginine-supplemented (30 g/kg of diet), or supplemented with ornithine on an equimolar basis to supplemental arginine. Control and ornithine-supplemented diets were made isonitrogenous to the arginine-supplemented diet with alanine. Food intake and body weight were monitored throughout the experimental period. Eight days after initiation of dietary treatments, 36 rats were given dorsal skin wounds. Rats were killed 7 days later. Blood was collected, spleen and thymus were weighed, and splenocytes were isolated to measure proliferation in response to mitogens and interleukin-2 production. Food intake, body weight gain, and thymus weight were lower in rats subjected to surgery than in controls rats (p < .01). Neither supplemental dietary arginine nor ornithine affected food intake, body weight gain, thymus weight, splenocyte proliferation, or splenocyte interleukin-2 production in any treatment group (p < .1). These data suggest that low-level dietary supplementation of arginine and ornithine did not ameliorate detrimental effects of minor surgery in rats.

Myopathy with a Possible Recessive X-Linked Inheritance in a Litter of Irish Terriers.

Five male Irish Terrier puppies had a stiff gait, difficulty in swallowing, dirty cheeks because of food residues, an enlarged tongue and atrophic muscles. At electromyographical examination high-frequency discharges suggestive of myotonia were present. The values for serum creatine-phosphokinase and aldolase were extremely high. Serum vitamin E values were normal. At necropsy the muscles were pale with yellowish white streaks. Histologically there was a patchy distribution of the lesions. Granular and floccular changes (Zenker's degeneration) with phagocytosis, giant cells and calcification were found. Histochemical changes were the same in all muscles investigated, but were not equally pronounced. In the muscle specimens with greatest change the distinction between type I and type II fibres was largely lost. Rounded hypertrophic fibres contained no glycogen, and most did not show activity of phosphorylase, dehydrogenases, and oxidases. Activity of glyccrol-3-phosphate oxidase and acid phosphatase was markedly increased. Abnormal mitochondria and unknown electron-dense bodies were found. The tubular system seemed to be reduced in some abnormal fibres. The disease is probably recessive X-linked.

The abstinence violation effect and very low calorie diet success.

This study evaluated the relationship between Marlatt and Gordon's (1985) Abstinence Violation Effect (AVE) and fasting outcomes of patients enrolled in a Very Low Calorie Diet (VLCD) and behavior education program. Within the first 11 weeks of the VLCD, 41 of 76 patients reported a fasting lapse and rated this lapse on an attribution scale. Patients reporting greater characterological attributions for their first lapse (i.e., a higher AVE) lost a smaller percentage of their excess weight during active fasting than patients reporting more situational attributions r(39) = -.36, p less than .025. First lapse AVE ratings did not distinguish between program dropout versus completer status, but high AVE dropouts did spend fewer weeks in the VLCD program than low AVE dropouts, r(12) = -.54, p less than .05. Although a faster's initial level of obesity accounted for the largest portion of weight loss outcome variance, the AVE accounted for a significant additional portion of outcome.

An in vitro study on joint fitting and cartilage thickness in the radiocarpal joint of foals.

The change in the degree of fitting of the opposing articular cartilage surfaces of the radiocarpal joint of foals was studied in vitro using a pneumatic loading device. The thickness of the articular cartilage of the distal radius was examined using radiographic and histological techniques. The thickest cartilage corresponded with the approximate centre of the contact area of the opposing articular surface. The variations in articular cartilage contact area and thickness are discussed.

A cinefluoroscopic study of the caecal base of the horse.

Separate mechanisms exist for transporting ingesta and gas from the caecum to the colon. Both involve the isolation of the cranial part of the base by a constriction cranial to the ileal papilla. This involves elevation of the floor of the base and is associated with dilation of the caecocolic ostium which at other times is closed. Contraction of the ingesta-filled cranial compartment expels some material to the colon but allows most to return to the body. Contractions which discharge gas do not result in the passage of significant amounts of ingesta. The gas expelled is at once hurried through much of the ascending colon. Any considerable reflux to the caecum is prevented by the sigmoid configuration of the caecocolic junction.

In vivo bone strain in the equine tibia before and after transection of the peroneus tertius muscle.

The present study was undertaken to determine the influence of the peroneus tertius muscle on the loading regime of the tibia in the horse. Strain gauge rosettes were bonded to the cranial and caudal cortices of the left and right tibiae in six Shetland ponies. In vivo bone strain recordings were made before and after unilateral transection of the peroneus tertius muscle. Relatively large individual variations in response to transection were observed in both the experimental and the contralateral control limbs. The principal strain values on the cranial and caudal cortices increased during the second peak in the support phase by approximately 10 per cent; the angle between the larger principal strains and the long axis of the bone, measured proximal to the gauges, rotated approximately 4 degrees medially in experimental limbs, but did not change in the control limbs. It seems unlikely that the peroneus tertius muscle has a substantial influence on the loading regime of the tibia during normal walking.

Predictive value of foal kinematics for the locomotor performance of adult horses.

The gait of 24 horses was recorded on a treadmill when they were trotting at 4 m sec-1, first when they were four months old and again when they were 26 months. The data recorded at four months were used to predict the locomotion of the adult horses, and the predictions were assessed against the data recorded at 26 months. The locomotion of the foals and the adults appeared to be closely related, when the differences in segment length and joint angles due to growth were taken into account. The duration of swing, the total range of protraction and retraction, and the maximum tarsal flexion could be used to predict adult locomotion, because they correlated very well between the foals and adults. The durations of stance and stride in the foals had to be linearly and dynamically scaled to the height at the withers to become predictive for the adult values. The duration of swing, and the total range of protraction and retraction and the maximum tarsal flexion are also indicators of the quality of gait and as a result studies of foal kinematics can be used objectively to predict the locomotor performance of adult horses.

Ground reaction force patterns of Dutch Warmblood horses at normal walk.

The ground reaction force patterns from 20 clinically sound Dutch Warmblood horses (Group A) were recorded at the normal walk. The data from four to 10 stance phases of each limb were computer averaged after normalisation to the animal's body mass and to the stance time. This analysis method allowed comparison of data from left and right fore- and hindlimbs within and between horses. The left-to-right symmetry in the reaction force peaks of contralateral limbs of one horse exceeded 90 per cent. The time in the stance phase at which the peaks occur were even more symmetrically distributed. A characteristic force-force diagram was constructed by plotting the longitudinal horizontal and the vertical ground reaction forces against each other; in this way the symmetry of loading of contralateral fore- and hindlimbs could be interpreted easily. Force plate tracings were obtained from eight horses (Group B) in three successive years. The similarity of the tracings from a sound, well-trained horse over that period was better than the differences between horses of the same breed.

The use of H(orse) INDEX: a method of analysing the ground reaction force patterns of lame and normal gaited horses at the walk.

The amplitudes, impulses and times of occurrence of a number of selected peaks in the ground reaction force tracings of 17 horses with various clinical histories were compared with those of 20 horses used to establish values for the 'standard' Dutch Warmblood horse. The resulting factors were combined, using different weighting factors, into indices characterising each limb. The symmetry between the loading of the forelimbs and the hindlimbs was used to calculate amplitude and peak-time symmetry indices. Limb and symmetry indices were combined in one H(orse) INDEX. This method of quantifying the ground reaction force pattern, together with appropriate graphic display of the tracings, was useful in clinical evaluation of force plate measurements.

How the horse moves: 1. Significance of graphical representations of equine forelimb kinematics.

The kinematics of 24 two-year-old Dutch Warmblood horses were recorded at the trot (4 m/s) on a high-speed treadmill to study the coordination of joints within the equine forelimb. Joint angle-time, angle-angle, stick, and marker diagrams were used to show forelimb motion graphically. Because the kinematic data referred to the joint angles of the horse standing squarely and were time-standardised to the duration of the stride cycle, mean joint curves could be calculated for the total group. The motion of each segment in the equine forelimb during a complete stride is described and its function in intralimb coordination evaluated. It appeared that the rotation of the scapula and the cranio-caudal movement of the distal forelimb are synchronous and pendular. The carpal joint rapidly snaps into overextension at the beginning of the stance phase to enable the forelimb to work as a propulsive strut. The fetlock joint acts as an elastic spring, thereby conserving energy and, at the same time, absorbs oscillations generated by initial ground contact. Furthermore, the coordination between carpal and fetlock joints in the swing phase appears to be strongly influenced by inertia. Using the graphic tools evaluated in this paper, we were able to visualise the kinematics of the equine forelimb and relate these to specific functions of the forelimb in locomotion. This information can be used to select kinematic variables for clinical studies in which equine forelimb function has to be described and quantified.

How the horse moves: 2. Significance of graphical representations of equine hind limb kinematics.

Kinematic data of the equine hind limb are presented graphically and related to functional aspects of the hind limb in locomotion. The trot of 24 two-year-old Dutch Warmblood horses was recorded at 4 m/s on a high-speed treadmill using kinematic analysis equipment. Joint angle-time, angle-angle, stick and marker diagrams were used to present graphically the data following standardised procedures. As the kinematic data were expressed with reference to the joint angles of the horse standing squarely and were time-standardised to the duration of the stride cycle, mean joint curves for the total group could be calculated and therefore describe the function of the different segments of the equine hind limb. The motion of the hind limb in the sagittal plane appeared to be pendular around a rotation point in the acetabulum. During the stance phase the extension of the fetlock joint and stance flexion of the stifle, tarsal and coffin joints illustrate the shock absorption of the hind limb. In the swing phase the reciprocal apparatus, which forms the coupling mechanism between stifle and tarsal joint, also influences the fetlock joint because synchronous flexion and extension between these 3 joints were demonstrated. By graphically presenting hind limb motion we were able to illustrate the relation between kinematics and function. This graphic analysis can be used in clinical studies involving quantification of equine hind limb coordination in the sagittal plane.

Measurements of bone strain in foals with altered foot balance.

Two to 7 days after birth, 9 foals were anesthetized, and strain gauges were applied to lateral and medial aspects of the third metacarpal bone of the left forelimb. In 5 of these foals, strain gauges also were applied to the radius of the left forelimb. Four to 6 days later, foals were walked (5 sets of 10 to 20 strides), and compressive and tensile strains in the bone beneath strain gauges were recorded on paper and diskette. After recording base-line data, a wedge was fitted to the hoof of the limb with the strain gauges, in such a way that the lateral bearing surface was raised, and strains were recorded again. The wedge was left in place, and further recordings were made every 2 to 3 days for 10 days. At the normal walk (base-line data), the compressive strain was higher than the tensile strain in the third metacarpal bone, on the medial side of which the mean principal compressive strain was approximately twice that on the lateral surface. Immediately after application of the wedge, strain values from the medial surface of the third metacarpal bone decreased by 40%, and the lateral surface compressive strain increased by 100%. These changes gradually decreased over 10 days, at which time there was no significant difference from base-line values (P less than 0.05). Similar but much less obvious trends were observed in the radius. Abnormal hoof balance apparently had no lasting effect on compressive forces running through the limb, and the natural situation of higher compressive strain medially was restored quickly.

Forces loading the tarsal joint in the hind limb of the horse, determined from in vivo strain measurements of the third metatarsal bone.

Strain gauge rosettes were bonded to the dorsal, lateral, medial, and plantar aspects of the third metatarsal bone in the hind limbs of 6 ponies. The maximal compressive principal strain was approximately -600 X 10(-6) m/m, and exceeded the amplitudes of the tensile strains at all aspects of the bone. After transformation, the shear strain and the principal strains parallel and perpendicular to the bone were obtained. The first peak in the bending strain was higher in the dorsal and lateral aspects, and the second peak was higher in the medial and plantar aspects. Young modulus of elasticity was determined in a 4-point bending test at the dorsal and plantar sides; it averaged 19.5 GPa in tension and compression. Applying linear bending theory, the eccentricity of an axial force parallel or a bending force perpendicular to the bone were calculated. The position where the total force penetrated the tarsometatarsal joint surface was largely within the joint surface, indicating that the joint is merely loaded in (eccentric) compression.