Objective and subjective sleep measures are associated with HbA1c and insulin sensitivity in the general population: Findings from the ORISCAV-LUX-2 study.

AIM: To analyze the association of objective and subjective sleep measures with HbA1c and insulin sensitivity in the general population. METHODS: Using a cross-sectional design, data from 1028 participants in the ORISCAV-LUX-2 study from the general population in Luxembourg were analyzed. Objective sleep measures were assessed using accelerometers whereas subjective measures were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Sleep measures were defined as predictors, while HbA1c and quantitative insulin sensitivity check index (QUICKI) scores were considered outcomes. Linear and spline regression models were fitted by progressively adjusting for demographic and lifestyle variables in the total sample population as well as by stratified analyses using gender, obesity status, depressive symptoms and diabetes status. RESULTS: In fully adjusted models, total and deep sleep durations were associated with lower HbA1c (mmol/mol) levels, whereas sleep coefficients of variation (%) and poor sleep efficiency, as measured by PSQI scores (units), were associated with higher HbA1c levels. In stratified models, such associations were observed mainly in men, and in subjects who had depressive symptoms, were overweight and no diabetes. In addition, total sleep, deep sleep, coefficients of variation and poor sleep efficiency as measured by PSQI revealed non-linear associations. Similarly, greater insulin sensitivity was associated with longer total sleep time and with PSQI-6 (use of sleep medication). CONCLUSION: Associations were more frequently observed between sleep characteristics and glycaemic control with the use of objective sleep measures. Also, such associations varied within subgroups of the population. Our results highlight the relevance of measuring sleep patterns as key factors in the prevention of diabetes.

Membranes Are Decisive for Maximum Freezing Efficiency of Bacterial Ice Nucleators.

Ice-nucleating proteins (INPs) from Pseudomonas syringae are among the most active ice nucleators known, enabling ice formation at temperatures close to the melting point of water. The working mechanisms of INPs remain elusive, but their ice nucleation activity has been proposed to depend on the ability to form large INP aggregates. Here, we provide experimental evidence that INPs alone are not sufficient to achieve maximum freezing efficiency and that intact membranes are critical. Ice nucleation measurements of phospholipids and lipopolysaccharides show that these membrane components are not part of the active nucleation site but rather enable INP assembly. Substantially improved ice nucleation by INP assemblies is observed for deuterated water, indicating stabilization of assemblies by the stronger hydrogen bonds of D2O. Together, these results show that the degree of order/disorder and the assembly size are critically important in determining the extent to which bacterial INPs can facilitate ice nucleation.

Produção de forragem e potencial de utilização do capim faixa-branca submetido a frequências de desfolhação / Production of forage potential of utilization of digit grass subjected to high defoliation frequencies

O objetivo deste trabalho foi avaliar a produção de forragem e o potencial de utilização do capim faixa-branca submetido a frequências de desfolhação. Os tratamentos foram constituídos de quatro frequências de desfolhação: muito alta (25cm), alta (35cm), média (45cm) e baixa (55cm), avaliados em duas épocas do ano (maior e menor insolação), entre 2015 e 2016. Utilizou-se o delineamento em blocos ao acaso, com quatro repetições e medidas repetidas no tempo. A produção diária de folhas foi menor na frequência muito alta em relação às outras frequências. A redução das frequências de desfolhação aumentou a produção diária de colmo, senescência diária de folhas, produção total diária e acúmulo líquido diário de forragem e diminuiu o potencial de utilização da forragem. No período de maior insolação, a produção diária de colmos, o acúmulo líquido diário de forragem e o potencial de utilização de forragem foram maiores e a senescência diária de folhas foi menor. A frequência de desfolhação muito alta não proporcionou um bom desenvolvimento da planta, enquanto a frequência baixa apresentou elevada produção de colmos. As frequências de desfolhação alta e média são mais indicadas para a desfolhação do capim faixa-branca, promovendo uma melhor proporção de folhas em relação a colmos.(AU)

The objective of this study was to evaluate the production of forage and the potential of utilization of digit grass subjected to four defoliation frequencies: very high (25cm), high (35cm), medium (45cm), and low (55cm), evaluated at two times of the year (higher and lower insolation), from January 2015 to January 2016. A randomized-block design with four replicates was adopted and measures repeated over time. The daily production of leaves was lower at the very high frequency in relation to the other frequencies. The reduction in defoliation frequency increased the daily production of stems, the daily leaf senescence, the total daily forage production, and the daily forage accumulation, and decreased the potential of forage utilization. At the time of higher insolation, the daily production of stems, the daily forage accumulation, the potential of utilization of forage were higher, and the daily leaf senescence was lower. The very high frequency of defoliation did not provide a good development of the plan, while the lower frequency displayed a high production of stems. The high and medium frequencies of defoliation are more indicated to the defoliation of digit grass, enabling a better proportion of leaves in relation to stems.(AU)

One Hundred Consecutive Liver Transplants Using Institutes Georges Lopez-1 Preservation Solution: Outcomes and Prognostic Factors.

BACKGROUND: There are only 4 prior studies reporting on outcomes of liver transplantation (LT) using Institutes Georges Lopez-1 (IGL-1) preservation solution. Detection of negative predictors of LT using IGL-1 may help finding strategies to protect selected recipients at higher risk of graft failure and death. METHODS: Review of all consecutive adult patients who underwent a first whole-graft LT using IGL-1 at authors' institution from 2013 to 2016. Primary end point was graft failure within the first 90 postoperative days (PODs). Graft losses due to any cause (including all deaths with a functioning graft) were recorded as graft failures. RESULTS: Of all 100 patients included in this study, 37 were women; median age was 58 years (range 18-71). There were 12 graft losses during the first 90 PODs (including 3 cases of primary nonfunction of the liver allograft), and 10 of the 12 graft losses occurred on first 30 PODs. All 12 patients who experienced graft loss (including 1 patient who underwent liver retransplantation) died within the first 90 PODs. Of the total 100 patients, 14 experienced biliary complications. Univariate analysis revealed prolonged warm ischemic time (WIT) as the only predictor of 90-day graft failure (odds ratio = 23.5, confidence interval = 1.29-430.18, P = .03). The cutoff by receiver operating characteristic curve for WIT was 38 minutes (area under the curve = 0.70). Positive predictive value for WIT >38 minutes was 94.3%. CONCLUSIONS: LT using IGL-1 can be performed safely. Similar to prior reports on LT using other preservation solutions, prolonged WIT was associated with adverse outcomes.

Liver regeneration model in growing rats with hepatic artery ligation: histologic and molecular studies.

BACKGROUND: Liver transplantation is an effective treatment for irreversible liver diseases. The incidence of hepatic artery thrombosis remains high. Our objective was to analyze the effect of ligature of the hepatic artery on liver regeneration in a growing animal model. METHODS: Seventy-five male Wistar rats were divided into the following 3 groups: group 1 (sham, G1): incision without intervention; group 2 (G2): 70% hepatectomy; group 3 (G3): 70% hepatectomy and ligation of the hepatic artery. Preceding the 70% hepatectomy, a hepatic artery ligature was performed with resection of a segment of the artery. The liver specimens were stained with hematoxylin-eosin, and immunohistochemical staining for Ki-67 was performed. The expression of the interleukin (IL) 6 gene was studied by means of reverse-transcription polymerase chain reaction. RESULTS: G2 and G3 demonstrated similar tendencies toward an increase in the gain weight ratio over time. The mitotic activity was significantly lower at 72 hours in G3 than in G2. There was no difference between Ki-67 staining between G2 and G3. The expression of the IL-6 gene was present in all of the groups, lower in G1, with no difference between G2 and G3. CONCLUSIONS: The experimental model was feasible and adequate for these investigations. Hepatectomy stimulated hepatocyte proliferation, and the obstruction of the arterial flow did not affect liver regeneration.

Hepatic artery graft in pediatric liver transplantation: single-center experience with 58 cases.

INTRODUCTION: The use of arterial grafts (AG) in pediatric orthotopic liver transplantation (OLT) is an alternative in cases of poor hepatic arterial inflow, small or anomalous recipient hepatic arteries, and retransplantations (re-OLT) due to hepatic artery thrombosis (HAT). AG have been crucial to the success of the procedure among younger children. Herein we have reported our experience with AG. METHODS: We retrospectively reviewed data from June 1989 to June 2010 among OLT in which we used AG, analyzing indications, short-term complications, and long-term outcomes. RESULTS: Among 437 pediatric OLT, 58 children required an AG. A common iliac artery interposition graft was used in 57 cases and a donor carotid artery in 1 case. In 38 children the graft was used primarily, including 94% (36/38) in which it was due to poor hepatic arterial inflow. Ductopenia syndromes (n = 14), biliary atresia (BA; n = 11), and fulminant hepatitis (n = 8) were the main preoperative diagnoses among these children. Their mean weight was 18.4 kg and mean age was 68 months. At the mean follow-up of 27 months, multiple-organ failure and primary graft nonfunction (PNF) were the short-term causes of death in 9 children (26.5%). Among the remaining 29 patients, 2 (6,8%) developed early graft thrombosis requiring re-OLT; 5 (17%) developed biliary complications, and 1 (3.4%) had asymptomatic arterial stenosis. In 20 children, a graft was used during retransplantation. The main indication was HAT (75%). BA (n = 15), ductopenia syndromes (n = 2), and primary sclerosing cholangitis (n = 2) were the main diagnoses. Their mean weight was 16.7 kg and age was 65 months. At a mean follow-up of 53 months, 7 children died due to multiple-organ failure or PNF. Among the remaining 13 patients, 3 developed biliary complications and 1 had arterial stenosis. No thrombosis was observed. CONCLUSION: The data suggested that use of an AG is useful alternative in pediatric OLT. The technique is safe with a low risk of thrombosis.

Orthotopic liver transplantation in biliary atresia: a single-center experience.

INTRODUCTION: Biliary atresia (BA) is the leading indication for orthotopic liver transplantation (OLT) among children. However, there are technical difficulties, including the limited dimensions of anatomical structures, hypoplasia and/or thrombosis of the portal vein and previous portoenterostomy procedures. OBJECTIVE: The objective of this study was to present our experience of 239 children with BA who underwent OLT between September 1989 and June 2010 compared with OLT performed for other causes. METHODS: We performed a retrospective analysis of patient charts and analysis of complications and survival. RESULTS: BA was the most common indication for OLT (207/409; 50.6%). The median age of subjects was 26 months (range, 7-192). Their median weight was 11 kg (range, 5-63) with 110 children (53.1%) weighing ≤10 kg. We performed 126 transplantations from cadaveric donors (60.8%) and 81 from living-related donors (LRD) (39.2%). Retransplantation was required for 31 recipients (14.9%), primarily due to hepatic artery thrombosis (HAT; 64.5%). Other complications included the following: portal vein thrombosis (PVT; 13.0%), biliary stenosis and/or fistula (22.2%), bowel perforation (7.0%), and posttransplantation lymphoproliferative disorder (PTLD; 5.3%). Among the cases of OLT for other causes, the median age of recipients was 81 months (range, 11-17 years), which was higher than that for children with BA. Retransplantation was required in 3.5% of these patients (P < .05), mostly due to HAT. The incidences of PVT, bowel perforation, and PTLD were significantly lower (P < .05). There was no significant difference between biliary complications in the 2 groups. The overall survival rates at 1 versus 5 years were 79.7% versus 68.1% for BA, and 81.2% versus 75.7% for other causes, respectively. CONCLUSIONS: Children who undergo OLT for BA are younger than those engrafted for other causes, displaying a higher risk of complications and retransplantations.

Increase in prevalence of rhinoconjunctivitis but not asthma and atopic eczema in teenagers.

OBJECTIVE: We sought to assess changes in the prevalence of asthma and other allergic diseases in schoolchildren of Curitiba between 1995 and 2001. METHODS: Schoolchildren (aged 13-14) were evaluated by a self-reported written questionnaire of ISAAC protocol for symptoms of asthma and allergic diseases. The diagnoses of asthma, rhinoconjunctivitis and atopic eczema were considered according to the ISAAC protocol. Probable asthma was considered: more than 4 attacks of wheezing in the last 12 months; 1 to 3 attacks of wheezing in the last 12 months with dry cough at night, and/or with sleep disturbance due to wheezing, and/or with wheezing after exercise. The data obtained in 2001 were compared with the data obtained in 1995 for the same age group. RESULTS: We evaluated 2,946 schoolchildren in 1995 and 3.628 in 2001. The prevalence of symptoms of asthma, probable asthma, rhinoconjunctivitis and eczema in 1995 and 2001 was 18.4% and 18.7%, 11.6% and 12.4%, 14.2% and 17.2%, 3.8% and 3.7%, respectively. There was a 23.7% increase in the prevalence of rhinoconjunctivitis symptoms (p < 0.05). CONCLUSIONS: The prevalence of symptoms of asthma, probable asthma and eczema did not change over the past 6 years but a significant increase of the rhinoconjunctivitis symptoms was detected.

[Measuring the effect of eyeglasses on determination of squint angle with Purkinje reflexes and the prism cover test]. / Messungen zum Einfluss von Brillengläsern auf die Bestimmung des Schielwinkels mit Purkinje-Reflexen und mit dem Prismenabdecktest.

BACKGROUND: The alternating prism and cover test is the conventional test for the measurement of the angle of strabismus. The error induced by the prismatic effect of glasses is typically about 27-30%/10 D. Alternatively, the angle of strabismus can be measured with methods based on Purkinje reflex positions. This study examines the differences between three such options, taking into account the influence of glasses. MATERIALS AND METHODS: The studied system comprised the eyes with or without glasses, a fixation object and a device for recording the eye position: in the case of the alternate prism and cover test, a prism bar was required; in the case of a Purkinje reflex based device, light sources for generation of reflexes and a camera for the documentation of the reflex positions were used. Measurements performed on model eyes and computer ray traces were used to analyze and compare the options. RESULTS: When a single corneal reflex is used, the misalignment of the corneal axis can be measured; the error in this measurement due to the prismatic effect of glasses was 7.6%/10 D, the smallest found in this study. The individual Hirschberg ratio can be determined by monocular measurements in three gaze directions. CONCLUSIONS: The angle of strabismus can be measured with Purkinje reflex based methods if the fundamental differences between these methods and the alternate prism and cover test, and if the influence of glasses and other sources of error are accounted for.

Improved computing scheme for measuring eye alignment with Purkinje images I and IV.

This study introduces an improved computing scheme for determining eye rotation from Purkinje images I and IV. The original computing scheme systematically underestimated eye rotation. Paraxial raytracing calculations revealed that this error resulted from failure to account for the fact that Purkinje images I and IV fall at different distances behind the cornea. The error could be overcome with a correction factor derived from paraxial raytracing calculations. A series of experiments were carried out to test the validity of this correlation factor, involving exact raytracing calculations as well as measurements on physical model eyes and human eyes. The influence on the correction factor of ocular surface asphericity, accommodation, age and ocular component variations were examined. The new method was also compared to Hirschberg's technique, which makes use of Purkinje image I alone, as a means of screening for strabismus.

Limbus versus pupil center for ocular alignment measurement with corneal reflexes.

PURPOSE: To investigate the accuracy of ocular misalignment measurement, using corneal reflections. METHODS: Corneal reflex positions were measured relative to two landmarks, the limbus center and the entrance pupil center, using high-resolution digital images for cyclopean gaze angles from 0 degree to 18.8 degrees (34.04 prism diopters; PD) to the right and to the left in 10 subjects. Distance h from the center of the corneal curvature to each landmark was determined from linear regressions and showed significant differences between both conditions: mean hlimbus was 5.243 mm, and mean hpupil was 4.884 mm. From these, limbus- and entrance-pupil-center-related Hirschberg ratios were determined as 11 degrees/mm (19.43 PD/mm) and 11.82 degrees/mm (20.92 PD/ mm), respectively; and ocular alignment was calculated for both conditions. Simulated angles of strabismus were calculated as the binocular difference between ocular alignment of the right and left eyes (condition 1), and as the monocular difference between the ocular alignment of right eyes and left eyes separately (condition 2). RESULTS: Condition 1: Errors in simulated angles of strabismus were approximately twice as large for entrance pupil center compared with those in limbus-center-based evaluation; in the primary position, the 95% pupil-related confidence interval of the binocular difference was +/- 5.217 degrees (9.1 PD), compared with +/- 3.174 degrees (5.5 PD) for the limbus-related option. Condition 2: Errors were approximately equal. CONCLUSIONS: The entrance pupil center is a less reliable landmark than is the limbus center for measuring ocular alignment by using corneal reflections, because of unreliable positions of the entrance pupil center; different mean Hirschberg ratios should be used in both conditions.