Risk-stratified faecal immunochemical testing (FIT) for urgent colonoscopy in Lynch syndrome during the COVID-19 pandemic.

BACKGROUND: Lynch syndrome is a hereditary cancer disease resulting in an increased risk of colorectal cancer. Herein, findings are reported from an emergency clinical service implemented during the COVID-19 pandemic utilizing faecal immunochemical testing ('FIT') in Lynch syndrome patients to prioritize colonoscopy while endoscopy services were limited. METHODS: An emergency service protocol was designed to improve colonoscopic surveillance access throughout the COVID-19 pandemic in England for people with Lynch syndrome when services were extremely restricted (1 March 2020 to 31 March 2021) and promoted by the English National Health Service. Requests for faecal immunochemical testing from participating centres were sent to the National Health Service Bowel Cancer Screening South of England Hub and a faecal immunochemical testing kit, faecal immunochemical testing instructions, paper-based survey, and pre-paid return envelope were sent to patients. Reports with faecal haemoglobin results were returned electronically for clinical action. Risk stratification for colonoscopy was as follows: faecal haemoglobin less than 10 µg of haemoglobin/g of faeces (µg/g)-scheduled within 6-12 weeks; and faecal haemoglobin greater than or equal to 10 µg/g-triaged via an urgent suspected cancer clinical pathway. Primary outcomes of interest included the identification of highest-risk Lynch syndrome patients and determining the impact of faecal immunochemical testing in risk-stratified colonoscopic surveillance. RESULTS: Fifteen centres participated from June 2020 to March 2021. Uptake was 68.8 per cent amongst 558 patients invited. For 339 eligible participants analysed, 279 (82.3 per cent) had faecal haemoglobin less than 10 µg/g and 60 (17.7 per cent) had faecal haemoglobin greater than or equal to 10 µg/g. In the latter group, the diagnostic accuracy of faecal immunochemical testing was 65.9 per cent and escalation to colonoscopy was facilitated (median 49 versus 122 days, χ2 = 0.0003, P < 0.001). CONCLUSION: Faecal immunochemical testing demonstrated clinical value for Lynch syndrome patients requiring colorectal cancer surveillance during the pandemic in this descriptive report of an emergency COVID-19 response service. Further longitudinal investigation on faecal immunochemical testing efficacy in Lynch syndrome is warranted and will be examined under the 'FIT for Lynch' study (ISRCTN15740250).

Evaluation of the effects of corn silage maturity and kernel processing on steer growth performance and carcass traits.

Two experiments were conducted to investigate the effects of feeding kernel processed corn silage to growing calves at 65% inclusion (dry matter [DM] basis; Exp. 1] and finishing beef steers at 20% inclusion (DM basis; Exp. 2). In Exp. 1, steers (n = 184; initial shrunk body weight [BW] = 388 ± 22.3 kg) were used to evaluate the influence that kernel processing of corn silage has on production responses when fed at 65% diet inclusion (DM basis) during a 46-d growing period. Steers were allotted to 1 of 24 pens (12 replicate pens/treatment). Treatments were based upon corn silage that was either kernel processed or not. In Exp. 2, steers (n = 192; initial shrunk BW = 446 ± 28.3 kg) were used in a 112-d finishing experiment. Treatments were grouped in a 2 × 2 factorial arrangement (24 pens total; 8 steers/pen) to evaluate corn silage harvest maturity (1/2 to 2/3 milk line or black layer) and kernel processing (processed or not) at time of corn silage harvest on finishing steer growth performance and carcass traits when corn silage is fed at a dietary DM inclusion of 20%. Both experiments were analyzed as a randomized completed block design with pen as experimental unit. In Exp. 1, final BW tended (P = 0.07) to be increased by 3 kg in kernel processed corn silage. Daily weight gain and DM intake were increased (P ≤ 0.04) by 6% and 2%, respectively, in steers fed kernel processed corn silage compared to controls; however, gain efficiency was not appreciably influenced by treatment (P = 0.15). In Exp. 2, there were no harvest maturity × kernel processing interactions (P ≥ 0.26) for any growth performance measures or any parameters related to efficiency of dietary NE utilization. No harvest maturity × kernel processing interactions (P ≥ 0.08) were observed for any carcass traits except for the distribution of USDA Prime carcasses (P = 0.04). Steers fed 2/3 milk line and unprocessed corn silage had a lower (P = 0.05) proportion of carcasses grade USDA Prime (0.0%) compared to all other treatments (12.0%). Harvest time (P ≥ 0.07) and kernel processing (P ≥ 0.07) of corn silage had no appreciable influence on any other carcass trait measures. These data indicate that kernel processed corn silage fed to growing calves at 65% diet inclusion (DM basis) enhances intake and daily gain, while kernel processed corn silage fed to finishing steers at 20% diet inclusion (DM basis) does not appreciably influence daily gain, efficiency of gain, or carcass parameters.

Kernel processing of corn silage has yielded inconsistent results on diet digestibility and growth performance in beef cattle. These are likely a function of a variety of factors such as differing dry matter concentration of corn silage at harvest, diet inclusion levels, and length of cut. Two experiments were conducted to determine the effect that kernel processing of corn silage has on production responses in growing (65% dietary dry matter inclusion) and finishing beef steers (20% dietary dry matter inclusion). Data from the growing steer experiment when corn silage was included in the diet at 65% (dry matter basis) indicate that kernel processing of corn silage enhances dry matter intake and daily weight gain of beef steers with no appreciable influence on DM conversion efficiency. Data from the finishing steer experiment indicate that harvest maturity and kernel processing of corn silage have minimal effects on animal growth performance and carcass traits in finishing steers when corn silage is fed at 20% inclusion (dry matter basis). Variable responses could be related to differences in inclusion level, differences in effective roughage level fed, and a variety of other factors. Overall, these results suggest that corn silage fed to growing calves should be kernel processed to enhance dry matter intake and daily weight gain, while kernel processed corn silage fed to finishing steers does not appreciably influence daily gain, efficiency of gain, or carcass parameters.

Perceived Impact of the COVID-19 Pandemic on Physical Activity Among Adult Patients With Rheumatologic Disease.

OBJECTIVE: The objective of this cross-sectional study was to investigate the impact of the COVID-19 pandemic on physical activity (PA) levels of patients with rheumatic and musculoskeletal diseases (RMDs) and to examine factors associated with decreased PA. METHODS: A sample of adult patients with RMDs (n = 7,776) was identified through electronic medical records from an academic health care system in North Carolina. Invitations to participate in an online survey were sent between July 2020 and September 2020 to assess self-reported changes in PA during the COVID-19 pandemic. Descriptive statistics, age-adjusted prevalence odds ratios (PORs), and 95% confidence intervals (CIs) were computed to examine patient characteristics associated with decreased PA. RESULTS: A total of 893 eligible participants completed the survey (mean age 57.8 ± 14.9 years, 75.8% female). The most common primary diagnoses reported among participants included rheumatoid arthritis (27.3%), osteoarthritis (16.0%), and systemic lupus erythematosus (SLE) (13.0%). More than half of participants (56.8%) reported engaging in less PA since the pandemic began. Factors associated with engaging in less PA included lower self-reported general health (POR, 2.21; CI, 1.64-2.97) and a diagnosis of SLE (POR, 1.57; CI, 1.03-2.38). Comorbidities associated with decreased PA included chronic pain (POR, 1.38; CI, 1.04-1.82), depression (POR, 1.48; CI, 1.09-2.01), and hypertension (POR, 1.44; CI, 1.10-1.90). CONCLUSION: The COVID-19 pandemic has exacerbated barriers to PA in patients with RMDs. There is a critical need to provide resources, support, and multifaceted programs to encourage PA in patients with RMDs during the COVID-19 pandemic.

Reduced trabecular bone mineral density and thinner cortices in men with distal forearm fractures.

Men with distal forearm fractures have reduced bone density, an increased risk of osteoporosis and of further fractures. The aim of the study was to investigate the structural determinants of these observations using quantitative CT (qCT). Ninety six men with low-trauma distal forearm fracture and 101 age-matched healthy control subjects were recruited. All subjects underwent a quantitative CT on a standard 64-slice whole body CT scanner. These were analysed on Mindways QCT PRO™ Software to generate volumetric and geometric data at the lumbar spine, femoral neck and total hip, ultra-distal and distal 33 % radius. Biochemical investigations, health questionnaires and measurements of bone turnover were made. Men with fracture had significantly lower total and trabecular vBMD at all sites. The greatest percentage reduction was at the ultra-distal radius (13.5 % total and 11.7 % trabecular vBMD). In the fracture group cortical vBMD was significantly higher in the femoral neck (p < 0.001) and maintained at the ultra-distal radius compared with control subjects. However, cortical cross-sectional area (CSA) and thickness were significantly reduced at the femoral neck (p < 0.001 and p = 0.002 respectively) and forearm sites (CSA ultradistal radius p = 0.001, cortical thickness p = 0.002, CSA distal one third radius p = 0.045 and cortical thickness p = 0.005). Cross sectional moment of inertia (CSMI) and section moduli were significantly reduced at the femoral neck (CSMI1 p = 0.002, CSMI2 p = 0.012 and section moduli Z1 p < 0.001, Z2 p = 0.004) and the ultra-distal radius (CSMI1 p = 0.008 and section moduli Z1 p = 0.018, Z2 p = 0.007). In stepwise logistic regression analysis distal forearm fracture showed the strongest association with a model comprising ultra-distal forearm trabecular vBMD (negative), procollagen type I N-terminal propeptide (PINP, positive) and sex hormone binding globulin (SHBG, negative). In conclusion, these observations explain the structural reasons for the increased fracture risk in men with distal forearm fractures.

Modulation of expression of estrus, steroidogenesis and embryo development following peri-artificial insemination nutrient restriction in beef heifers.

Nutritional changes immediately after insemination cause increased embryonic mortality, but the mechanisms controlling this are not well known. Our objective was to evaluate the impact of nutritional change on estrus expression, steroid concentrations, peripheral and uterine luminal fluid metabolites, and embryo quality in beef heifers. Heifers (n = 139) were assigned to one of two pre-artificial insemination (AI) dietary treatments: LOW (≤ 90% NEm) or HIGH (≥ 139% NEm). Heifers were on treatment for 33-36 days before AI (d0) when half of the heifers in each treatment were randomly reassigned to generate four treatments; HIGH-HIGH, HIGH-LOW, LOW-HIGH, and LOW-LOW. Heifers remained on treatments until embryo collection (d 6-8). Negative energy balance was achieved among LOW heifers as demonstrated by body weight loss and increased NEFA concentrations (P < 0.05). Pre-AI treatment influenced expression of estrus (P = 0.05; HIGH 80.4 ± 4.0% vs. LOW 69.4 ± 4.2%). Estradiol concentrations and interval to estrus were not affected by treatment (P > 0.55); however, progesterone concentrations were reduced among LOW compared to HIGH (3.57 ± 0.27, 4.64 ± 0.26 ng/mL, respectively; P = 0.004), and heifers maintained on the HIGH pre-AI diet had consistently greater concentrations of progesterone from d 0 to d 8 (P = 0.014). Pre-AI treatment influenced embryo stage (P = 0.05; HIGH 3.61 ± 0.32 vs. LOW 2.72 ± 0.30). Post-AI treatment affected embryo grade (P = 0.02; HIGH 1.78 ± 0.23 vs. LOW 2.64 ± 0.27). In summary, pre-AI nutrient restriction caused decreased expression of estrus, reduced progesterone concentrations after AI, and negatively impacted embryo development, while post-AI restriction hindered embryo quality.

The structure and activities of the archaeal transcription termination factor Eta detail vulnerabilities of the transcription elongation complex.

Transcription must be properly regulated to ensure dynamic gene expression underlying growth, development, and response to environmental cues. Regulation is imposed throughout the transcription cycle, and while many efforts have detailed the regulation of transcription initiation and early elongation, the termination phase of transcription also plays critical roles in regulating gene expression. Transcription termination can be driven by only a few proteins in each domain of life. Detailing the mechanism(s) employed provides insight into the vulnerabilities of transcription elongation complexes (TECs) that permit regulated termination to control expression of many genes and operons. Here, we describe the biochemical activities and crystal structure of the superfamily 2 helicase Eta, one of two known factors capable of disrupting archaeal transcription elongation complexes. Eta retains a twin-translocase core domain common to all superfamily 2 helicases and a well-conserved C terminus wherein individual amino acid substitutions can critically abrogate termination activities. Eta variants that perturb ATPase, helicase, single-stranded DNA and double-stranded DNA translocase and termination activities identify key regions of the C terminus of Eta that, when combined with modeling Eta-TEC interactions, provide a structural model of Eta-mediated termination guided in part by structures of Mfd and the bacterial TEC. The susceptibility of TECs to disruption by termination factors that target the upstream surface of RNA polymerase and potentially drive termination through forward translocation and allosteric mechanisms that favor opening of the clamp to release the encapsulated nucleic acids emerges as a common feature of transcription termination mechanisms.

Proteomics dataset of epididymal fluid, seminal plasma, and proteins loosely attached to epididymal and ejaculated sperm from Angus bulls.

Peptides and proteins were identified by liquid chromatography with tandem mass spectrometry analysis (LCMS-MS) on an Orbitrap Velos mass spectrometer to further understand biological mechanisms that regulate increased longevity in epididymis compared to ejaculated sperm. Semen from sexually mature bulls were collected and then bulls were slaughtered to collect epididymal samples from the cauda epididymis. All samples were centrifuged to separate spermatozoa from fluids. A high ionic solution was used to remove surface proteins from spermatozoa. Four unique samples were generated: (1) epididymal fluid, (2) seminal plasma (ejaculated fluid), and proteins stripped from (3) epididymal sperm, and (4) ejaculated sperm. Samples were analyzed by LCMS-MS, and data were interpreted with Protein Pilot 5. False discovery rate (FDR) was set at 1%. Unique proteins (n = 458) were identified in ejaculated samples, 178 proteins in seminal plasma and 298 proteins stripped from ejaculated sperm. In epididymal samples, 311 proteins were identified in the fluid, and 334 were identified among proteins stripped from epididymal sperm. This dataset can be useful for further understand of biological mechanisms that control sperm longevity. This dataset is related to the article 'Proteomic analyses identify differences between bovine epididymal and ejaculated spermatozoa that contribute to longevity' by (Zoca et al., 2022).

Governance and the mangrove commons: Advancing the cross-scale, nested framework for the global conservation and wise use of mangroves.

Mangroves provide critical ecosystems services, contributing an estimated 42 billion US dollars to global fisheries, storing 25.5 million tons of carbon per year, and providing flood protection to over 15 million people annually. Yet, they are increasingly threatened by factors ranging from local resource exploitation to global climate change, with an estimated 35% of mangrove forests lost in the past two decades. These threats are difficult to manage due to the intrinsic characteristics of mangrove systems and their provisioning services, and their transboundary and pan-global nature. Due to their unique intertidal ecological niche, mangroves are often treated as a "common pool resource" within national legal frameworks, making them particularly susceptible to exploitation. Moreover, they form ecological connections through numerous biotic and abiotic processes that cross political boundaries. Because of these qualities a cross-scale nested framework of international, regional, and local coordination is necessary to successfully sustain mangrove ecosystems and their valuable services. Although coordination across the geopolitical spectrum is often cited as a need for effective management of common resources such as mangroves, there has been no formal analysis of mangrove multiscale governance. In this paper we address this gap by providing a comprehensive analysis of interactions between and within international, regional, and local mangrove management regimes and examine the challenges and opportunities such multiscale governance frameworks present. We highlight Costa Rica as a case study to demonstrate the universal relevance and potential of multi-scale governance and explore its downscale potential. Using Elinor Ostrom's principles for self-governance of the commons as our touchstone, we identify where improvements to the status quo could be implemented to increase its effectiveness of the current frameworks to meet the ongoing challenge of managing mangrove-derived resources and services in the face of a changing climate and human needs.

Proteomic analyses identify differences between bovine epididymal and ejaculated spermatozoa that contribute to longevity.

Sperm are stored for extended periods of time in the epididymis, but upon ejaculation motility is increased and lifespan is decreased. The objective of this study was to identify differences in proteins between epididymis and ejaculated samples that are associated with longevity. Ejaculated semen was collected from mature Angus bulls (n = 9); bulls were slaughtered and epididymal semen was collected. Epididymal and ejaculated semen were centrifuged to separate sperm and fluid. Fluids were removed and sperm pellets were resuspended in a high ionic solution and vortexed to remove loosely attached proteins. Sperm samples were centrifuged, and the supernatant was removed; both fluid and sperm samples were snap frozen in liquid nitrogen and stored at -80 °C. Protein analysis was performed by LCMS/MS. A different group of yearling Angus cross bulls (n = 40) were used for sperm cultures. Ejaculated (n = 20) and epididymal (n = 20) semen were diluted and cultured in a commercial media at pH 5.8, 6.8 and 7.3, at 4 °C. Sperm were evaluated for motility and viability every 24 h until motility was lower than 20%. There was an effect of pH, time and pH by time interaction for motility and viability for both ejaculated and epididymal sperm (P ≤ 0.05). At 216 h of incubation epididymal sperm at pH 7.3 and ejaculated sperm at pH 6.8 reached motility below 20%. A total of 458 unique proteins were identified; 178, 298, 311, and 344 proteins were identified in ejaculated fluid, ejaculated sperm, epididymal fluid and epididymal sperm, respectively. There were 8, 24, 10, and 18 significant KEGG pathways (FDR <0.05) for ejaculated fluid, epididymal fluid, ejaculated sperm, and epididymal sperm, respectively. The metabolic pathway was identified as the most important KEGG pathway; glycolysis/gluconeogenesis, pentose phosphate, and glutathione metabolism pathways were significant among proteins only present in epididymal samples within the metabolic pathway. Other proteins identified that may be related to epididymal sperm's increased longevity were peroxidases and glutathione peroxidases for their antioxidant properties. In summary, energy metabolism in the epididymis appears to be more glycolytic compared to ejaculated and epididymis sperm have a larger number of antioxidants available which may be helping to maintain sperm in a quiescent state. Epididymal sperm remained viable (membrane integrity) longer than ejaculated sperm when cultured at the same pH.

Acute nontraumatic rhabdomyolysis in a Greyhound after albuterol toxicosis.

OBJECTIVE: To describe the clinical features of rhabdomyolysis due to albuterol toxicosis in a Greyhound. CASE SUMMARY: A 4-year-old neutered male Greyhound was presented for albuterol toxicosis leading to severe hypokalemia and respiratory paralysis. After 3 hours of mechanical ventilation, pigmenturia and marked enlargement, firmness, and pain of the left thigh muscles were noted. Severe hyperkalemia and cardiac arrhythmias were identified after turning the patient. After discontinuation of mechanical ventilation, other muscles became involved, and the patient developed acute kidney injury and concern for multiple organ dysfunction syndrome over the next 5 days. On day 6, the patient was euthanized, and necropsy revealed myocardial and skeletal muscle necrosis, myoglobinuria, and acute tubular degeneration. NEW OR UNIQUE INFORMATION PROVIDED: To the authors' knowledge, this is the first case of albuterol toxicosis leading to rhabdomyolysis.

Thermographic imaging in a dog with macroglossia from an encircling, strangulating lingual linear foreign body.

A dog presented 16 hours after an acute onset of severe generalized lingual swelling from an unknown cause. The dog had recently chewed a deer carcass. Initial physical examination and diagnostic testing did not reveal an underlying cause, and supportive care was provided. After 16 hours of hospitalization strangulating organic foreign material was found at the base of the tongue and removed. Macroglossia and secondary superficial lingual necrosis were successfully managed with supportive care while the patient was hospitalized. Thermographic imaging was used and indicated lingual hypothermia and subsequent normothermia, before and after removal of the linear foreign body respectively. Histopathologic analysis revealed the foreign body consisted of degenerate and autolyzed collagenous connective tissue, likely representing tissues such as tendon, fascia or a large thick-walled blood vessel which was suspected to have been consumed from the deer carcass. Thermographic imaging was employed and demonstrated to be consistent with hypoperfusion (hypothermia) of the affected tissue. Thermographic imaging adds value as an additional diagnostic tool for conditions with compromised blood flow.

Pilot study of an internet-based pain coping skills training program for patients with systemic Lupus Erythematosus.

BACKGROUND: Patients with Systemic Lupus Erythematosus (SLE) often experience pain and other symptoms that negatively impact quality of life. Interventions that enhance the use of behavioral and cognitive coping strategies may lead to improved outcomes among patients with SLE. Pain coping skills training (PCST) programs have been shown to improve outcomes among patients with other rheumatic conditions, but there have been no trials of PCST among patients with SLE. This study was a preliminary assessment of the feasibility and efficacy of painTRAINER, an automated, internet-based PCST program, among patients with SLE. METHODS: Participants (n = 60) with SLE from one health care system were randomly assigned with equal allocation to painTRAINER or a wait list control group. PainTRAINER involves 8 modules; participants were instructed to complete one module weekly, along with practice activities for each cognitive or behavioral coping skill. Outcome measures were assessed at baseline and 9-week follow-up, including the Pain Catastrophizing Scale, PROMIS Subscales (Pain Interference, Physical Function, Sleep Disturbance, Anxiety, Depression, Fatigue and Participation), and the LupusPRO questionnaire. Mean changes in outcomes from baseline to follow up and Cohen's d effect sizes were computed. RESULTS: Effect sizes for the painTRAINER group (relative to the wait list group) were small, with changes being greatest for the PROMIS Depression score (d = - 0.32). Among those randomized to the painTRAINER group, 50% accessed the program ("painTRAINER users"). Most of those who did not access the program stated that they did not receive instructions via email. Effect sizes for "painTRAINER users" (relative to wait list) were larger than for the whole painTRAINER group: Pain Catastrophizing d = - 0.60, PROMIS Pain Interference d = - 0.3., PROMIS Depression d = - 0.44, LupusPRO Health-Related Quality of Life d = 0.30. CONCLUSIONS: PainTRAINER users reported meaningful improvements in multiple physical and psychological outcomes, supporting the potential of PCST programs to benefit individuals with SLE. However, strategies are needed to improve engagement with the program and tailor content to comprehensively address key SLE symptoms and challenges. TRIAL REGISTRATION: NCT03933839 , May 1, 2019.

Impact of trace mineral source on beef replacement heifer growth, reproductive development, and biomarkers of maternal recognition of pregnancy and embryo survival.

Trace minerals are known to play important roles in early embryo development. The study objective was to determine effects of trace mineral source on heifer reproductive performance. Beef heifers (n = 129) were randomly assigned to one of two treatments. From weaning through breeding, all heifers were individually fed a basal diet supplemented with cobalt (Co), copper (Cu), manganese (Mn), and zinc (Zn) either from organic sources (COMP; Cu, Mn, and Zn amino acid complexes and Co glucoheptonate; Availa-4, Zinpro Corporation, Eden Prairie, MN) or inorganic sources (INORG; Cu, Mn, and Zn hydroxychlorides; Intellibond C, M, and Z, Micronutrients, Indianapolis, IN) and Co as CoSO4. Blood samples and a reproductive tract score (RTS) were collected to determine pubertal status. All animals were synchronized and artificially inseminated. Pregnancy status was determined by lymphocyte gene expression, circulating concentrations of pregnancy-associated glycoproteins (PAGs), and by transrectal ultrasonography after artificial insemination. Embryonic loss was defined as when a previously pregnant animal was subsequently diagnosed not pregnant. Data were analyzed using the MIXED procedure in SAS. Puberty (P = 0.44), pelvic area (P = 0.74), RTS (P = 0.49), and estrus expression (P = 0.82) were not influenced by treatment. There was no effect of treatment (P = 0.37) or treatment by time (P = 0.19) on pregnancy, but there was a tendency (P = 0.13) for decreased embryonic loss among COMP heifers (27 ± 6%) compared to INORG heifers (38 ± 6%). There was a treatment by pregnancy status by time interaction (P < 0.01) on circulating PAG concentrations with PAG concentrations tending (P = 0.08) to be greater on day 25 among heifers in the COMP treatment compared to heifers in the INORG group. In summary, source of trace mineral did not affect puberty, RTS, pelvic area, or overall pregnancy success, but feeding complexed trace minerals tended to increase circulating PAG concentrations and embryo survival.

Acute interstitial nephritis due to sodium-glucose co-transporter 2 inhibitor empagliflozin.

Biopsy-proven acute interstitial nephritis (AIN) secondary to sodium-glucose co-transporter 2 (SGLT2) inhibitors has not been described previously. Here, we report on the management of a patient with severe acute kidney injury that developed 6 weeks after starting empagliflozin. The cause was confirmed as AIN on renal biopsy. Our patient recovered, without the need for dialysis, with discontinuation of empagliflozin and corticosteroid treatment. This novel clinical observation is likely to occur more frequently as these drugs are increasingly being prescribed, given that recent randomized controlled trials including EMPA-REG (Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes) showed SGLT2 inhibitors can decrease cardiovascular mortality, among other benefits, in high-risk diabetic populations.

Evaluation of Bacillus subtilis PB6 on feedlot phase growth performance, efficiency of dietary net energy utilization, and fecal and subiliac lymph node Salmonella prevalence in spring placement yearling beef steers fed in southeastern South Dakota,.

Yearling crossbred beef steers [N = 238; initial shrunk body weight (BW) = 402 ± 31.2 kg] were used to investigate the influence of a Bacillus subtilis probiotic on animal growth performance, efficiency of dietary net energy (NE) utilization, carcass characteristics, and fecal and subiliac lymph node Salmonella prevalence during a 140-d finishing period at the Southeast Research Farm in Beresford, SD. Steers were allotted to 1 of 24 pens (N = 9-10 steers/pen) and assigned to 1 of 2 dietary treatments (12 pens/treatment): no probiotic (CON) or 0.5 g/steer/d of a B. subtilis PB6 probiotic (CLOSTAT500, Kemin Industries, Des Moines, IA; CLO). Bunks were managed according to a slick bunk management approach. Fecal samples were collected on study days 1, 28, 56, 112, and 140 from a subsample of steers from each pen (N = 5 steers/pen) via rectal palpation and composited by pen for the determination of Salmonella prevalence using selective enrichment and culture media. Upon harvest, subiliac lymph nodes were obtained from an equal number of steers from each treatment (collected from every other steer) following evisceration and hide removal. Data were analyzed as a randomized complete block design and pen served as the experimental unit; an α of 0.05 determined significance. Live-basis final BW and average daily gain tended (P ≤ 0.06) to be reduced for CLO. No differences were detected (P ≥ 0.11) between treatments for dry matter intake or gain efficiency. Treatment neither altered the efficiency of dietary NE utilization nor calculated dietary NE content based upon observed performance (P ≥ 0.46). No differences were detected between treatments for any carcass traits (P ≥ 0.15). No Salmonella was recovered in any fecal samples collected on study days 1, 28, or 56. On day 112, steers from CLO had a numerically lower (P = 0.17; 25.0 vs. 8.3%) incidence of fecal Salmonella compared to CON. On study day 140, fecal Salmonella incidence did not differ between treatments (P = 0.34; 0.0 vs. 8.3%) for CON and CLO, respectively. Upon harvest, no Salmonella was recovered in any subiliac lymph nodes. These data indicate that B. subtilis PB6 did not influence feedlot phase growth performance or fecal Salmonella prevalence. Additionally, Salmonella was not observed in the subiliac lymph nodes of any steers upon harvest.

Paget's Disease of the Bone: Patterns of Referral to Secondary Care Following Diagnosis on X-rays.

Paget's disease of bone (PDB) is the second commonest metabolic bone disorder in the UK after osteoporosis and is both underdiagnosed and undertreated. PDB is often found incidentally on plain X-rays. There is effective treatment so identification of affected individuals is important. The aim was to conduct an audit to determine what proportion of individuals with X-ray evidence of PDB were referred to secondary care. A retrospective audit of X-rays reports in men and women over 55 years of age was undertaken over 18 months searching for the key word "Paget's." The images of possible cases were reviewed and the presence of PDB confirmed. The proportion already known to secondary care was determined and those that had had isotope bone scans and treatment. Data recorded included site of lesion, age, gender, level of total alkaline phosphatase (ALP) and complications. A total of 68,873 X-rays were screened and 43 cases found. Pelvic images had the highest proportion of positive findings at 0.2% and 65% of the cases. 74% had not been referred to secondary care. The mean age was 86.7 years (range 65-95) and the ALP was elevated in 65% with a mean of 189u/L (range 47-804u/L). In 33 individuals, PDB had been recorded in the reports of previous X-rays. The rate of referral for specialist care remains low. The prevalence of the condition appears to be falling.

Associations of meaning of illness with psychosocial, clinical, and immunological characteristics in patients with Leptomeningeal metastasis.

Background: Leptomeningeal metastasis (LM) creates symptoms related to both the disease within the nervous system and treatment toxicities. Biologic processes, such as inflammation and behavioral processes, such as the meaning ascribed to illness (Meaning of Illness: MoI), can impact physical and psychosocial symptoms. The aim of this study was to understand the relationships among MoI, physical and psychosocial symptoms, and inflammation in patients with LM. Methods: Thirty enrolled participants completed the MD Anderson Symptom Inventory-Brain Tumor with spine experimental symptoms added. Meaning of illness, quality of life (QoL), and depression were captured by validated instruments. Interleukin (IL)-6 and tumor necrosis factor (TNF)-α in serum and cerebrospinal fluid (CSF) were measured by ELISA. Correlations were performed to assess relationships among the variables. Results: Participants were primarily white (73%), female (63%). Median age was 54 years (34-83). Breast (50%) and lung (20%) were most common diagnosis. Higher MoI scores were associated with better QoL (p < .01) and fewer depressive symptoms (p < .01). All CSF samples contained IL-6 and all but one sample had elevated IL-6. Higher levels of IL-6 in the CSF were associated with greater symptom burden (p < .01) and interference of symptoms in daily life (p = .02) but not MoI. Conclusions: MoI was associated with QoL and depression. High levels of IL-6 in the CSF were associated with more severe symptoms. This study provides the groundwork for future research, including interventional studies to improve QoL in patients with LM.

Evaluation of hybrid rye on growth performance, carcass traits, and efficiency of net energy utilization in finishing steers.

Crossbred beef steers with a high percentage of Angus ancestry [n = 240, initial shrunk body weight (BW), 404 ± 18.5 kg] were used in a 117-d feedlot experiment to evaluate the effect of hybrid rye (Rye; KWS Cereals USA, LLC, Champaign, IL) as a replacement for dry-rolled corn (DRC) on growth performance, carcass traits, and comparative net energy (NE) value in diets fed to finishing steers. Rye from a single hybrid (KWS Bono) with an ergot alkaloid concentration of 392 ppb was processed with a roller mill to a processing index (PI) of 78.8 ± 2.29. Four treatments were used in a completely randomized design (n = 6 pens/treatment; 10 steers/pen), where DRC (PI = 86.9 ± 4.19) was replaced by varying proportions of Rye [DRC:Rye, dry matter (DM) basis (60:0), (40:20), (20:40), and (0:60)]. Liver abscess scores and carcass characteristics were collected at the abattoir. Carcass-adjusted performance was calculated from hot carcass weight (HCW)/0.625. Performance-adjusted NE was calculated using carcass-adjusted average daily gain (ADG), DM intake (DMI), and mean equivalent shrunk BW with the comparative NE values for rye calculated using the replacement technique. Data were analyzed using the GLIMMIX procedure of SAS 9.4 (SAS Inst. Inc., Cary, NC) with pen as the experimental unit. Treatment effects were tested using linear and quadratic contrasts, as well as between diets with and without Rye. Replacing DRC with Rye linearly decreased (P ≤ 0.01) carcass-adjusted final BW, ADG, DMI, and gain:feed (G:F). Feeding rye linearly decreased HCW and longissimus muscle area (P ≤ 0.04). Distributions of liver scores and USDA grades for quality and yield were unaffected by treatment (P ≥ 0.09). Estimated replacement NE for maintenance (NEm) and gain (NEg) values for rye, when included at 60% of diet DM, were 1.90 and 1.25 Mcal/kg, respectively. Rye can be a suitable feed ingredient in finishing diets for feedlot steers. Estimated replacement values of Rye when fed at 60% of diet DM closely agreed with current tabular standards but, when included at 20% of diet DM, estimated NEm and NEg values of Rye were increased 9.5% and 12.8%, respectively. Net energy value of Rye for gain is approximately 84% compared to DRC; thus, the complete replacement of DRC with Rye depressed DMI, ADG, G:F, and carcass weight.

Adult Paget's disease of bone.

Adult Paget's disease of bone is the second commonest metabolic bone condition after osteoporosis. The condition is characterised by increased bone cell activity, with bone-resorbing osteoclasts often larger and containing more nuclei than normal and osteoblasts producing increased amounts of disorganised bone. This leads to expanded bone of poor quality possessing both sclerotic and lytic areas. Paget's disease of bone has a strong genetic element, with a family history being noted in 10-20% of cases. A number of genetic defects have been found to be associated with the condition. The most common disease-associated variants identified affect the SQSTM1 gene, providing insights into disease aetiology, with the clinical value of knowledge of SQSTM1 mutation status currently under active investigation. The diagnosis may be suggested by an isolated raised total alkaline phosphatase (ALP) without other identifiable causes. This can be confirmed on plain X-ray and the extent determined by isotope bone scan. The mainstay of treatment are the bisphosphonates, especially intravenous zoledronate which results in long-term suppression of bone turnover. ALP is the usual means of monitoring the condition, although more specific bone turnover markers can be helpful, especially in coincident liver disease. Patients should be followed up to monitor for biochemical relapse or development of complications, which may require medical or surgical intervention.

South Dakota State University Beef 2020 increases participant knowledge of the beef industry.

South Dakota State University has developed a hands-on program that addresses the preharvest management factors that influence beef carcass value to aid producers in their management and marketing decisions. The 3-d program includes live cattle and carcass evaluation, beef carcass fabrication, a harvest demonstration, sensory panel, and presentations on topics including live market cattle evaluation, health, and disposition in relation to carcass quality, feeding and management, and value-added beef cuts. To evaluate program effectiveness, data were collected from all programs held between 2013 and 2019. Participants were asked to evaluate their perceived value for each program component, as well as their knowledge of the industry prior to and after completing the program. Upon completion of the 2018 Beef 2020, a focus group of program alumni was assembled to better understand participant experiences, application of the material, and guide future programming. The recommendations of the focus group were implemented during the 2019 program. Component value scores are reported in a box and whisker plot and participant knowledge was evaluated using a paired t-test with significance determined at P < 0.05. Special attention was given to the results of 2019 compared to previous years to determine the efficacy of the program changes. Overall, the average value scores for the sessions all ranked above 8 on a scale of 1-10, indicating a relatively large value to participants. Knowledge of carcass traits, carcass value, and management factors that influence those traits increased after participation in the Beef 2020 program (5.18 vs. 7.67 ± 0.16; P < 0.0001). The use of a focus group was concluded to be an effective means of assessing program value, strengths, and weaknesses. The Beef 2020 program can be used as a model for other Extension professionals to create programs intended to link livestock producers to their end products.