Effects of Amount and Profile of Amino Acids Supply on Lactation Performance, Mammary Gland Metabolism, and Nitrogen Efficiency in Holstein Dairy Cows.

To evaluate the effects of amount and profile of amino acid (AA) on milk protein yield (MPY), mammary metabolism, and efficiency of nitrogen use (ENU), ten cows were used in 5 × 5 replicated Latin squares and fed a positive control (16.1% crude protein-CP) or two lower CP diets (14.6 and 13.2%) with or without essential AA (EAA) infusion. The EAA solutions provided predicted limiting EAA in each treatment and were continuously infused into the abomasum of the cows. Milk production and MPY were not affected by treatment (mean 35.4 kg/d and 1.03 kg/d, respectively). Efficiency of nitrogen utilization was increased as dietary CP decreased but was not affected by EAA infusion (p < 0.01). Energy-corrected milk production was increased by EAA infusion into 13.2% CP, but not into 14.6% CP diet (p = 0.09), reaching the positive control value. Infusions increased mammary affinity for non-infused EAA (Ile, Phe, Thr, and Trp), allowing the same MPY despite lower arterial concentrations of these AA. Higher arterial concentrations of infused EAA did not increase their mammary uptake and MPY (p = 0.40; p = 0.85). Mammary metabolism did not fully explain changes in N efficiency, suggesting that it might be driven by less extramammary catabolism as AA supply was reduced.

Titratable partial aortic occlusion: Extending Zone I endovascular occlusion times.

BACKGROUND: Extending the time to definitive hemorrhage control in noncompressible torso hemorrhage (NCTH) is of particular importance in the battlefield where transfer times are prolonged and NCTH remains the leading cause of death. While resuscitative endovascular balloon occlusion of the aorta is widely practiced as an initial adjunct for the management of NCTH, concerns for ischemic complications after 30 minutes of compete aortic occlusion deters many from zone 1 deployment. We hypothesize that extended zone 1 occlusion times will be enabled by novel purpose-built devices that allow for titratable partial aortic occlusion. METHODS: This is a cross-sectional analysis describing pREBOA-PRO zone 1 deployment characteristics at seven level 1 trauma centers in the United States and Canada (March 30, 2021, and June 30, 2022). To compare patterns of zone 1 aortic occlusion, the AORTA registry was used. Data were limited to adult patients who underwent successful occlusion in zone 1 (2013-2022). RESULTS: One hundred twenty-two patients pREBOA-PRO patients were included. Most catheters were deployed in zone 1 (n = 89 [73%]) with a median zone 1 total occlusion time of 40 minutes (interquartile range, 25-74). A sequence of complete followed by partial occlusion was used in 42% (n = 37) of zone 1 occlusion patients; a median of 76% (interquartile range, 60-87%) of total occlusion time was partial occlusion in this group. As was seen in the prospectively collected data, longer median total occlusion times were observed in the titratable occlusion group in AORTA compared with the complete occlusion group. CONCLUSION: Longer zone 1 aortic occlusion times seen with titratable aortic occlusion catheters appear to be driven by the feasibility of controlled partial occlusion. The ability to extend safe aortic occlusion times may have significant impact to combat casualty care where exsanguination from NCTH is the leading source of potentially preventable deaths. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

Resuscitative endovascular balloon occlusion of the aorta in Canada: a context-specific position paper from the Canadian Collaborative for Urgent Care Surgery (CANUCS).

SummaryResuscitative endovascular balloon occlusion of the aorta (REBOA) is a well-described intervention for noncompressible torso hemorrhage. Several Canadian centres have included REBOA in their hemorrhagic shock protocols. However, REBOA has known complications and equipoise regarding its use persists. The Canadian Collaborative on Urgent Care Surgery (CANUCS) comprises surgeons who provide acute trauma care and leadership in Canada, with experience in REBOA implementation, use, education and research. Our goal is to provide evidence- and experience-based recommendations regarding institutional implementation of a REBOA program, including multidisciplinary educational programs, attention to device and care pathway logistics, and a robust quality assurance program. This will allow Canadian trauma centres to maximize patient benefits and minimize risks of this potentially life-saving technology.

Errata - Is it Important to Know Where to Place the Spherical Marker for Hip Replacement Digital Planning??

[This corrects the article DOI: 10.1055/s-0039-1693052.][This corrects the article DOI: 10.1055/s-0039-1693052.].

Is it Important to Know Where to Place the Spherical Marker for Hip Replacement Digital Planning?

Objective The present paper aims to evaluate the influences of individual characteristics in radiographic magnification and to identify the most accurate method for radiographic calibration. Methods During radiographical exam of 50 patients with hip prosthesis, anthropometric data was collected and 4 spherical metal markers with 25 mm diameters were positioned: at the greater trochanter level and lateral to it, over the pubic symphysis, between the thighs at the greater trochanter level, and over the exam table. Since the prosthesis head is the best internal radiographic marker for hip arthroplasty, it was our calibration parameter. Two examiners measured the markers' image for further analysis. Results The sample consisted of 50 participants, 19 of whom were male. A difference in pubic symphysis magnification was found. Other individual characteristics (weight, height and body mass index) had weak correlation. The higher accuracy of the markers was at the greater trochanter, between 68.4 and 78.9%, visualized in only19 radiographs. The marker positioned between the thighs was visualized in all radiographs, with an accuracy ranging from 30 to 46%. Conclusions Of all individual characteristics, only gender influences magnification at the pubic symphysis. We suggest the use of two spherical markers: at the greater trochanter, due the best accuracy, and between the thighs, considered the best positioning for better visibility.

Is it Important to Know Where to Place the Spherical Marker for Hip Replacement Digital Planning? / É importante saber onde posicionar o marcador esférico para o planejamento digital de artroplastia de quadril?

Abstract Objective The present paper aims to evaluate the influences of individual characteristics in radiographic magnification and to identify the most accurate method for radiographic calibration. Methods During radiographical exam of 50 patients with hip prosthesis, anthropometric data was collected and 4 spherical metal markers with 25 mm diameters were positioned: at the greater trochanter level and lateral to it, over the pubic symphysis, between the thighs at the greater trochanter level, and over the exam table. Since the prosthesis head is the best internal radiographic marker for hip arthroplasty, it was our calibration parameter. Two examiners measured the markers' image for further analysis. Results The sample consisted of 50 participants, 19 of whom were male. A difference in pubic symphysis magnification was found. Other individual characteristics (weight, height and body mass index) had weak correlation. The higher accuracy of the markers was at the greater trochanter, between 68.4 and 78.9%, visualized in only19 radiographs. The marker positioned between the thighs was visualized in all radiographs, with an accuracy ranging from 30 to 46%. Conclusions Of all individual characteristics, only gender influences magnification at the pubic symphysis. We suggest the use of two spherical markers: at the greater trochanter, due the best accuracy, and between the thighs, considered the best positioning for better visibility.

Resumo Objetivo Os objetivos desse artigo são avaliar as influências das características pessoais na magnificação radiográfica e identificar o método de maior acurácia e o mais adequado. Métodos Durante o exame radiográfico em 50 pacientes com prótese de quadril, foram coletados dados antropométricos e posicionados quatro marcadores metálicos esféricos: ao nível e lateral ao trocânter maior, na sínfise púbica, ao nível do trocânter maior entre as coxas, sobre a mesa do exame. A cabeça da prótese é o melhor marcador radiográfico interno e foi o nosso parâmetro de calibragem. Dois avaliadores mediram as imagens desses marcadores para análise de resultados. Resultados Foram selecionados 50 participantes, sendo 19 do sexo masculino. Houve diferença de magnificação entre os sexos na posição sínfise púbica. As outras características pessoais avaliadas (peso, altura e índice de massa corpórea) tiveram correlação fraca. A maior acurácia do marcador foi no trocânter maior, entre 68,4 e 78,9%, visualizado em apenas 19 radiografias. O marcador entre as coxas obteve acurácia entre 30 e 46% e foi visualizado em todas as radiografias. Conclusão Das características pessoais, apenas o sexo influencia a magnificação e somente na posição da sínfise púbica. Sugerimos padronizar o uso de duas esferas: no trocanter maior, pela maior acurácia, e entre as coxas, por ser o mais adequado e com melhor visibilidade em todas radiografias.

A taxonomic review of the brachiopod genus Australocoelia (Boucot amp; Gill, 1956) in the Devonian of Brazil.

The rhynchonellide brachiopod genus Australocoelia was widely distributed across the Southern Hemisphere in the Devonian with three species recognized; A. palmata, A. peruviana and A. polyspera. In Brazil, A. palmata was initially reported from the Ponta Grossa and São Domingos formations (Paraná Basin), later recorded from the western border of the Parnaíba Basin (Pimenteira Formation, State of Tocantins), and is now shown to occur on the eastern border of the same basin (Pimenteira Formation, State of Piauí). In this paper, we describe a fourth species from the Paraná Basin as Australocoelia boucoti n. sp. It differs from A. palmata and the other species of Australocoelia in features of ornamentation and interspace, in addition to paleoecological characteristics.

Susceptibility of Triatoma sordida Stal, 1859 (Hemiptera: Reduviidae) to alpha-cypermethrin under natural climatic conditions.

INTRODUCTION: Despite the recommendations by interpretation of resistance ratios obtained in laboratory bioassays, little is known about the actual impact of these results in the effectiveness of vector control activities in the field. In this context, our objective was to determine the mean value of different resistance ratios obtained by laboratory bioassays performed as part of the chemical control strategies of Triatoma sordida in the field. METHODS: Field bioassays were developed in Monte Azul and Coração de Jesus (Southeast, Brazil). In each location, samples were formed with three domestic units treated with alpha-cypermethrin 20.0% (Alfatek (r) 200 SC). One day after spraying, 10 fifth-instar nymphs remained in contact with the surfaces treated (adobe with plaster, adobe without plaster, or wood) with insecticide in plastic cones for 72h. Three cones were exposed inside the intradomicile and the peridomicile. The insects in the control group were exposed to an insecticide-free piece of cardboard. Mortality was measured 72h after removal of the insects from the treated surfaces. The tests were realized in triplicate. RESULTS: Mortality was 100.0% in all locations, except for Monte Azul; Landinho (96.6%) and Coração de Jesus; Barriguda (96.6%). CONCLUSIONS: Although the resistant populations in laboratory tests proved to be susceptible in the field, this observation is not sufficient to suggest that the cut-off points used to justify the resistance ratio should be changed. In this sense, we recommend that laboratory and field bioassays are carried out with a greater number of Triatominae populations to allow more in-depth consideration of the subject.

Susceptibility of Triatoma sordida Stal, 1859 (Hemiptera: Reduviidae) to alpha-cypermethrin under natural climatic conditions

Despite the recommendations by interpretation of resistance ratios obtained in laboratory bioassays, little is known about the actual impact of these results in the effectiveness of vector control activities in the field. In this context, our objective was to determine the mean value of different resistance ratios obtained by laboratory bioassays performed as part of the chemical control strategies of Triatoma sordida in the field.

Deltamethrin toxicological profile of peridomestic Triatoma sordida in the North of Minas Gerais, Brazil.

BACKGROUND: In general, there was a large reduction in the occurrence of cases of Chagas disease in the last decades in Brazil. However, despite all of these efforts, there have been various reports of persistent reinfestations of T. sordida in a large part of the state of Minas Gerais, for reasons still little investigated. Thus, this purpose of this study was to characterize the deltamethrin susceptibility profile of peridomestic T. sordida populations from North of Minas Gerais-Brazil. METHODS: Susceptibility to deltamethrin was assessed in seventeen peridomestic populations of T. sordida from North region of Minas Gerais, Brazil. Serial dilutions of deltamethrin in acetone (0.2 µL) were topically applied in first instar nymphs (F1, five days old, fasting, weight 1.2 ± 0.2 mg). Dose response results were analyzed with POLO program, determining the lethal doses, slope and resistance ratios (RR). RESULTS: Susceptibility profile characterization of T. sordida populations revealed resistance ratios (RR50) ranging from 2.50 to 7.08. CONCLUSIONS: In fact, we know very little about the real impact of the resistance ratios obtained in the laboratory bioassays on the effectiveness of the vector control activities in the field. Thus, we prefer to refer to the populations with RR > 5 as populations with altered susceptibility. For these populations, the realization of laboratory and field trials, simultaneous and complementary, permitting the evaluation of both, is recommended.

RARS with fibrosis and del(20q) transformed into ALL.

Transformation of myelodysplastic syndrome (MDS) into acute myelogenous leukemia occurs in approximately 30 % of cases, while progression into acute lymphoblastic leukemia (ALL) is rare. We report on a 67-year-old man with the diagnosis of MDS, subtype refractory anemia with ring sideroblasts (RARS), karyotype 20q- , JAK-2 negative and grade III fibrosis on the bone marrow biopsy, who evolved into ALL 33 months after the diagnosis of MDS. RARS is one of the subtypes of MDS with most indolent course. Deletion of the long arm of chromosome 20 (20q-) is considered as good prognosis by the International Prognostic Scoring System, an important scoring system for predicting survival and evolution of MDS. Primary MDS with bone marrow fibrosis may represent a distinct clinicopathological and is supposed to have an unfavorable prognosis. The combined analysis of these features makes this rare report still more challenging and illustrates that biology of MDS is yet to be discovered.

Identification of serine proteases from Leishmania braziliensis.

Leishmania (V) braziliensis is one of the most important ethiologic agents of the two distinct forms of American tegumentary leishmaniasis (cutaneous and mucosal). The drugs of choice used in leishmaniasis therapy are significantly toxic, expensive and are associated with frequent refractory infections. Among the promising new targets for anti-protozoan chemotherapy are the proteases. In this study, serine proteases were partially purified from aqueous, detergent and extracellular extracts of Leishmania braziliensis promastigotes by aprotinin-agarose affinity chromatography. By zymography, the enzymes purified from the aqueous extract showed apparent activity bands of 60 kDa and 45 kDa; of 130 kDa, 83 kDa, 74 kDa and 30 kDa from the detergent extract; and of 62 kDa, 59 kDa, 57 kDa, 49 kDa and 35 kDa from the extracellular extract. All purified proteases exhibited esterase activity against Nalpha-benzoyl-L-arginine ethyl ester hydrochloride and Nalpha-p-tosyl-L-arginine methyl ester hydrochloride (serine protease substrates) and optimal activity at pH 8. 0. Proteases purified from the aqueous and extracellular extracts were effectively inhibited by benzamidine (trypsin inhibitor) and those from the detergent extract were inhibited by N-tosyl-L-phenyl-alanine chloromethyl ketone (chymotrypsin inhibitor) indicating that all these enzymes are serine proteases. These findings indicate that L. braziliensis serine proteases display some biochemical similarities with L. amazonensis serine proteases, demonstrating a conservation of this enzymatic class in the Leishmania genus. This is the first study to report the purification of a serine protease from Leishmania braziliensis.

Acerca do surgimento do hospital / On the origins of the hospital

Mostra "o espaço hospitalar" a partir de dois momentos: o hospital enquanto espaço de "reclusäo", empreendimento sustentado por um "saber religioso"; e o hospital enquanto espaço de "normalizaçäo", empreendimento sustentado por um "saber médico". O tema é abordado a partir da eficácia desses empreendimentos no contexto sócio-político no qual foram efetuados.(AU)