Helmet wearing and related factors among electric personal mobility device users in Korea.

Using data from the 2022 Korea Community Health Survey (n = 13 320), this study investigated helmet use and related factors among Korean adults using personal mobility devices, without distinguishing between private and hired users. Among mobility device users, 32.1% responded that they always wore a helmet. The proportion of helmet use was 35.2% among men, 25.8% among women, 29.2% among those aged 19-44 years, 42.3% among those aged 45-64 years and 26.6% among those aged 65 years or older. Furthermore, those who drank less frequently and were physically active were more likely to wear helmets. Moreover, people who always wore a seat belt when driving a car or sitting in the rear seat and people who always wore a helmet when riding a motorcycle were more likely to wear a helmet while using electric personal mobility devices. Approximately one-third of users always wore a helmet. The helmet-wearing rate was related to general characteristics such as gender and education level, and to safety behaviors such as wearing a seat belt when driving a car, sitting in the rear seat of a car, or when riding a motorcycle. In addition to considering personal characteristics investigated in this study, the helmet-wearing rate should be improved through policies or systems at the national or regional levels.

Development and Standardization of an Osteoradionecrosis Classification System in Head and Neck Cancer: Implementation of a Risk-Based Model.

PURPOSE: Osteoradionecrosis of the jaw (ORN) can manifest in varying severity. The aim of this study is to identify ORN risk factors and develop a novel classification to depict the severity of ORN. METHODS: Consecutive patients with head and neck cancer (HNC) treated with curative-intent intensity-modulated radiation therapy (IMRT) (≥45 Gy) from 2011 to 2017 were included. Occurrence of ORN was identified from in-house prospective dental and clinical databases and charts. Multivariable logistic regression model was used to identify risk factors and stratify patients into high-risk and low-risk groups. A novel ORN classification system was developed to depict ORN severity by modifying existing systems and incorporating expert opinion. The performance of the novel system was compared with 15 existing systems for their ability to identify and predict serious ORN event (jaw fracture or requiring jaw resection). RESULTS: ORN was identified in 219 of 2,732 (8%) consecutive patients with HNC. Factors associated with high risk of ORN were oral cavity or oropharyngeal primaries, received IMRT dose ≥60 Gy, current/ex-smokers, and/or stage III to IV periodontal condition. The ORN rate for high-risk versus low-risk patients was 12.7% versus 3.1% (P < .001) with an AUC of 0.71. Existing ORN systems overclassified serious ORN events and failed to recognize maxillary ORN. A novel ORN classification system, ClinRad, was proposed on the basis of vertical extent of bone necrosis and presence/absence of exposed bone/fistula. This system detected serious ORN events in 5.7% of patients and statistically outperformed existing systems. CONCLUSION: We identified risk factors for ORN and proposed a novel ORN classification system on the basis of vertical extent of bone necrosis and presence/absence of exposed bone/fistula. It outperformed existing systems in depicting the seriousness of ORN and may facilitate clinical care and clinical trials.

A Randomized Comparison of Multimodal Analgesia and Fentanyl-Based Patient-Controlled Analgesia in Women Undergoing Robot-Assisted Bilateral Axillary Breast Approach Thyroidectomy.

Opioid-free multimodal analgesia (MMA) emerges as a preferable approach for postoperative pain management compared to opioid-based patient-controlled analgesia (PCA) in robot-assisted bilateral axillary breast approach thyroidectomy, a procedure commonly undergone by young female patients. We compared the analgesic efficacy and other recovery profiles between MMA and PCA. In total, 88 female patients were administered fentanyl-based PCA or the combination of lidocaine continuous infusion and nefopam injection before recovery from general anesthesia. The visual analog scale score of postoperative pain was assessed at the post-anesthesia care unit and at 6, 12, and 24 h after the termination of surgery. Postoperative nausea and vomiting (PONV), rescue analgesic and anti-emetic agents, recovery profiles, and adverse events were also compared. The median numeric rating scores on postoperative pain at 6 h after recovery from general anesthesia were three in both groups, with no significant difference between the groups at any time point. The PONV incidence was significantly higher in the PCA group than in the MMA group. The combination of systemic lidocaine infusion and nefopam injection has an analgesic effect equivalent to that of fentanyl-based PCA without PONV.

Dental Extractions Before Radiation Therapy and the Risk of Osteoradionecrosis in Patients With Head and Neck Cancer.

Importance: Patients with head and neck cancer undergo extraction of teeth with poor prognoses to minimize post-radiation therapy (RT) extractions, which are known to cause osteoradionecrosis (ORN). However, many patients are required to start RT before the extraction sites are completely healed. The role of pre-RT extractions in the development of ORN has been disputed in literature. Objective: To determine whether the timing of pre-RT dental extractions is associated with ORN development in patients with head and neck cancer. Design, Setting, and Participants: This retrospective cohort study was conducted at a single institution (Princess Margaret Cancer Centre, Toronto, Canada) between January 1, 2011, and January 1, 2018, and included 879 patients with head and neck cancer who underwent pre-RT dental extractions before curative RT of 45 Gy or greater. Patient demographic information and clinical characteristics (eg, primary cancer site, nodal involvement, chemotherapy, smoking status, dental pathology) were considered. Data analyses were performed from July to December 2022. Main outcomes and measures: Timing (number of days) from dental extractions to RT start date and pre-RT extractions categorized as healed, minor bone spicules (MBS), or ORN. Results: The study population consisted of 879 patients with a median (range) age of 62 (20-96) years, with 685 men (78%) and 194 women (22%). Of these, 847 (96.3%) healed from pre-RT dental extractions, 16 (1.8%) developed MBS, and 16 (1.8%) developed ORN. The median (range) time in number of days from pre-RT extraction(s) to start of RT was 9 (0-98) days in the healed cohort, 6 (3-23) days in the MBS cohort, and 6 (0-12) days in the ORN cohort. There was a large difference in the timing of pre-RT extractions between the healed and the MBS cohorts (mean 11.9 vs 7.4 days to radiation; difference 4.4; 95% CI, 1.5-7.3), and the healed and the ORN cohorts (mean 11.9 vs 7.1 days; difference 4.8 days; 95% CI, 2.6-7.1). Conclusion: The findings of this retrospective cohort study suggest that there was an important association between the timing of pre-RT dental extractions and ORN when extractions occurred within 7 days of the RT start date. Despite this, ORN after pre-RT extractions is relatively rare. These findings indicate that patients with head and neck cancer who are to undergo RT should not delay treatment for extractions when it might compromise oncologic control.

Development and Standardization of a Classification System for Osteoradionecrosis: Implementation of a Risk-Based Model.

Purpose: Osteoradionecrosis of the jaw (ORN) can manifest in varying severity. The aim of this study is to identify ORN risk factors and develop a novel classification to depict the severity of ORN. Methods: Consecutive head-and-neck cancer (HNC) patients treated with curative-intent IMRT (≥ 45Gy) in 2011-2018 were included. Occurrence of ORN was identified from in-house prospective dental and clinical databases and charts. Multivariable logistic regression model was used to identify risk factors and stratify patients into high-risk and low-risk groups. A novel ORN classification system was developed to depict ORN severity by modifying existing systems and incorporating expert opinion. The performance of the novel system was compared to fifteen existing systems for their ability to identify and predict serious ORN event (jaw fracture or requiring jaw resection). Results: ORN was identified in 219 out of 2732 (8%) consecutive HNC patients. Factors associated with high-risk of ORN were: oral-cavity or oropharyngeal primaries, received IMRT dose ≥60Gy, current/ex-smokers, and/or stage III-IV periodontal disease. The ORN rate for high-risk vs low-risk patients was 12.7% vs 3.1% (p<0.001) with an area-under-the-receiver-operating-curve (AUC) of 0.71. Existing ORN systems overclassified serious ORN events and failed to recognize maxillary ORN. A novel ORN classification system, RadORN, was proposed based on vertical extent of bone necrosis and presence/absence of exposed bone/fistula. This system detected serious ORN events in 5.7% of patients and statistically outperformed existing systems. Conclusion: We identified risk factors for ORN, and proposed a novel ORN classification system based on vertical extent of bone necrosis and presence/absence of exposed bone/fistula. It outperformed existing systems in depicting the seriousness of ORN, and may facilitate clinical care and clinical trials.

Growth and response to Escherichia coli lipopolysaccharide challenge in Lohmann LSL-Lite pullets when fed a source of omega-3 fatty acids and yeast bioactives from hatch through to 16 wk of age.

Growth and response to Escherichia coli lipopolysaccharide (LPS) challenge in Lohmann LSL-Lite pullets when fed a source of omega-3 fatty acids (n-3 FA) and yeast bioactives (YB) from hatch through to 16 wk of age (woa) were investigated. Co-extruded full fat flaxseed and pulse mixture (FFF; 1:1 wt/wt) supplied n-3 FA and YB were yeast cell walls processed with ß-1,3-glucan hydrolase. A total of 1,064-day-old pullets were placed in cages (19 birds/cage) and allocated to 7 diets (n = 8). The iso-caloric and iso-nitrogenous diets were control, control + 1, 3, or 5% FFF and + 0.025, 0.05, or 0.1% YB. The birds had ad libitum access to feed and water. Body weight (BW), feed intake, and lymphoid organs weight were recorded. At 15 woa, 2 pairs of pullets/cage received intravenous injection of either 1 mL of sterile saline without or with 8 mg LPS/kg BW. Injected pullets were bled, monitored for BW and cloaca temperature at time points within 168 h. Birds fed 1% FFF were heavier (P < 0.04) than birds fed other diets at 16 woa with FFF and YB exhibiting non-linear responses. Control birds had heavier (P = 0.02) thymus at 4 woa. Spleen weight increased quadratically (P < 0.05) in response to FFF at 8 and YB at 16 woa. The LPS increased cloaca temperature and altered concentration of several plasma metabolites (P < 0.05). The interaction (P < 0.05) between LPS and diet was such that control birds exhibited lower creatine kinase (CK) upon challenge with LPS relative to birds fed other diets. The LPS birds fed 1% FFF and 0.05% YB showed higher plasma albumin than non-LPS cohorts. Non-LPS birds fed control, 1 and 3% FFF had higher plasma K than LPS cohorts. In general, FFF and YB exhibited linear and quadratic effects (P < 0.05) on select plasma metabolites. In conclusion, dietary provision of n-3 FA and YB influenced pullet BW at sexual maturity, development of lymphoid organs and modulated some plasma metabolites in response to LPS.

Comparison of the Effects of Lumbar Spine Flexion on the Acoustic Windows Between Young and Elderly Patients.

BACKGROUND: The effects of lumbar flexion on posterior longitudinal ligament (PLL) length as an acoustic window for neuraxial block in older patients have not been fully elucidated. OBJECTIVE: This study aimed to compare changes in PLL length during lumbar spine flexion in young and old patients. STUDY DESIGN: Observational cohort study. SETTING: Tertiary University Hospital. METHODS: Forty young and older adult patients were placed in the lateral decubitus position. To flex the lumbar spine, patients were asked to flex their hips and knees and then their neck and shoulder toward their knees as much as they could (fetal position). An assistant pushed the patients' abdomen to the back and held their neck and legs to help them maintain position. To obtain an optimal ultrasound view, lumbar spinal ultrasonography was performed from L5/S1 to L2/L3 using a paramedian oblique sagittal plane. PLL lengths were measured on the ultrasound image before fetal position, after unassisted fetal position, and after assisted fetal position. RESULTS: PLL lengths increased after lumbar spine flexion in both young and older adult  patients, except at the L3-L4 level in old patients. The change in PLL length during lumbar spine flexion was significantly lower in old patients than in young patients at the L5-S1 and L3-L4 levels (P = 0.0028 and P = 0.0134, respectively). After lumbar spine flexion, the PLL length was significantly different between the spinal levels in older patients (P = 0.0392). LIMITATIONS: First, we measured the PLL length as an acoustic window for neuraxial block using lumbar spinal ultrasonography. Second, the researcher who obtained the spinal ultrasound view was not blinded to the patient's group and position. However, the researcher who measured the PLL lengths on ultrasonography was blinded. Third, all participants had no history of surgery, trauma, or congenital abnormalities of the spine, regardless of age. CONCLUSION: Lumbar spine flexion can increase PLL length in young and old patients. However, lumbar spine flexion is less effective in increasing the PLL length in old patients than in young patients.

Remodeling Pattern of Spinal Canal after Full Endoscopic Uniportal Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression: One Year Repetitive MRI and Clinical Follow-Up Evaluation.

Objective: There is limited literature on repetitive postoperative MRI and clinical evaluation after Uniportal Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression. Methods: Clinical visual analog scale, Oswestry Disability Index, McNab's criteria evaluation and MRI evaluation of the axial cut spinal canal area of the upper end plate, mid disc and lower end plate were performed for patients who underwent single-level Uniportal Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression. From the evaluation of the axial cut MRI, four types of patterns of remodeling were identified: type A: continuous expanded spinal canal, type B: restenosis with delayed expansion, type C: progressive expansion and type D: restenosis. Result: A total of 126 patients with single-level Uniportal Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression were recruited with a minimum follow-up of 26 months. Thirty-six type A, fifty type B, thirty type C and ten type D patterns of spinal canal remodeling were observed. All four types of patterns of remodeling had statistically significant improvement in VAS at final follow-up compared to the preoperative state with type A (5.59 ± 1.58), B (5.58 ± 1.71), C (5.58 ± 1.71) and D (5.27 ± 1.68), p < 0.05. ODI was significantly improved at final follow-up with type A (49.19 ± 10.51), B (50.00 ± 11.29), C (45.60 ± 10.58) and D (45.60 ± 10.58), p < 0.05. A significant MRI axial cut increment of the spinal canal area was found at the upper endplate at postoperative day one and one year with type A (39.16 ± 22.73; 28.00 ± 42.57) mm2, B (47.42 ± 18.77; 42.38 ± 19.29) mm2, C (51.45 ± 18.16; 49.49 ± 18.41) mm2 and D (49.10 ± 23.05; 38.18 ± 18.94) mm2, respectively, p < 0.05. Similar significant increment was found at the mid-disc at postoperative day one, 6 months and one year with type A (55.16 ± 27.51; 37.23 ± 25.88; 44.86 ± 25.73) mm2, B (72.83 ± 23.87; 49.79 ± 21.93; 62.94 ± 24.43) mm2, C (66.85 ± 34.48; 54.92 ± 30.70; 64.33 ± 31.82) mm2 and D (71.65 ± 16.87; 41.55 ± 12.92; 49.83 ± 13.31) mm2 and the lower endplate at postoperative day one and one year with type A (49.89 ± 34.50; 41.04 ± 28.56) mm2, B (63.63 ± 23.70; 54.72 ± 24.29) mm2, C (58.50 ± 24.27; 55.32 ± 22.49) mm2 and D (81.43 ± 16.81; 58.40 ± 18.05) mm2 at postoperative day one and one year, respectively, p < 0.05. Conclusions: After full endoscopic lumbar decompression, despite achieving sufficient decompression immediately postoperatively, varying severity of asymptomatic restenosis was found in postoperative six months MRI without clinical significance. Further remodeling with a varying degree of increment of the spinal canal area occurs at postoperative one year with overall good clinical outcomes.

Efficacy of enhanced Escherichia coli phytase on growth performance, bone quality, nutrient digestibility, and metabolism in nursery pigs fed corn-soybean meal diet low in calcium and digestible phosphorous.

Efficacy of Escherichia coli phytase (ASP) was evaluated in nursery pigs fed low Ca and digestible P corn and soybean meal diet. Piglets were weaned on day 21, fed a common commercial starter diet for 7 d, and assigned to pens (4 pigs/pen: 2 ♀ and 2 ♂) based on day 7 BW. Positive control (PC) and negative (NC) diets were formulated with similar energy and nutrients with exception of total Ca, total P, and digestible P concentrations being 79%, 67%, and 55% that of PC diet, respectively. Two other diets were formulated by adding ASP in NC at 500 and 1,000 FTU/kg. All diets had 0.2% TiO2 indigestible marker. The diets were allocated to pens to give 6 replicates per diet and fed for 42 d. Feed intake and body weight were monitored at 14-d intervals. On day 42, 1 pig/pen was bled and euthanized to access blood and tissue samples. Analyzed total Ca and P in NC diet was 71% and 69% of concentration in PC diet. Recovery of phytase in pelleted diets was 66.2% and 73.5% for NC+500 FTU/kg and NC+1,000 FTU/kg diets, respectively. Between days 15 and 42, pigs fed NC diet grew slower and ate less feed than pigs fed the other diets. Overall (days 0-42), phytase in NC increased (P ≤ 0.05) ADG linearly and quadratically. On day 42, pigs fed PC, NC+500 FTU/kg, and NC+1,000 FTU/kg were +6.1, +5.9, and +7.1 kg heavier (P < 0.05) than pigs fed NC, respectively. Pigs fed PC and NC plus phytase exhibited higher (P = 0.003) G:F relative to NC pigs between days 15 and 28. Pigs fed NC diet had lower (P < 0.001) plasma P concentration, apparent total tract digestibility (ATTD) of Ca and P, and metacarpal and metatarsal bone attributes than pigs fed any other diets. Supplementation of phytase in NC linearly increased (P < 0.05) plasma P concentration, ATTD of Ca and P, and bone attributes. Specifically, phytase increased (P ≤ 0.025) dry weight, length, and ash weight in metacarpals and metatarsals. In conclusion, low total Ca and digestible P diet depressed growth and P utilization in piglets. Supplemental phytase improved performance in pigs fed NC linked to enhanced nutrients uptake and metabolism commensurate to pigs fed adequate total Ca and digestible P from inorganic source.

Supplementation of nano-zinc in lower doses as an alternative to pharmacological doses of ZnO in weanling pigs.

A set of studies was performed to determine the influence of dietary ZnO concentration and source during two phases (days 0 to 14 and days 15 to 28). Experiment 1: 168 weaned piglets were allocated to four treatment groups in six replicates. The treatments included a basal diet without ZnO supplementation (control), 2,500 mg ZnO/kg (In2500), 500 mg nano-ZnO/kg (N500), and 150 mg nano-ZnO/kg (N150). Experiment 2: 168 weaned piglets were divided into three treatment groups with eight replicates. The treatments included control, In2500, N300, and 150 mg nano-ZnO/kg (N150). An in vitro trial showed that the growth of Listeria monocytogenes, Escherichia coli, and Salmonella typhimurium was inhibited when exposed to 300 and 500 ppm of ZnO after 24 h of incubation. In experiment 1, the average daily gain (ADG) by the pigs was improved in the N500 and IN2500 treatment groups. Colonization of coliforms and Clostridium spp. significantly decreased in the pigs fed the N500 and IN2500 diets in phase 1. The total plasma antioxidant capacity was greater in the IN2500 and N500 treatment groups than in the control. Superoxide dismutase (SOD) activity was greater in pigs fed the IN2500 (phase 1) or the IN2500 and N500 (phase 2) diets than in the control and N150 treatment group. In experiment 2, pigs in the N300 treatment group showed a higher ADG and lower fecal score colonization of coliforms and Clostridium spp. compared with those in the N150 treatment group. In conclusion, nano-ZnO at a dose of 300 ppm showed the same growth as the pharmacological dose of Zn. This provides an option to the pharmacological dose.

Improved Growth Performance, Antioxidant Status, Digestive Enzymes, Nutrient Digestibility and Zinc Bioavailability of Broiler Chickens with Nano-Sized Hot-Melt Extruded Zinc Sulfate.

This experiment was conducted to investigate the effect of the supplementation of hot-melt extrusion (HME) processed zinc sulfate (ZnSO4) on the growth performance, antioxidative activity, pancreatic digestive enzyme, small intestinal morphology, nutrient digestibility, and Zn content in broilers. The chicks were allocated to three treatments, each of which had five replicates of 15 chicks per replicate. The broiler chickens were assigned to three dietary treatments: the control (without supplemental Zn), IN-Zn (ZnSO4, 80 mg/kg), and HME-Zn (HME processed ZnSO4 as nano-Zn, 80 mg/kg). The broilers fed diets supplemented with 80 mg/kg of HME-Zn improved the BWG (P < 0.05) and FCR (P < 0.05) compared to the broilers fed the control and IN-Zn diets in phase 2. The Zn supplementation significantly enhanced the superoxide dismutase (SOD) activity in the serum (P < 0.05) and liver (P < 0.05), and HME-Zn supplementation significantly increased the SOD in the liver compared to the IN-Zn supplementation. Reduced malondialdehyde (MDA) concentration was seen with the Zn supplementation compared to the control (P < 0.05). The chickens fed diets supplemented with the HME-Zn had higher activity of amylase (P < 0.05) and trypsin (P < 0.05) than those of the chickens fed the control and IN-Zn diets. The villus height (VH) in the duodenum (P < 0.05) and jejunum (P < 0.05) increased with the ZnSO4 and HME-Zn supplementation compared to the control. The VH and crypt depth rate (VH:CD) in the jejunum improved with the HME-Zn compared to the control (P < 0.05). The HME-Zn significantly increased the apparent ileal digestible crude protein (CP) (P < 0.05) and energy corrected by nitrogen (AIDEn) (P < 0.05) compared to the control or IN-Zn. In phases 1 and 2, the HME-Zn significantly increased Zn concentration in the liver and tibia compared to control and IN-Zn (P < 0.05). The excretion of Zn was significantly decreased in the HME-Zn compared to the IN-Zn (P < 0.05). In conclusion, supplementation of 80 mg/kg of HME-Zn in diets improved the growth performance, antioxidative activity, pancreatic enzyme activity, intestinal villus height, and nutrient digestibility with the improved Zn bioavailability in broilers.

Enhancement of tensile toughness of poly(lactic acid) (PLA) through blending of a polydecalactone-grafted cellulose copolymer: The effect of mesophase transition on mechanical properties.

Increasing the toughness of poly(lactic acid) (PLA), i.e., simultaneously increasing both the tensile strength and ductility, remains a major challenge. In this study, fully bio-based PLA blends with polydecalactone (PDL)-grafted cellulose copolymer (CgPD) were prepared and comprehensively analyzed to enhance the toughness of the PLA matrix. The blends were found by FT-IR and solid-state 1H NMR to be physically intact and miscible at the sub-twenty-nanometer scale. The WXRD and DSC analyses indicated that the addition of the alkyl-branched CgPD imparts a more structurally disordered PLA mesophase state to the prepared PLA_CgPD bio-blends. UTM analysis was used to characterize the macroscopic mechanical properties of the PLA_CgPD bio-blends. Both the tensile strength and elongation properties were simultaneously improved with the addition of 1 wt% CgPD loading amount to PLA (PLA_CgPD1). This study experimentally demonstrates that the enhanced mechanical properties of PLA_CgPD1 are closely related to the existence of more ordered PLA mesophases induced by the introduction of an optimal amount of CgPD into the PLA matrix.

Evaluation of Two Methods (Inside-Out/Outside-In) Inferior Articular Process Resection for Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion: Technical Note.

Objective: There is limited literature comparing the uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion outside-in approach (ETLIF (O)) with the inside-out approach (ETLIF (I)). Methods: Radiological evaluation was performed on disc height restoration and coronal wedging angle, and operation time (inferior articular process resection time/total operation time) and clinical evaluation were made. Result: 48 cases of inside-out and 38 cases of outside-in cases were included. Compared to inside-out, the outside-in approach had significantly less operative time required to resect inferior articular process: 36.55 ± 10.37, and total operative time: 87.45 ± 20.14 min compared to 49.83 ± 23.97 and 102.56 ± 36.53 min, respectively, for the inside-out approach, p < 0.05. Compared to the preoperative state, both cohorts achieved significant improvement of VAS and ODI at post-operative 1 week, 3 months and at final follow up. Both cohorts achieved statistically significant increased disc height with 5.00 ± 2.87 mm, 5.49 ± 2.33 mm and statistically significant improvement in coronal wedge angle with 1.76 ± 1.63°, 3.24 ± 2.92° in the inside-out and outside-in approaches respectively. Conclusions: Complete removal of inferior articular process is the key part of endoscopic fusion with two methods that can be applied: an inside-out approach or an outside-in approach. Comparing both techniques, the outside-in approach has a shorter operative time required for inferior articular process resection and total length of operation with similar good clinical and radiological outcomes.

Comparison of Retrievability and Indwelling Complications of Celect and Denali Infrarenal Vena Cava Filters: A Randomized, Controlled Trial.

PURPOSE: To compare the Celect and Denali filters in terms of complex filter retrieval and indwelling complications after a 2-month indwelling time. MATERIALS AND METHODS: In this prospective, randomized trial, 153 subjects were assessed for eligibility between May 2016 and July 2018. A total of 136 participants were randomly assigned to receive either Celect (n = 68) or Denali (n = 68) filter placement in the infrarenal inferior vena cava. Tilt angles at placement and retrieval and rates of overall filter retrieval, indwelling complication, and complex retrieval were compared. RESULTS: Of 136 participants (mean age, 62 ± 12.8 years, 55 male), 24 (17.6%) were lost to follow-up. The mean indwelling time of filter was 60.4 ± 7 days and there was no significant difference in the baseline characteristics between the two groups. Filter retrieval was successful in all participants (112/112, 100%). Significantly higher rates of filter tilt > 15° (n = 8) and strut penetration (n = 14) were found with the Celect filter than with the Denali filter (1 significant tilt and 1 penetration) (P = 0.033 and 0.001, respectively). No filter fractures were observed and there was no significant difference in tip embedment, filter fracture, filter migration, or mean fluoroscopy times. There were 3 cases of complex retrieval (1 for Denali vs. 2 for Celect, P = 0.500), for which the loop-snare technique was used. CONCLUSION: Denali filters demonstrated significantly lower rates of tilt angle > 15° and strut penetration. However, there was no significant difference in the complex filter retrieval rate between the Celect and Denali filters.

Effects of hot-melt extruded nano-copper on the Cu bioavailability and growth of broiler chickens.

This study was aimed to investigate the Cu bioavailability, growth response, digestibility of nutrients, and blood metabolites of broiler chicks fed CuSO4 in nano or common forms. A total of 720 broiler chickens were distributed between eight treatments according to a completely randomized design. There were 8 treatments and 6 replicates in each treatment with 15 birds/replicate. The treatments were divided into common copper sulfate at the doses of 16 ppm, 40 ppm, 80 ppm, and 120 ppm (INO) and hot-melt extruded copper sulfate at the doses of 16 ppm, 40 ppm, 80 ppm, and 120 ppm (HME-Cu). The experiment was operated for 35 days in 2 phases (phase 1, d 0 to 14; and phase 2, d 15 to 35). No significant differences were shown in growth performance, feed intake, FCR, and nutrient digestibility among the treatments. The concentration of Cu in the serum was increased in the HME-Cu broilers compared with the INO broilers at phase 2. A linear increase was observed in the concentration of Cu in the liver in broilers fed INO diets, however, no significant differences were observed by the supplementation of HME-Cu levels. The linear increase was detected in the content of Cu in excreta in the INO and HME-Cu treatments by increasing the dietary Cu content. The HME-Cu treatments showed a lower Cu concentration in the excreta compared with the INO treatments. The higher bioavailability of Cu in HME form can decrease the recommended dose of Cu in broiler diets.

Nano-sized Zinc in Broiler Chickens: Effects on Growth Performance, Zinc Concentration in Organs, and Intestinal Morphology.

The effects of dietary supplementation of zinc (Zn) sources and concentrations were investigated on growth performance, absorption into tissues, fecal excretion, nutrient retention, and intestinal morphology in broilers fed a corn-soybean meal basal diet. A total of 525 one-day-old chicks (Ross 308) were assigned based on body weight to seven dietary treatments. There were five replicate pens for each treatment and 15 broilers per replicate pen. The dietary treatments included a basal diet (control, without supplementing Zn), and basal diet supplemented with Zn, as inorganic zinc sulfate (ZnS; 110 mg/kg); organic Zn-methionine (ZnM; 110 mg/kg); hot-melt extruded (HME) 25 zinc sulfate (27.5 mg/kg); HME50 zinc sulfate (55 mg/kg); HME75 zinc sulfate (82.5 mg/kg); or HME100 zinc sulfate (110 mg/kg) for 35 days in two phases (d 1-21, phase I and d 22-35, phase II). Bodyweight and feed efficiency of broiler chicks fed diets supplemented with increasing dietary concentrations of HME-Zn improved linearly during the study period (P<0.05). Compared to the control treatment, the ZnS, ZnM, and HME diets increased Zn concentrations in the serum and liver. Inorganic ZnS supply resulted in the highest Zn concentration in excreta. Increasing supplemented Zn content in diets as HME linearly increased Zn concentration in the excreta, serum, liver, and tibia. Broiler chicks fed diets supplemented with increasing concentrations of HME increased villus height (VH; linear and quadratic) of the jejunum and VH of the ileum (linear). Increasing concentrations of dietary Zn supplied as HME resulted in linearly enhanced dry matter, gross energy, and nitrogen retention of broilers on day 21. These results suggest that dietary HME-Zn at a lower level (55 ppm) shows the same growth performance as common ZnSO4 at 110 ppm.

Superselective transcatheter arterial embolization for acute small bowel bleeding: clinical outcomes and prognostic factors for ischemic complications.

BACKGROUND: Small bowel bleeding (SBB) accounts for 5%-10% of all cases of acute gastrointestinal bleeding. Transcatheter arterial embolization (TAE) plays an important role in the treatment of SBB. PURPOSE: To evaluate the safety and efficacy of superselective TAE exclusively for SBB and to assess factors associated with clinical outcomes. MATERIAL AND METHODS: From January 2006 to April 2017, 919 patients were admitted with signs and symptoms of gastrointestinal bleeding; 74 patients (mean age = 57.5 years; age range = 14-82 years) with positive angiographic findings for SBB were retrospectively analyzed. The technical success of TAE and clinical outcomes, including recurrent bleeding, major complications, and in-hospital mortality were evaluated. The associations of various clinical and technical factors with clinical outcomes were analyzed. RESULTS: The bleeding foci were in the ileum in 48 (65%) patients and the jejunum in 26 (35%). Technical success was achieved in 72 (97%) patients. The rates of recurrent bleeding, major complications, and in-hospital mortality were 12% (7/57), 21% (15/71), and 25% (18/72), respectively. Superselective embolization was a significant prognostic factor associated with fewer major complications (OR = 0.069; P = 0.003). The increased number of embolized vasa recta was significantly associated with a higher probability of major complications (OR = 2.64; P < 0.001). The use of N-butyl cyanoacrylate was associated with lower rates of major complication (OR = 0.257; P = 0.027). CONCLUSION: TAE is a safe and effective treatment modality for SBB. In addition, whenever possible, TAE should be performed in a superselective manner to minimize ischemic complications.

Effects of Hot-Melt Extruded Nano-Copper as an Alternative for the Pharmacological Dose of Copper Sulfate in Weanling Pigs.

This study was conducted to investigate the effects of hot-melt extrusion (HME)-processed copper (Cu) sulfate supplementation on the growth performance, gut microbiota, metabolic function of Cu, and bioavailability of Cu in weanling pigs fed a corn-soybean meal basal diets. A total of 180 piglets (Yorkshire × Landrace × Duroc) of mixed-sex randomly were allotted to six treatments on the basis of initial average body weight (6.36 ± 0.39 kg) to six dietary treatments. There were six replicates in each treatment with 5 pigs per replicates. The dietary treatments included levels of CuSO4 (IN6, 6 mg Cu/kg diets; IN125, 125 mg Cu/kg diets), nano-CuSO4 (HME6, 6 mg Cu/kg diets; HME65, 65 mg Cu/kg diets; and HME125, 125 mg Cu/kg diets), and Cu-methionine (ORG125, 125 mg Cu/kg diets). The weanling pigs fed diets supplemented with the HME65 and HME125 showed a greater body weight and feed intake compared with IN6 and IN125 (P < 0.05). The weaning pigs fed diets supplemented with the HME125 showed the highest digestibility of gross energy in phase 1 and phase 2 (P < 0.05). The supplementation of HME125 significantly reduced the Escherichia coli (E.coli) in cecum and colon (P < 0.05). The supplementation of HME65 showed statistically equivalent effect on reduction of E. coli in the cecum and colon compared with IN125 and ORG125 treatments. The villus height in duodenum and jejunum of piglets in HME65 and HME125 treatments were higher than ORG125, HME6, IN6, and IN125 (P < 0.05). The gene expression of Atox1 was upregulated in IN125, HME125, and ORG125 treatments (P < 0.05). The expression of Sod1 was increased in IN125 treatment compared with IN6 treatment (P < 0.05). The HME125 treatment had the highest gene expression of ghrelin (P < 0.05). The Cu concentration of serum and liver was higher in the HME125 treatment than the HME6, IN6, and IN125 treatments (P < 0.05). The HME125 and ORG125 treatments showed a lower fecal Cu compared with IN125 treatment (P < 0.05). Taken together, these results suggest that the HME65 can be an alternative to IN125 in weanling pigs due to the greater overall average daily gain, improved villus height, and higher bioavailability.

Hot-Melt Extruded Selenium: a Highly Absorbable Nano-Selenium in Lactating Sows Exposed to High Ambient Temperature.

To study the role of hot-melt extruded (HME) selenium (Se) and in the lactating sows' reproductive performance and litter growth, a total of 60 crossbred sows (Yorkshire × Landrace; average body weight, 245.3 kg) were allotted to one of four treatments according to a 2 × 2 factorial arrangement. The performance of lactating sows was investigated in the different average room temperatures (high temperature (HT), 28.1 °C vs. low temperature (LT), 24.6 °C), and different selenium sources (INO, 0.15 mg common sodium selenite/kg diet; HME, 0.15 mg nano-sodium selenite/kg diet) during the summer season. At days 10 and 21, the serum glutathione peroxidase (GPx) activity and Se concentration were greater in lactating sows fed HME compared with sows fed INO diet. The concentration of Se in the serum was greater in piglets from the HME treatment compared with piglets from the INO treatment. The HT treatment had a significantly higher body weight loss, backfat thickness loss, and weaning-to-estrus interval. The piglets' survivability, total weight gain, daily feed intake, and average daily gain during the lactation were greater in the LT sows compared with the HT sows. A higher blood cortisol concentration was observed in the HT sows compared with the LT. Selenium contents of milk at days 10 and 21 postpartum were increased by dietary supplementation of HME. In conclusion, the results of the present study demonstrated that there are no performance differences between sows fed different Se sources; however, HME supplementation increased serum and milk Se content, resulting in increased serum GPx concentration in sows and a greater serum Se in the litters.

Comparison of the therapeutic efficacy and ovarian reserve between catheter-directed sclerotherapy and surgical excision for ovarian endometrioma.

OBJECTIVES: To compare the efficacies of catheter-directed sclerotherapy (CDS) with 99% ethanol and surgery for ovarian endometrioma and their impact on the ovarian reserve. METHODS: From January 2011 to June 2019, 71 patients who underwent surgical excision (n = 51) or CDS (n = 20) for symptomatic ovarian endometriomas were reviewed. To analyze the effect on the ovarian reserve, serum anti-Müllerian hormone (AMH) levels were compared before and after the procedure. Symptoms, serum cancer antigen 125 (CA-125), lesion size, recurrence, hospitalization, and complications were reviewed retrospectively. RESULTS: During a mean follow-up of 22.3 months (range, 6 to 94 months), no significant difference in symptom relief was found between CDS and surgery (95.0% [19/20] and 92.2% [47/51], respectively, p > 0.999). The hospital stay was shorter with CDS than with surgery (2.6 ± 0.6 days and 4.1 ± 0.5 days, respectively, p < 0.001). There was no significant difference in serum AMH levels before and after CDS (2.3 (interquartile range (IQR) 1.1-5.3) ng/mL and 2.6 (IQR 0.9-4.9) ng/mL, respectively, p = 0.243), but there was a significant decrease in serum AMH in the surgery group (3.0 (IQR 1.3-5.5) ng/mL and 1.6 (IQR 0.7-3.2) ng/mL, respectively, p < 0.001). CA-125 decreased in both CDS and surgery groups (p = 0.001 and < 0.001, respectively). Two minor complications occurred in the surgery group, while no complication was observed in the CDS group. CONCLUSIONS: The therapeutic efficacy of CDS appears to be comparable to that of surgical resection for ovarian endometrioma. Ovarian function was well-preserved, and a shorter hospital stay was required in patients who underwent CDS. KEY POINTS: • There was no significant difference in symptom relief between CDS and surgery (95.0% [19/20], 92.2% [47/51], respectively, p >0.999). • No significant difference in serum AMH levels was seen before and after CDS (2.3 (1.1, 5.3)* ng/mL, 2.6 (0.9, 4.9)* ng/mL, respectively, p = 0.243), whereas serum AMH levels significantly decreased after surgical resection (3.0 (1.3, 5.5)* ng/mL, 1.6 (0.7, 3.2)* ng/mL, respectively, p <0.001). *Median (25 quartiles, 75 quartiles) • The hospitalization period was shorter with CDS than with surgery (2.6 ± 0.6 days, 4.1 ± 0.5 days, respectively, p <0.001).