Nutritional profile of rodent diets impacts experimental reproducibility in microbiome preclinical research.

The lack of reproducibility of animal experimental results between laboratories, particularly in studies investigating the microbiota, has raised concern among the scientific community. Factors such as environment, stress and sex have been identified as contributors, whereas dietary composition has received less attention. This study firstly evaluated the use of commercially available rodent diets across research institutions, with 28 different diets reported by 45 survey respondents. Secondly, highly variable ingredient, FODMAP (Fermentable Oligo-, Di-, Mono-saccharides And Polyols) and gluten content was found between different commercially available rodent diets. Finally, 40 mice were randomized to four groups, each receiving a different commercially available rodent diet, and the dietary impact on cecal microbiota, short- and branched-chain fatty acid profiles was evaluated. The gut microbiota composition differed significantly between diets and sexes, with significantly different clusters in ß-diversity. Total BCFA were highest (p = 0.01) and SCFA were lowest (p = 0.03) in mice fed a diet lower in FODMAPs and gluten. These results suggest that nutritional composition of commercially available rodent diets impact gut microbiota profiles and fermentation patterns, with major implications for the reproducibility of results across laboratories. However, further studies are required to elucidate the specific dietary factors driving these changes.

Achieving Self-Directed Integrated Cancer Aftercare (ASICA) in melanoma: protocol for a randomised patient-focused pilot trial of delivering the ASICA intervention as a means to earlier detection of recurrent and second primary melanoma.

BACKGROUND: Melanoma is common; 15,906 people in the UK were diagnosed with melanoma in 2015 and incidence has increased fivefold in 30 years. Melanoma affects old and young people, with poor prognosis once metastatic. UK guidelines recommend people treated for cutaneous melanoma receive extended outpatient, hospital follow up to detect recurrence or new primaries. Such follow up of the growing population of melanoma survivors is burdensome for both individuals and health services. Follow up is important since approximately 20% of patients with early-stage melanoma experience a recurrence and 4-8% develop a new primary; the risk of either is highest in the first 5 years. Achieving Self-directed Integrated Cancer Aftercare (ASICA) is a digital intervention to increase total-skin-self-examination (TSSE) by people treated for melanoma, with usual follow up. METHODS: We aim to recruit 240 adults with a previous first-stage 0-2C primary cutaneous melanoma, from secondary care in North-East Scotland and the East of England. Participants will be randomised to receive the ASICA intervention (a tablet-based digital intervention to prompt and support TSSE) or control group (treatment as usual). Patient-reported and clinical data will be collected at baseline, including the modified Melanoma Worry Scale (MWS), the Hospital Anxiety and Depression Scale (HADs), the EuroQoL 5-dimension 5-level questionnaire (EQ-5D-5 L), and questions about TSSE practice, intentions, self-efficacy and planning. Participants will be followed up by postal questionnaire at 3, 6 and 12 months following randomization, along with a 12-month review of clinical data. The primary timepoint for outcome analyses will be12 months after randomisation. DISCUSSION: If the ASICA intervention improves the practice of TSSE in those affected by melanoma, this may lead to improved psychological well-being and earlier detection of recurrent and new primary melanoma. This could impact both patients and National Health Service (NHS) resources. This study will determine if a full-scale randomised controlled trial can be undertaken in the UK NHS to provide the high-quality evidence needed to determine the effectiveness of the intervention. ASICA is a pilot study evaluating the effectiveness of the practice of digitally supported TSSE in those affected by melanoma. TRIAL REGISTRATION: Clinical Trials.gov, NCT03328247 . Registered on 1 November 2017.

Writing life.

SUMMARY In her 1994 essay "Writing Life," Beth Brant discusses the role of writing in her life, the circumstances that surrounded her writing and editing endeavours, and her relationships with loved ones. Issues of racism, homophobia, and class oppression are explored through writing.

Late clinical and hemodynamic sequelae of isolated calf vein thrombosis.

PURPOSE: Despite the frequent occurrence of isolated calf vein thrombosis (ICVT), little is known about the long-term clinical and hemodynamic sequelae of this condition. This study was conducted to determine late clinical symptoms and vascular laboratory abnormalities in patients after ICVT. METHODS: Of 146 patients in whom ICVT was documented by color flow duplex scanning between 1989 and 1994, 37 were reexamined. Data included history, physical examination, venous recovery time (VRT), and duplex valve closure time (DVCT). A control group with no history of venous disease also underwent identical clinical and hemodynamic testing. RESULTS: Thirty-seven patients (18 male and 19 female) with a median age of 56 years (range, 22 to 76 years) were examined at a mean follow-up of 3.4 years (range, 2.2 to 5.8 years) after the diagnosis of ICVT in 39 extremities. Seventeen subjects (34 extremities) were recruited as normal controls. Presenting symptoms at the time of ICVT included calf pain in 17 patients, calf swelling in seven, pain and swelling in seven, pulmonary symptoms in four, pulmonary symptoms and calf pain in one, and no symptoms in one. In the patients with ICVT, VRT was abnormal in 23% of extremities with ICVT and in 9% of extremities without ICVT. None of the extremities in the control group had an abnormal VRT (p < 0.05). DVCT was abnormal in one or more venous segments in 26% of extremities diagnosed with ICVT and in 6% of control extremities (p < 0.05). Follow-up clinical examination in patients with ICVT revealed 13 (35%) with reticular veins, 10 (27%) with varicose veins, two (5.4%) with edema, one (2.7%) with pigmentation and ulcer (contralateral extremity to ICVT with a previous history of proximal deep venous thrombosis), 13 (35%) with mild discomfort, and one (2.7%) with severe pain. All symptoms attributable to ICVT were mild in nature except in one patient who had severe pain and no physical or hemodynamic vascular laboratory abnormalities at follow-up. CONCLUSION: At an average of 3.4 years after ICVT, approximately one third of patients showed evidence of mild to moderate venous valvular insufficiency, but mostly in segments not involved with ICVT, and few had significant clinical symptoms attributable to venous disease.

The suicidal patient in long-term care institutions.

In comparison with older adults living in the community, elders who are institutionalized are older, sicker, and more likely to have no living family members, factors that place them at risk for suicide. Somatization, or physical suffering, is a frequently overlooked symptom of elderly depression, perhaps because it is falsely assumed that such symptoms expressed by the older adult are normal concomitants of aging. Strengthening and extending existing family roles in supporting the elder who is suicidal and depressed is vital to reducing loneliness, emotional pain, loss of independence, and to increasing self-concept. An expanded knowledge of mental health needs of older adults and their families is critical in suicide prevention. A major step toward prevention is the recognition of depressive symptomatology and key elements and clues to suicide in the institutionalized elderly.

Suicidal behavior in long-term care facilities.

Questionnaires were mailed to a random sample of administrators of 1,080 long-term care facilities, in order to obtain information on the extent and nature of overt suicide and intentional life-threatening behavior (ILTB). Rates were calculated for death for overt suicides and ILTB. In-depth case studies, involving observation, interviews, and examination of medical records, were conducted in four facilities. Quantitative analysis revealed that white males were most at risk. Refusing to eat or drink and refusing medications were the most common suicidal behaviors. Depression, loneliness, feelings of family rejection, and loss were significant factors.

Endoscopic biliary stents and obstructive jaundice.

Eighty-four patients with obstructive jaundice due to various causes were treated with endoscopically placed plastic stents. Seventy-two patients had malignant obstructive disease, 5 patients had common bile duct stones, 4 patients had bile duct injuries, and 3 patients had inflammatory processes resulting in common bile duct obstruction. Straight as well as double pigtail stents ranging from 9 to 12 F. were used. Restenting was employed only in patients with malignancy, and the longest period of a single stent drainage was 406 days with the average of 132 days. There was one procedure-related mortality in a patient with pancreatic cancer in whom the stent was misplaced. Inadequate drainage resulted in cholangitis and death. There were 14 nonfatal complications which included 1 myocardial infarction, 2 liver abscesses, 2 early closures (at 8 and 18 days), 1 episode of cholecystitis, 3 displacements of the stent which required restenting, and 4 spontaneous passages of the stent through the gastrointestinal tract. There were no perforations and no significant bleeding was encountered.

Autogenous reversed vein bypass for lower extremity ischemia in patients with absent or inadequate greater saphenous vein.

This report has presented the results of 329 reversed vein bypasses performed for lower extremity ischemia over a 6 3/4 year period. One hundred eighty-nine bypasses were formed from intact ipsilateral greater saphenous veins of adequate size and length. One hundred forty bypasses were formed in patients in whom the ipsilateral greater saphenous vein was absent or of inadequate size or length to complete the bypass. The grafts in these patients were accomplished using a variety of techniques including distal graft origin, use of arm veins and lesser saphenous veins, and use of vein splicing. The patency rates of these grafts were equivalent to those achieved using adequate intact ipsilateral greater saphenous vein. In view of these results, we conclude that the absence of a greater saphenous vein does not preclude successful autogenous lower extremity vein bypass and that prosthetic bypass is rarely justified.

Nursing home case mix. Patient classification by nursing resource use.

A model is presented for classifying nursing home patients according to nursing resource use. The model is derived from a study of 558 Medicaid nursing home patients in 12 facilities in Virginia. Data were obtained from self-reports of nursing staff for care delivered over a 52-hour period. The measure of care time was validated through concurrent work sampling. Project staff also assessed the patients' health and functional status using a standardized instrument. Using AID analysis patients were classified into six groups that were homogeneous in their use of nursing resources. Patients were initially categorized by presence or absence of conditions requiring specialized care (e.g., nutritional intake problems, quadriplegia, wounds or lesions, coma, and physical rehabilitation potential). For the specialized care category, two groups were formed by presence or absence of a catheter/ostomy. In the nonspecialized care category, four groups were formed by ADL impairment score and assistance required in eating/feeding. Mean resource use for the highest group was nearly four times that of the lowest group. The model accounted for 53% of the variance in nursing resource use.

Epidermal nucleases. III. The ribonucleases of human epidermis.

Sodium acetate and sulphuric acid extracts of human epidermis can each be separated by chromatographic techniques into three or more fractions with ribonuclease activity. Eight of these fractions were compared with respect to molecular weight, pH activity profile, polyribonucleotide hydrolysis, and activity in the presence of low levels of spermidine. Sodium acetate and sulphuric acid extracts were also prepared from callus and from psoriatic lesions and compared with extracts from normal epidermis for their response to exogenous spermidine. All eight human epidermal ribonuclease fractions studied had an apparent molecular weight of 15,000 daltons. Seven of the ribonuclease fractions were optimally active at alkaline pHs (pH 7.3-7.6 in sodium phosphate and pH 8.I in Tris-HCl) while the eighth ribonuclease was most active at pH 5.6 in a citrate-phosphate buffer. All enzymes hydrolyzed polycytidylic acid and five also hydrolyzed polyuridylic acid. None hydrolyzed polyadenylic acid. Seven of the eight ribonucleases studied exhibited greater activity in the presence of added spermidine. The extracts from psoriatic scales showed markedly elevated ribonuclease levels which could not be raised further by the addition of spermidine.

Surgical treatment of late esophageal perforations.

The salvage of patients with late esophageal perforations is a formidable surgical undertaking. The basic objectives of surgical therapy should be: prompt debridement and control of sepsis by establishing an adequate, controlled route of decompression drainage, salvage of all viable and functional esophagus (except in massive disruptions with circumferential loss), adequate support of life control systems, and establishment of an appropriate alternate route for supportive alimentation. The method of treatment used in the group of patients reported here satisfies all these objectives. Our experience justifies further consideration of this technique in dealing with this catastrophic illness.