The Effect of Propofol on Peri-Induction Hemodynamics and Resuscitation in Operative Penetrating Trauma.

BACKGROUND: Hemorrhaging trauma patients may be disproportionately affected by choice of induction agent during rapid sequence intubation (RSI). Etomidate, ketamine, and propofol are safe in the trauma population-at-large but have not been assessed in patients with ongoing hemorrhage. We hypothesize that in hemorrhaging patients with penetrating injury, propofol deleteriously affects peri-induction hypotension compared to etomidate and ketamine. METHODS: Retrospective cohort study. Primary outcome was the effect of induction agent on peri-induction systolic blood pressure. Secondary outcomes were the incidence of peri-induction vasopressor use and quantity of peri-induction blood transfusion requirements. Linear multivariate regression modeling assessed the effect of induction agent on the variables of interest. RESULTS: 169 patients were included, 146 received propofol and 23 received etomidate or ketamine. Univariate analysis revealed no difference in peri-induction systolic blood pressure (P = .53), peri-induction vasopressor administration (P = .62), or transfusion requirements within the first hour after induction (PRBC P = .24, FFP P = .19, PLT P = .29). Choice of RSI agent did not independently predict peri-induction systolic blood pressure or blood product administration. Rather, only presenting shock index independently predicted peri-induction hypotension. CONCLUSIONS: This is the first study to directly assess the peri-induction effects of anesthetic induction agent choice in penetrating trauma patients undergoing emergent hemorrhage control surgery. Propofol does not appear to worsen peri-induction hypotension regardless of dose. Patient physiology is most predictive of peri-induction hypotension.

Detailed insights into the formation pathway of CdS and ZnS in solution: a multi-modal in situ characterisation approach.

The high stability, high availability, and wide size-dependent bandgap energy of sulphidic semiconductor nanoparticles (NPs) render them promising for applications in optoelectronic devices and solar cells. However, the tunability of their optical properties depends on the strict control of their crystal structure and crystallisation process. Herein, we studied the structural evolution during the formation of CdS and ZnS in solution by combining in situ luminescence spectroscopy, synchrotron-based X-ray diffraction (XRD) and pair distribution function (PDF) analyses for the first time. The influence of precursor type, concentration, temperature and heating program on the product formation and on the bandgap or trap emission were investigated in detail. In summary, for CdS, single-source precursor (SSP) polyol strategies using the dichlorobis(thiourea)cadmium(II) complex and double-source precursor approaches combining Cd(CH3COO)2·2H2O and thiourea led to the straightforward product at 100 °C, while the catena((m2-acetato-O,O')-(acetate-O,O')-(m2-thiourea)-cadmium) complex was formed at 25 and 80 °C. For ZnS, the reaction between Zn(CH3COO)2·2H2O and thiourea at 100 °C led to the product formation after the crystallisation and dissolution of an unknown intermediate. At 180 °C, besides an unknown phase, the acetato-bis(thiourea)-zinc(II) complex was also detected as a reaction intermediate. The formation of such reaction intermediates, which generally remain undetected applying only ex situ characterisation approaches, reinforce the importance of in situ analysis for promoting the advance on the production of tailored semiconductor materials.

MiRNA-149 as a Candidate for Facial Clefting and Neural Crest Cell Migration.

Nonsyndromic cleft lip with or without palate (nsCL/P) ranks among the most common human birth defects and has a multifactorial etiology. Human neural crest cells (hNCC) make a substantial contribution to the formation of facial bone and cartilage and are a key cell type in terms of nsCL/P etiology. Based on increasing evidence for the role of noncoding regulatory mechanisms in nsCL/P, we investigated the role of hNCC-expressed microRNAs (miRNA) in cleft development. First, we conducted a systematic analysis of miRNAs expressed in human-induced pluripotent stem cell-derived hNCC using Affymetrix microarrays on cell lines established from 4 unaffected donors. These analyses identified 152 candidate miRNAs. Based on the hypothesis that candidate miRNA loci harbor genetic variation associated with nsCL/P risk, the genomic locations of these candidates were cross-referenced with data from a previous genome-wide association study of nsCL/P. Associated variants were reanalyzed in independent nsCL/P study populations. Jointly, the results suggest that miR-149 is implicated in nsCL/P etiology. Second, functional follow-up included in vitro overexpression and inhibition of miR-149 in hNCC and subsequent analyses at the molecular and phenotypic level. Using 3'RNA-Seq, we identified 604 differentially expressed (DE) genes in hNCC overexpressing miR-149 compared with untreated cells. These included TLR4 and JUNB, which are established targets of miR-149, and NOG, BMP4, and PAX6, which are reported nsCL/P candidate genes. Pathway analyses revealed that DE genes were enriched in pathways including regulation of cartilage development and NCC differentiation. At the cellular level, distinct hNCC migration patterns were observed in response to miR-149 overexpression. Our data suggest that miR-149 is involved in the etiology of nsCL/P via its role in hNCC migration.

Method to characterize a thermal diode in saturated steam atmosphere.

We present a novel measurement method for the characterization of thermal diodes in a saturated steam atmosphere. A measuring setup has been developed in which two pressure sensors are integrated. Using a developed analytical model, the heat flow, the volume flow, and the cracking pressure are determined from the measured absolute pressures and the pressure difference. The analytical model was verified using a flow through an orifice. We first calculated the volume flow through the orifice, with a diameter of 3 mm, using the Reader-Harris equation and then compared it to experimentally determined values. The experimentally determined values showed a discrepancy of 9%. With the measurement setup, we have characterized a check valve developed for magnetocaloric heat pumps, which has a thermally rectifying behavior. The developed check valve consists of three spring arms, which are radially attached to a valve disk. The heat flow through the check valve in the forward direction is 166 W for water, 239 W for ethanol, and 547 W for methanol at a temperature difference of 1 K. In the reverse direction, the heat flow is -0.03 W at a temperature difference of -1 K. For methanol, this corresponds to a rectification coefficient of more than 18 000.

Vitamin D and bisphosphonate therapy in systemic lupus erythematosus patients who receive glucocorticoids: are we offering the best care?

OBJECTIVE: This study aimed to evaluate management practices for glucocorticoid (GC)-induced osteoporosis (GIOP) in systemic lupus erythematosus (SLE) patients using 2017 American College of Rheumatology guidelines as a gold standard. METHODS: We conducted a retrospective cohort study using a clinical database from the years 2011 to 2016. SLE cases with >90 days continuous prednisone use at doses of ≥7.51 mg daily were identified. Osteoporosis risk factors were assessed via chart review. The Fracture Risk Assessment (FRAX) score was estimated for patients > 40 years of age. Vitamin D, bisphosphonate prescriptions, and osteoporotic (OP) fractures were ascertained through chart review. A classification tree was used to identify the key patient-related predictors of bisphosphonate prescription. RESULTS: A total of 203 SLE patients met the inclusion criteria. The recommended dose of vitamin D supplement was prescribed to 58.9% of patients < 40 years of age and 61.5% of patients ≥ 40 years of age. Among patients aged ≥ 40 years, 25% were prescribed bisphosphonates compared to 36% who met indications for bisphosphonates per the ACR guidelines. Another 10% were prescribed a bisphosphonate, despite not having indication per the ACR guidelines, which was considered as overtreatment. Among patients aged ≥ 40 years, older age and a higher FRAX score for major OP fracture and hip fracture predicted bisphosphonate prescription. In a classification tree analysis, patients with FRAX scores (for major OP fracture) of ≥ 23.5% predicted bisphosphonate prescription in this SLE population. Among patients who had OP fractures in the follow-up period, nine (6.50%) were inpatients receiving appropriate GIOP care versus 12 (13.6%) who were inpatients not receiving ACR-appropriate care (p = 0.098). CONCLUSIONS: In clinical practice, fewer SLE patients with or at risk for GIOP are prescribed vitamin D and bisphosphonates than recommended by the 2017 ACR guidelines. Also, in this study, another 10% were prescribed a bisphosphonate, despite not having an indication per the ACR guidelines. Patients were most likely to receive a bisphosphonate prescription if they had a major OP FRAX score of > 23.5%.

Lipidograma e sensibilidade à insulina em éguas Mangalarga Marchador / Lipidogram and insulin sensitivity in Mangalarga Marchador mares

A dislipidemia é um achado comum, porém não determinante, na síndrome metabólica equina (SME). O objetivo do presente trabalho foi caracterizar a dislipidemia em animais obesos com risco de SME. Para isso, 18 éguas foram alocadas em grupos, de acordo com escore corporal (EC) de 1 a 9: no grupo ideal, animais com EC de 4,5 a 5,5 (n= 6), no grupo sobrepeso, com EC de 6 a 7 (n= 6) e no grupo obeso, animais com EC de 7,5 a 9 (n= 6). Coletaram-se amostras de sangue em jejum de concentrado para determinação de triglicerídeos, colesterol total, glicemia e concentração de insulina. Valores preditivos de sensibilidade à insulina (RISQI) e de secreção ß-pancreática (MIRG) foram calculados. O grupo obeso apresentou níveis maiores em relação aos outros grupos de triglicerídeos (P=0,001) e acima do ideal em concentrações de colesterol (P=0,012). Não foi observada diferença nas concentrações plasmáticas de glicose (P=0,53), de insulina (P=0,10) ou de RISQI (P=0,46). Houve diferença entre os grupos nos valores de MIRG (P=0,048), tendo o grupo obeso obtido resultados maiores quando comparado com o grupo ideal. O aumento do EC foi associado ao aumento das concentrações plasmáticas de colesterol e triglicerídeos, o que caracteriza um estado de dislipidemia e de elevação da secreção das células ß-pancreáticas.(AU)

Increased indicators of fat metabolites are found in Equine Metabolic Syndrome (EMS) subjects, although these parameters are not included in the EMS definition described in the literature and in its diagnosis. The objective of this study was to characterize dyslipidemia in obese insulin resistant mares. 18 mares were allocated in three groups according to body condition score (BCS) in a 1 to 9 scale. In the Ideal group there were animals with BCS 4.5 to 5.5 (n= 6), in the Overweight group, the BCS were 6 to 7 (n= 6), and in the Obese group (n= 6), BCS 7.5 to 9. Concentrate fasting blood samples were taken to determine triglycerides, total cholesterol, glucose, and insulin concentrations in plasma. Insulin sensitivity proxy (RISQI) and ß-pancreatic secretion proxy (MIRG) were calculated from glucose and insulin data. The Obese group had higher triglyceride levels (P= 0.001), compared to other groups, and higher total cholesterol compared to the Ideal Group (P= 0.012). No differences in plasma glucose (P= 0.53), insulin (P= 0.10) concentrations and insulin sensitivity (RISQI: P= 0.463) were seen among groups. The Obese Group had a higher ß-pancreatic secretion (MIRG: P= 0.048) compared to the Ideal Group. The increased BCS was related to the plasma fat metabolites a higher ß-pancreatic secretion.(AU)

Transcriptome-wide analysis of filarial extract-primed human monocytes reveal changes in LPS-induced PTX3 expression levels.

Filarial nematodes modulate immune responses in their host to enable their survival and mediate protective effects against autoimmunity and allergies. In this study, we examined the immunomodulatory capacity of extracts from the human pathogenic filaria Brugia malayi (BmA) on human monocyte responses in a transcriptome-wide manner to identify associated pathways and diseases. As previous transcriptome studies often observed quiescent responses of innate cells to filariae, the potential of BmA to alter LPS driven responses was investigated by analyzing >47.000 transcripts of monocytes from healthy male volunteers stimulated with BmA, Escherichia coli LPS or a sequential stimulation of both. In comparison to ~2200 differentially expressed genes in LPS-only stimulated monocytes, only a limited number of differentially expressed genes were identified upon BmA priming before LPS re-stimulation with only PTX3↓ reaching statistical significance after correcting for multiple testing. Nominal significant differences were reached for metallothioneins↑, MMP9↑, CXCL5/ENA-78↑, CXCL6/GCP-2↑, TNFRSF21↓, and CCL20/MIP3α↓ and were confirmed by qPCR or ELISA. Flow cytometric analysis of activation markers revealed a reduced LPS-induced expression of HLA-DR and CD86 on BmA-primed monocytes as well as a reduced apoptosis of BmA-stimulated monocytes. While our experimental design does not allow a stringent extrapolation of our results to the development of filarial pathology, several genes that were identified in BmA-primed monocytes had previously been associated with filarial pathology, supporting the need for further research.

[Evaluation of a prostate cancer E­health tutorial : Development and testing of the website prostata-information.ch]. / Evaluation eines Online-Tutorials zum Prostatakarzinom : Entwicklung und Überprüfung der Seite prostata-information.ch.

BACKGROUND: Due to the multitude of therapy options, the treatment decision after diagnosis of localized prostate cancer is challenging. Compared to printed booklets, web-based information technology offers more possibilities to tailor information to patients' individual needs. OBJECTIVES: To support the decision-making process as well as the communication with patients, we developed an online tutorial in a systematic process in the German-speaking part of Switzerland and then tested it in a pilot study. The study investigated users' satisfaction, the coverage of information needs, the preparation for decision making, and the subjective quality of the decision. MATERIALS AND METHODS: Based on already existing information material, the online tutorial was developed in an iterative process using focus groups with patients and urologists. For the following evaluation in eight clinics a total of 87 patients were invited to access the platform and participate in the study. Of these patients, 56 used the tutorial and 48 answered both surveys (the first one 4 weeks after the first login and the second one 3 months after treatment decision). The surveys used the Preparation for Decision Making Scale (PDMS), the Decisional Conflict Scale (DCS), and the Decisional Regret Scale (DRS). RESULTS AND CONCLUSION: Satisfaction with the tutorial is very high among patients with newly diagnosed localized prostate cancer. Users find their information needs sufficiently covered. Three months after the decision they felt that they were well prepared for the decision making (mean PDMS 75, standard deviation [SD] 23), they had low decisional conflict (mean DCS 9.6, SD 11), and almost no decisional regret (mean DRS 6.4, SD 9.6). Based on these findings, further use of the tutorial can be recommended.

Grazing management of mixed alfalfa bermudagrass pastures.

Rotational grazing management is commonly recommended to improve persistence of legumes interseeded into bermudagrass, but impacts on animal performance are poorly understood. Steers (n = 365, BW = 249 ± 22.9 kg) grazed mixed alfalfa (Medicago sativa L.)/bermudagrass (Cynodon dactylon [L.] Pers.) pastures (n = 10; 1.6-ha) with either continuous grazing (CONT) or rotational grazing (ROT) management over 3 yr. Initial stocking rate was set at 6.25 steers/ha. When forage allowance of CONT became limiting in mid-July each year, 2 randomly selected steers were removed from all pastures to maintain equal stocking rates in CONT and ROT. Rotational grazing pastures were divided into 8 paddocks with 3-d grazing and 21-d rest between grazing events. Initial, final, and interim (28-d) BW were collected following a 16-h removal from feed and water. Data were analyzed as a repeated measures experiment with completely random design using the mixed procedure of SAS (SAS Inst. Inc., Cary, NC) using pasture within treatment by year in the random statement. Across years, steer BW did not differ (P ≥ 0.47) at the midpoint or end of the grazing season. Daily BW gains during the early summer period tended (P = 0.10) to be 0.11 kg greater for CONT than ROT in yr 1, but did not differ (P ≥ 0.24) in yr 2 and 3. In the late summer, ADG was 0.15 kg less (P < 0.01) for CONT than ROT in yr 1, were not different (P = 0.23) in yr 2, and were 0.29 kg less (P < 0.01) for CONT than ROT in yr 3. Over the entire experimental period, ADG did not differ (P ≥ 0.67) in yr 1 or 2, but tended (P = 0.09) to be 0.10 kg greater for ROT than CONT in yr 3. Forage mass of ROT was greater (P < 0.01) than CONT throughout the grazing season. Because stocking rates were maintained at the same level, ROT pastures provided greater (P < 0.01) forage allowance during the grazing season than CONT explaining differences in ADG between treatments. Alfalfa stand percentage did not differ (P = 0.79) at the beginning of the experiment, but was less (P ≤ 0.03) for CONT than ROT at all other sampling dates. These data indicate that at equal stocking rates, ROT can maintain greater alfalfa persistence, forage nutritive quality, and forage allowance compared with continuous grazing and provided increased animal performance during the late summer when the alfalfa stand was reduced in CONT pastures.

Influence of an n-3 long-chain polyunsaturated fatty acid-enriched diet on experimentally induced synovitis in horses.

Dietary n-3 long-chain polyunsaturated fatty acid (LCPUFA) supplementation has previously been shown to modify joint-related inflammation in several species, although information in the horse is lacking. We investigated whether dietary supplementation with n-3 LCPUFA would modify experimentally induced synovitis in horses. Twelve, skeletally mature, non-pregnant mares were randomly assigned to either a control diet (CONT) or an n-3 long-chain fatty acid-enriched treatment diet (N3FA) containing 40 g/day of n-3 LCPUFA for 91 days. Blood samples taken on days 0, 30, 60 and 90, and synovial fluid collected on days 0 and 90 were processed for lipid composition. On day 91, joint inflammation was stimulated using an intra-articular (IA) injection of 100 ng of recombinant equine IL-1beta (reIL-1ß). Synovial fluid samples taken at post-injection hours (PIH) 0, 4, 8 and 24 were analysed for prostaglandin E2 (PGE2 ), matrix metalloproteinase (MMP) activity and routine cytology. Synovium and articular cartilage samples collected at PIH 8 were analysed for gene expression of MMP 1 and MMP 13, interleukin-1beta (IL-1ß), cyclooxygenase 2 (COX-2), tumour necrosis factor-alpha and the aggrecanases, a disintegrin and metalloprotease with thrombospondin motifs (ADAMTS)-4 and ADAMTS-5. A 90-day feeding period of n-3 LCPUFA increased serum phospholipid and synovial fluid lipid compositions of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) compared to CONT horses. The reIL-1ß injection caused an inflammatory response; however, there was no effect of dietary treatment on synovial fluid PGE2 content and MMP activity. Synovial tissue collected from N3FA horses exhibited lower expression of ADAMTS-4 compared to CONT horses. Despite the presence of EPA and DHA in the synovial fluid of N3FA horses, dietary n-3 LCPUFA supplementation did not modify synovial fluid biomarkers compared to CONT horses; however, the lower ADAMTS-4 mRNA expression in N3FA synovium warrants further investigation of n-3 LCPUFA as a joint therapy.

Emerging role of fecal microbiota therapy in the treatment of gastrointestinal and extra-gastrointestinal diseases.

In the recent decade our understanding of the role of the human gut microbiome has been revolutionized by advances in development of molecular methods. Approximately, up to 100 trillion (10(14)) microorganisms per human body colonize the intestinal tract making an additional acquired organ that provides many vital functions to the host. A healthy gut microbiome can be defined by the presence of the various classes of microbes that enhance metabolism, resistance to infection and inflammation, prevention against cancer and autoimmunity and that positively influence so called braingut axis. Diet represents one of the most important driving forces that besides environmental and genetic factors, can define and influence the microbial composition of the gut. Aging process due to different changes in gut physiology (i.e. gastric hypochlorhydria, motility disorders, use of drugs, degenerative changes in enteric nervous system) has a profound effect on the composition, diversity and functional features of gut microbiota. A perturbed aged gut microbiome has been associated with the increasing number of gastrointestinal (e.g. Clostridium difficile infection - CDI) and non-gastrointestinal diseases (metabolic syndrome, diabetes mellitus, fatty liver disease, atherosclerosis etc.). Fecal microbiota transplantation (FMT) is a highly effective method in the treatment of refractory CDI. FMT is the term used when stool is taken from a healthy individual and instilled during endoscopy (colonoscopy or enteroscopy) into a gut of the sick person to cure certain disease. FMT represents an effective therapy in patient with recurrent CDI and the effectiveness of FMT in the prevention of CDI recurrence had reached approx. 90%. There is also an increasing evidence that the manipulation of gut microbiota by FMT represents a promising therapeutic method in patients with inflammatory bowel disease and irritable bowel syndrome. There is also an increased interest in the role of FMT for the treatment of metabolic syndrome and obesity which collectively present the greatest health challenge in the developed world nowadays. Targeting of gut microbiota by FMT represents an exciting new frontier in the prevention and management of gastrointestinal and non-gastrointestinal diseases that awaits further studies in preclinical and clinical settings.

Time-varying signal analysis to detect high-altitude periodic breathing in climbers ascending to extreme altitude.

This work investigates the performance of cardiorespiratory analysis detecting periodic breathing (PB) in chest wall recordings in mountaineers climbing to extreme altitude. The breathing patterns of 34 mountaineers were monitored unobtrusively by inductance plethysmography, ECG and pulse oximetry using a portable recorder during climbs at altitudes between 4497 and 7546 m on Mt. Muztagh Ata. The minute ventilation (VE) and heart rate (HR) signals were studied, to identify visually scored PB, applying time-varying spectral, coherence and entropy analysis. In 411 climbing periods, 30-120 min in duration, high values of mean power (MP(VE)) and slope (MSlope(VE)) of the modulation frequency band of VE, accurately identified PB, with an area under the ROC curve of 88 and 89%, respectively. Prolonged stay at altitude was associated with an increase in PB. During PB episodes, higher peak power of ventilatory (MP(VE)) and cardiac (MP(LF)(HR) ) oscillations and cardiorespiratory coherence (MP(LF)(Coher)), but reduced ventilation entropy (SampEn(VE)), was observed. Therefore, the characterization of cardiorespiratory dynamics by the analysis of VE and HR signals accurately identifies PB and effects of altitude acclimatization, providing promising tools for investigating physiologic effects of environmental exposures and diseases.

Is a single positive blood culture for Enterococcus species representative of infection or contamination?

Data on the clinical outcomes of patients with a single compared with multiple positive blood cultures for Enterococcus species is limited. We undertook a retrospective cohort study in adults with at least one positive blood culture for Enterococcus species in a single institution. Clinical outcomes included death and elimination of infection. We included 471 positive blood cultures from 206 enterococcal positive blood culture episodes in 189 patients. Multiple positive blood cultures for Enterococcus species occurred in 110/206 (53.4 %) episodes; 31.6 % of patients had diabetes mellitus; 42.9 % of patients had solid or hematologic malignancy; 26.5 % of patients were solid organ transplant recipients; hospital-acquired and healthcare-associated acquisition represented 55.3 % and 33.0 % of episodes, respectively. Thirty-five patients died and 110 episodes of enterococcal bloodstream infection were successfully treated. In the multivariable analysis, multiple positive blood cultures were not statistically significantly associated with an increased likelihood of in-hospital death [odds ratio (OR) 1.00, 95 % confidence interval (CI) 0.42-2.40] or elimination (OR 1.41, 95 % CI 0.76-2.64) compared with single positive blood cultures. Hematologic malignancy and diabetes mellitus were independently associated with in-hospital death (OR 2.83, 95 % Cl 1.02-7.82; OR 2.79, 95 % Cl 1.16-6.70, respectively). Infectious disease consultation was associated with a greater likelihood of elimination (OR 2.50, 95 % Cl 1.32-4.72). The clinical outcomes of patients with single versus multiple positive blood cultures with Enterococcus species were similar in our institution. Further studies should examine efficient methods to detect contamination versus true infection.

The Tucker technique: the proximal hollow grind to address a root concavity.

Cast gold inlays have long been used to conservatively restore compromised tooth structure. When the mesial or distal proximal surfaces are indicated for restoration and a cast gold restoration is desired, traditionally a box is prepared with an external bevel. Often a root concavity does not allow for a standard box form or the external and/or internal bevels. A proximal hollow grind can be utilized to address limits of standard inlay or onlay preparation design.

Additive effects of growth promoting technologies on performance of grazing steers and economics of the wheat pasture enterprise.

This research was designed to evaluate the effect of monensin (Elanco Animal Health, Greenfield, IN) supplementation via mineral or pressed protein block with or without a growth-promoting implant on performance of steers grazing wheat pasture in Arkansas over 2 yr. Preconditioned steers (n = 360, BW = 238 ± 5.1 kg) grazed 15 1.6-ha wheat pastures in the fall (n = 60 steers each fall, stocking rate of 2.5 steers/ha) or 30 0.8-ha wheat pastures in the spring (n = 120 steers each spring, stocking rate of 5 steers/ha). Steers in each pasture were given free-choice access to nonmedicated mineral (CNTRL; MoorMan's WeatherMaster Range Minerals A 646AAA; ADM Alliance Nutrition, Inc., Quincy, IL), or were supplemented with monensin (Elanco Animal Health, Greenfield, IN) via mineral containing 1.78 g monensin/kg (RMIN; MoorMan's Grower Mineral RU-1620 590AR; ADM Alliance Nutrition, Inc.), or pressed protein block containing 0.33 g monensin/kg (RBLCK; MoorMan's Mintrate Blonde Block RU; ADM Alliance Nutrition, Inc.). Additionally, one-half of the steers in each pasture were implanted (IMPL) with 40 mg trenbolone acetate and 8 mg estradiol (Component TE-G with Tylan; Elanco Animal Health). There was no interaction (P ≥ 0.71) between supplement treatment and growth-promoting implants, and ADG for RMIN and RBLCK were increased (P < 0.01) over CNTRL by 0.07 to 0.09 kg/d, respectively. Implanting steers with Component TE-G increased (P < 0.01) ADG by 0.14 kg/d. The combination of these growth-promoting technologies are a cost-effective means of increasing beef production by 22% without increasing level of supplementation or pasture acreage. Utilizing ionophores and implants together for wheat pasture stocker cattle decreased cost of gain by 26%. Utilizing both IMPL and monensin increased net return by $30 to $54/steer for RMIN or $18 to $43/steer for RBLCK compared with UNIMPL CNTRL at Low and High values of BW gain, respectively.

Disease-related surgery in patients with distant metastatic breast cancer.

INTRODUCTION: This study evaluates the frequency of and indications for disease-related surgical procedures in the palliative breast cancer (BC) situation. PATIENTS & METHODS: Based on a cohort of women who were treated for newly diagnosed BC during a 20-year period (1990-2009), we analyzed 340 patients who developed distant metastatic disease (DMD) until 2011 and died (i.e. still ongoing palliative disease courses were not included). RESULTS: One hundred and twenty-seven surgical procedures were performed in 100 patients (29.4% of all patients with metastatic disease). The most common site for surgery was breast (n = 60, 47.2%). The primary tumor was removed at first diagnosis of DMD in 43 patients (33.9%); sixteen operations (12.6%) were performed for local recurrence. In 37 patients, 50 surgical procedures (39.4%) were necessary to stabilize osseous structures due to metastases. Procedures were rarely performed on other common metastatic sites: lung: n = 1 (0.8%); liver: n = 1 (0.8%), brain: n = 4 (3.1%). When excluding surgery for primary breast tumors at initial diagnosis of DMD from analysis, 34 of 84 surgeries (40.4%) were performed in the first third of survival follow-up (i.e. period of metastatic disease survival); operations in the last two-thirds each totaled 29.8% (n = 25). The median survival after surgery was 16 months (range: 0.5-89 months). CONCLUSIONS: In a cohort of BC patients who had primary or developed secondary DMD, nearly one third of the patients received disease-related surgical procedures during their palliative disease course. This high rate of operations shows that surgery has a clearly established role in the palliative therapy concept.

Performance by spring and fall-calving cows grazing with full, limited, or no access to toxic Neotyphodium coenophialum-infected tall fescue.

Replacing toxic, wild-type Neotyphodium coenophialum-infected tall fescue (E+) with nontoxic, N. coenophialum-infected tall fescue (NE+) has improved cow performance, but producer acceptance of NE+ has been slow. The objective was to compare performance by spring- and fall-calving cows grazing either E+ or NE+ at different percentages of the total pasture area. Gelbvieh×Angus crossbred cows (n=178) were stratified by BW and age within calving season and allocated randomly to 1 of 14 groups representing 5 treatments for a 3-yr study: i) Fall-calving on 100% E+ (F100); ii) Spring-calving on 100% E+ (S100); iii) Fall-calving on 75% E+ and 25% NE+ (F75); iv) Spring-calving on 75% E+ and 25% NE+ (S75); and v) Spring-calving on 100% NE+ (SNE100). Groups allocated to F75 and S75 grazed E+ until approximately 28 d before breeding and weaning, then were then moved to their respective NE+ pasture area for 4 to 6 wk; those allocated to F100, S100, and SNE100 grazed their pastures throughout the entire year. Samples of tall fescue were gathered from specific cells within each pasture at the time cows were moved into that particular cell (∼1 sample/mo). Blood samples were collected from the cows at the start and end of the breeding season. Stocking rate for each treatment was 1 cow/ha. Forage IVDMD, CP, and total ergot alkaloid concentrations were affected (P<0.05) by the treatment×sampling date interaction. Hay offered, cow BW, and BCS at breeding, end of breeding, and at weaning were greater (P<0.05) from fall-calving vs. spring-calving. Cow BW at weaning was greater (P<0.05) from F75 and S75 vs. F100 and S100. The calving season×NE+ % interaction affected (P<0.05) calving rates. Preweaning calf BW gain, actual and adjusted weaning BW, ADG, sale price, and calf value at weaning were greater (P<0.05) from fall-calving vs. spring-calving and from SNE100 vs. S75 except for sale price which was greater (P<0.05) from S75 vs. SNE100. Cow concentrations of serum prolactin at breeding and serum NEFA at the end of breeding were affected (P<0.05) by the calving season×NE+ % interaction. Serum Zn and Cu concentrations from cows were affected (P<0.05) by calving season. A fall-calving season may be more desirable for cows grazing E+, resulting in greater calving rates, cow performance, and calf BW at weaning, whereas limited access to NE+ may increase calving rates, serum prolactin, and NEFA concentrations during certain times in the production cycle, particularly in spring-calving cows.

Acclimatization improves submaximal exercise economy at 5533 m.

We tested whether the better subjective exercise tolerance perceived by mountaineers after altitude acclimatization relates to enhanced exercise economy. Thirty-two mountaineers performed progressive bicycle exercise to exhaustion at 490 m and twice at 5533 m (days 6-7 and day 11), respectively, during an expedition to Mt. Muztagh Ata. Maximal work rate (W(max)) decreased from mean ± SD 356 ± 73 watts at 490 m to 191 ± 49 watts and 193 ± 45 watts at 5533 m, days 6-7 and day 11, respectively; corresponding maximal oxygen uptakes (VO2max ) were 50.7 ± 9.5, 26.3 ± 5.6, 24.7 ± 7.0 mL/min/kg (P = 0.0001 5533 m vs 490 m). On days 6-7 (5533 m), VO(2) at 75% W(max) (152 ± 37 watts) was 1.75 ± 0.45 L/min, oxygen saturation 68 ± 8%. On day 11 (5533 m), at the same submaximal work rate, VO(2) was lower (1.61 ± 0.47 L/min, P < 0.027) indicating improved net efficiency; oxygen saturation was higher (74 ± 7%, P < 0.0004) but ratios of VO(2) to work rate increments remained unchanged. On day 11, mountaineers climbed faster from 4497 m to 5533 m than on days 5-6 but perceived less effort (visual analog scale 50 ± 15 vs 57 ± 20, P = 0.006) and reduced symptoms of acute mountain sickness. We conclude that the better performance and subjective exercise tolerance after acclimatization were related to regression of acute mountain sickness and improved submaximal exercise economy because of lower metabolic demands for non-external work-performing functions.

[Secondary hypogammaglobulinemia with recurrent opportunistic pulmonary infection]. / Wiederholte opportunistische Infektionbei sekundärem Immunglobulinmangel.

Secondary hypogammaglobulinemia may be a relevant predisposing condition in patients with recurrent bacterial upper airway disease (pneumonia, sinusitis) or first-time opportunistic infection, particularly if additional immunosuppressive factors like underlying hematological disease or immunosuppressive therapy are present. As an example, we present a retired farmer with myeloma, treated Hodgkin-lymphoma and hypogammaglobulinemia suffering from the third episode of Rhodococcus equi pneumonia. Screening for hypogammaglobulinemia is recommended in patients with unexplained recurrent bacterial airway infection or first time opportunistic disease, particularly with micro-organisms controlled by humoral immunity. Screening should include the analysis of total immunoglobulin levels (IgA, IgG and IgM). If results are ambiguous, tetanus toxoid and pneumococcal polysaccharide vaccine should be administered with measurement of specific antibody titer before and one month after vaccination. An adequate antibody response largely excludes a clinically significant humoral immunodeficiency. If hypogammaglobulinemia is present in a patient with recurrent or opportunistic infections, periodical substitution of IVIG in a dose and frequency to prevent further infectious episodes should be initiated. This is usually achieved with an IVIG-dose of 0.4g/kg body weight every 3 - 4 weeks to reach a trough IgG-level of 5 - 7g/L.