Revision/Conversion Surgeries After One Anastomosis Gastric Bypass-An Experts' Modified Delphi Consensus.

PURPOSE: There is a lack of evidence for treatment of some conditions including complication management, suboptimal initial weight loss, recurrent weight gain, or worsening of a significant obesity complication after one anastomosis gastric bypass (OAGB). This study was designed to respond to the existing lack of agreement and to provide a valuable resource for clinicians by employing an expert-modified Delphi consensus method. METHODS: Forty-eight recognized bariatric surgeons from 28 countries participated in the modified Delphi consensus to vote on 64 statements in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was regarded to indicate a consensus. RESULTS: A consensus was achieved for 46 statements. For recurrent weight gain or worsening of a significant obesity complication after OAGB, more than 85% of experts reached a consensus that elongation of the biliopancreatic limb (BPL) is an acceptable option and the total bowel length measurement is mandatory during BPL elongation to preserve at least 300-400 cm of common channel limb length to avoid nutritional deficiencies. Also, more than 85% of experts reached a consensus on conversion to Roux-en-Y gastric bypass (RYGB) with or without pouch downsizing as an acceptable option for the treatment of persistent bile reflux after OAGB and recommend detecting and repairing any size of hiatal hernia during conversion to RYGB. CONCLUSION: While the experts reached a consensus on several aspects regarding revision/conversion surgeries after OAGB, there are still lingering areas of disagreement. This highlights the importance of conducting further studies in the future to address these unresolved issues.

Senescent glia link mitochondrial dysfunction and lipid accumulation.

Senescence is a cellular state linked to ageing and age-onset disease across many mammalian species1,2. Acutely, senescent cells promote wound healing3,4 and prevent tumour formation5; but they are also pro-inflammatory, thus chronically exacerbate tissue decline. Whereas senescent cells are active targets for anti-ageing therapy6-11, why these cells form in vivo, how they affect tissue ageing and the effect of their elimination remain unclear12,13. Here we identify naturally occurring senescent glia in ageing Drosophila brains and decipher their origin and influence. Using Activator protein 1 (AP1) activity to screen for senescence14,15, we determine that senescent glia can appear in response to neuronal mitochondrial dysfunction. In turn, senescent glia promote lipid accumulation in non-senescent glia; similar effects are seen in senescent human fibroblasts in culture. Targeting AP1 activity in senescent glia mitigates senescence biomarkers, extends fly lifespan and health span, and prevents lipid accumulation. However, these benefits come at the cost of increased oxidative damage in the brain, and neuronal mitochondrial function remains poor. Altogether, our results map the trajectory of naturally occurring senescent glia in vivo and indicate that these cells link key ageing phenomena: mitochondrial dysfunction and lipid accumulation.

Female Deer Movements Relative to Firearms Hunting in Northern Georgia, USA.

Perceived risk associated with hunters can cause white-tailed deer (Odocoileus virginianus) to shift their activity away from key foraging areas or alter normal movements, which are important considerations in managing hunting and its effects on a population. We studied the effects of seven firearms hunts on the movements of 20 female deer in two Wildlife Management Areas within the Chattahoochee National Forest of northern Georgia, USA, during the 2018-2019 and 2019-2020 hunting seasons. Deer populations and the number of hunters in our study area have declined significantly since the 1980s. In response, hunting regulations for the 2019-2020 hunting season eliminated opportunities for harvesting female deer. To evaluate the indirect effects of antlered deer hunting on non-target female deer, we calculated 90% utilization distributions (UDs), 50% UDs, and step lengths for pre-hunt, hunt, and post-hunt periods using the dynamic Brownian bridge movement model. Data included 30 min GPS locations for 44 deer-hunt combinations. Pre-hunt 50% UDs (x- = 7.0 ha, SE = 0.4 ha) were slightly greater than both hunt (x- = 6.0 ha, SE = 0.3 ha) and post-hunt (x- = 6.0 ha, SE = 0.2 ha) 50% UDs (F = 3.84, p = 0.03). We did not detect differences in step length, nor did we detect differences in size or composition of 90% UDs, among the periods. Overall, our results suggest that the low level of hunting pressure in our study area and lack of exposure to hunters led to no biologically significant changes in female deer movements. To the extent of the findings presented in this paper, adjustments to the management of hunting in our study area do not appear to be necessary to minimize hunting-related disturbances for female deer. However, managers should continue to consider female deer behavior when evaluating future changes to hunting regulations.

Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus.

Metabolic and bariatric surgery (MBS) is widely considered the most effective option for treating obesity, a chronic, relapsing, and progressive disease. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines. The aim of this study is to establish the first set of consensus guidelines for selecting procedures in Class I and II obesity, using an Expert Modified Delphi Method. In this study, 78 experienced bariatric surgeons from 32 countries participated in a two-round Modified Delphi consensus voting process. The threshold for consensus was set at an agreement or disagreement of ≥ 70.0% among the experts. The experts reached a consensus on 54 statements. The committee of experts reached a consensus that MBS is a cost-effective treatment option for Class II obesity and for patients with Class I obesity who have not achieved significant weight loss through non-surgical methods. MBS was also considered suitable for patients with Type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 30 kg/m2 or higher. The committee identified intra-gastric balloon (IGB) as a treatment option for patients with class I obesity and endoscopic sleeve gastroplasty (ESG) as an option for patients with class I and II obesity, as well as for patients with T2DM and a BMI of ≥ 30 kg/m2. Sleeve gastrectomy (1) and Roux-en-Y gastric bypass (RYGB) were also recognized as viable treatment options for these patient groups. The committee also agreed that one anastomosis gastric bypass (OAGB) is a suitable option for patients with Class II obesity and T2DM, regardless of the presence or severity of obesity-related medical problems. The recommendations for selecting procedures in Class I and II obesity, developed through an Expert Modified Delphi Consensus, suggest that the use of standard primary bariatric endoscopic (IGB, ESG) and surgical procedures (SG, RYGB, OAGB) are acceptable in these patient groups, as consensus was reached regarding these procedures. However, randomized controlled trials are still needed in Class I and II Obesity to identify the best treatment approach for these patients in the future.

A mitochondria-regulated p53-CCF circuit integrates genome integrity with inflammation.

Genomic instability and inflammation are distinct hallmarks of aging, but the connection between them is poorly understood. Understanding their interrelationship will help unravel new mechanisms and therapeutic targets of aging and age-associated diseases. Here we report a novel mechanism directly linking genomic instability and inflammation in senescent cells, through a mitochondria-regulated molecular circuit that connects the p53 tumor suppressor and cytoplasmic chromatin fragments (CCF), a driver of inflammation through the cGAS-STING pathway. Activation or inactivation of p53 by genetic and pharmacologic approaches showed that p53 suppresses CCF accumulation and the downstream inflammatory senescence-associated secretory phenotype (SASP), independent of its effects on cell cycle arrest. p53 activation suppressed CCF formation by promoting DNA repair, reflected in maintenance of genomic integrity, particularly in subtelomeric regions, as shown by single cell genome resequencing. Activation of p53 by pharmacological inhibition of MDM2 in old mice decreased features of SASP in liver, indicating a senomorphic role in vivo . Remarkably, mitochondria in senescent cells suppressed p53 activity by promoting CCF formation and thereby restricting ATM-dependent nuclear DNA damage signaling. These data provide evidence for a mitochondria-regulated p53-CCF circuit in senescent cells that controls DNA repair, genome integrity and inflammatory SASP, and is a potential target for senomorphic healthy aging interventions.

Population Dynamics of a Declining White-Tailed Deer Population in the Southern Appalachian Region of the United States.

Although generally abundant, white-tailed deer (Odocoileus virginianus) populations in the southeastern United States have recently experienced several localized declines attributed to reduced fawn recruitment following the establishment of coyotes (Canis latrans). The Southern Appalachians is a mountainous region suggested to be experiencing white-tailed deer declines, as harvest numbers and hunter success rates have substantially decreased in northern Georgia since 1979. Low fawn survival (16%) was also recently documented in the Chattahoochee National Forest (CNF) in northern Georgia, necessitating further examination. We radio-collared 14 yearling and 45 adult female white-tailed deer along with 71 fawns during 2018-2020 in the CNF to estimate field-based vital rates (i.e., survival and fecundity) and parameterize stage-structured population models. We projected population growth rates (λ) over 10 years to evaluate the current rate of decline and various other management scenarios. Our results indicated that the observed population would decline by an average of 4.0% annually (λ = 0.960) under current conditions. Only scenarios including antlerless harvest restrictions in addition to improved fawn survival resulted in positive growth (λ = 1.019, 1.085), suggesting these measures are likely necessary for population recovery in the region. This approach can be applied by wildlife managers to inform site-specific management strategies.

Bariatric Evaluation Through AI: a Survey of Expert Opinions Versus ChatGPT-4 (BETA-SEOV).

BACKGROUND: Recent advancements in artificial intelligence, such as OpenAI's ChatGPT-4, are revolutionizing various sectors, including healthcare. This study investigates the use of ChatGPT-4 in identifying suitable candidates for bariatric surgery and providing surgical recommendations to improve decision-making in obesity treatment amid the global obesity epidemic. METHODS: We devised ten patient scenarios, thoughtfully encompassing a spectrum that spans from uncomplicated cases to more complex ones. Our objective was to delve into the decision-making process regarding the recommendation of bariatric surgery. From July 29th to August 10th, 2023, we conducted a voluntary online survey involving thirty prominent bariatric surgeons, ensuring that there was no predetermined bias in the selection of a specific type of bariatric surgery. This survey was designed to collect their insights on these scenarios and gain a deeper understanding of their professional experience and background in the field of bariatric surgery. Additionally, we consulted ChatGPT-4 in two separate conversations to evaluate its alignment with expert opinions on bariatric surgery options. RESULTS: In 40% of the scenarios, disparities were identified between the two conversations with ChatGPT-4. It matched expert opinions in 30% of cases. Differences were noted in cases like gastrointestinal metaplasia and gastric adenocarcinoma, but there was alignment with conditions like endometriosis and GERD. CONCLUSION: The evaluation of ChatGPT-4's role in determining bariatric surgery suitability uncovered both potential and shortcomings. Its alignment with experts was inconsistent, and it often overlooked key factors, emphasizing human expertise's value. Its current use requires caution, and further refinement is needed for clinical application.

Influence of visual perception on movement decisions by an ungulate prey species.

Visual perception is dynamic and depends on physiological properties of a species' visual system and physical characteristics of the environment. White-tailed deer (Odocoileus virginianus) are most sensitive to short- and mid-wavelength light (e.g. blue and green). Wavelength enrichment varies spatially and temporally across the landscape. We assessed how the visual perception of deer influences their movement decisions. From August to September 2019, we recorded 10-min locations from 15 GPS-collared adult male deer in Central Florida. We used Hidden-Markov models to identify periods of movement by deer and subset these data into three time periods based on temporal changes in light environments. We modeled resource selection during movement using path-selection functions and simulated 10 available paths for every path used. We developed five a priori models and used 10-fold cross validation to assess our top model's performance for each time period. During the day, deer selected to move through woodland shade, avoided forest shade, and neither selected nor avoided small gaps. At twilight, deer avoided wetlands as cloud cover increased but neither selected nor avoided other cover types. Visual cues and signals are likely more conspicuous to deer in short-wavelength-enriched woodland shade during the day, while at twilight in long-wavelength-enriched wetlands during cloud cover, visual cues are likely less conspicuous. The nocturnal light environment did not influence resource selection and likely has little effect on deer movements because it's relatively homogenous. Our findings suggest visual perception relative to light environments is likely an underappreciated driver of behaviors and decision-making by an ungulate prey species.

White-tailed deer (Odocoileus virginianus) fawn survival and the influence of landscape characteristics on fawn predation risk in the Southern Appalachian Mountains, USA.

In the Southern Appalachian region of the United States, harvest data has indicated the occurrence of low deer densities while exposing a trend of declining white-tailed deer (Odocoileus virginianus) populations over the past several decades in northern Georgia. A triumvirate of increasing fawn predator populations reside in the Southern Appalachian Mountains including coyotes (Canis latrans), black bears (Ursus americanus) and bobcats (Lynx rufus). This region is also characterized by a homogenous landscape composed of mature forests and sparse understory vegetation, likely lacking adequate cover to offer fawns refugia from predators. Our objectives were to estimate survival and cause-specific mortality rates of fawns while assessing a possible link between mortality risk, intrinsic fawn characteristics (i.e., birth mass, Julian birth date, sibling status), and landscape features within fawn usage areas. During 2018-2020, we radio-collared 71 fawns within the Chattahoochee National Forest of northern Georgia, USA and monitored survival to 12 weeks of age. We observed low fawn survival (cumulative = 0.157, 95% CI = 0.091-0.273; vaginal implant transmitter = 0.196, 95% CI = 0.096-0.403) with predation as the leading cause of all known mortalities (45 of 55 mortalities; 82%) due primarily to coyotes (n = 22), black bears (n = 12), and bobcats (n = 7). Relationships between landscape features and fawn predation risk were minimal with only one informative covariate. Increasing amounts of early successional land cover within fawn usage areas decreased fawn mortality risk within the first 20 days of life, but elevated mortality risk thereafter. All fawns with any amount of early successional land cover in their usage areas died of predation (n = 13) at various time intervals, suggesting limited areas of potential fawning cover may be targeted by predators. However, fawn predation risk seemed to be high regardless of landscape covariates due to the limited number of surviving fawns. Coyote-caused mortality occurred over a longer period at a consistently higher magnitude than all other forms of mortality, indicating possible delayed prey-switching behavior and coyote predation as an important factor of fawn survival. The low recruitment of fawns influenced by high predation rates and homogenous habitat conditions is likely the cause of deer population declines in the region.

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus.

BACKGROUND: Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. METHODS: Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. RESULTS: Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redo-procedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. CONCLUSION: Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.

The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery.

BACKGROUND: Laparoscopic surgery has almost replaced open surgery in many areas of Gastro-Intestinal (GI) surgery. There is currently no published expert consensus statement on the principles of laparoscopic GI surgery. This may have affected the training of new surgeons. This exercise aimed to achieve an expert consensus on important principles of laparoscopic GI surgery. METHODS: A committee of 38 international experts in laparoscopic GI surgery proposed and voted on 149 statements in two rounds following a strict modified Delphi protocol. RESULTS: A consensus was achieved on 133 statements after two rounds of voting. All experts agreed on tailoring the first port site to the patient, whereas 84.2% advised avoiding the umbilical area for pneumoperitoneum in patients who had a prior midline laparotomy. Moreover, 86.8% agreed on closing all 15 mm ports irrespective of the patient's body mass index. There was a 100% consensus on using cartridges of appropriate height for stapling, checking the doughnuts after using circular staplers, and keeping the vibrating blade of the ultrasonic energy device in view and away from vascular structures. An 84.2% advised avoiding drain insertion through a ≥10 mm port site as it increases the risk of port-site hernia. There was 94.7% consensus on adding laparoscopic retrieval bags to the operating count and ensuring any surgical specimen left inside for later removal is added to the operating count. CONCLUSION: Thirty-eight experts achieved a consensus on 133 statements concerning various aspects of laparoscopic GI Surgery. Increased awareness of these could facilitate training and improve patient outcomes.

Monitoring partially marked populations using camera and telemetry data.

Long-term monitoring is an important component of effective wildlife conservation. However, many methods for estimating density are too costly or difficult to implement over large spatial and temporal extents. Recently developed spatial mark-resight (SMR) models are increasingly being applied as a cost-effective method to estimate density when data include detections of both marked and unmarked individuals. We developed a generalized SMR model that can accommodate long-term camera data and auxiliary telemetry data for improved spatiotemporal inference in monitoring efforts. The model can be applied in two stages, with detection parameters estimated in the first stage using telemetry data and camera detections of instrumented individuals. Density is estimated in the second stage using camera data, with all individuals treated as unmarked. Serial correlation in detection and density parameters is accounted for using time-series models. The two-stage approach reduces computational demands and facilitates the application to large data sets from long-term monitoring initiatives. We applied the model to 3 years (2015-2017) of white-tailed deer (Odocoileus virginianus) data collected in three study areas of the Big Cypress Basin, Florida, USA. In total, 59 females marked with ear tags and fitted with GPS-telemetry collars were detected along with unmarked females on 180 remote cameras. Most of the temporal variation in density was driven by seasonal fluctuations, but one study area exhibited a slight population decline during the monitoring period. Modern technologies such as camera traps provide novel possibilities for long-term monitoring, but the resulting massive data sets, which are subject to unique sources of observation error, have posed analytical challenges. The two-stage spatial mark-resight framework provides a solution with lower computational demands than joint SMR models, allowing for easier implementation in practice. In addition, after detection parameters have been estimated, the model may be used to estimate density even if no synchronous auxiliary information on marked individuals is available, which is often the case in long-term monitoring.

Keeping the service running: Examining working relationships and workload of London bus network iBus controllers.

Bus controllers are an essential part of the London bus network. Although the bus driver is the individual directly in control of the vehicle, inputs from both the controller and driver influence operations. Currently, little research has focused on the dynamic between these parties, and how it works in the day-to-day operation of a bus. In the current study, data was collected across focus groups with controllers to understand the controller-driver relationship from the controller perspective. The objectives of the research were to: investigate interactions and working relationships between bus controllers and drivers in London and to explore the effect of controller/driver relationships on workload, stress and fatigue. It is clear that the working relationship between controllers and drivers is a challenging one, with both parties often misunderstanding the role of the other. This is made worse by the nature of communication via radio including poor quality audio leading to difficult interactions. All of the participating controllers expressed being overloaded with work, leading to feelings of stress and fatigue, with shift work and irregular hours being discussed as a cause of controller fatigue. Any steps taken to improve the difficult working relationship between drivers and controllers can be seen as beneficial because they could improve efficiency, worker wellbeing, and possibly safety.

Modeling abundance, distribution, movement and space use with camera and telemetry data.

Studies of animal abundance and distribution are often conducted independently of research on movement, despite the important links between processes. Movement can cause rapid changes in spatial variation in density, and movement influences detection probability and therefore estimates of abundance from inferential methods such as spatial capture-recapture (SCR). Technological developments including camera traps and GPS telemetry have opened new opportunities for studying animal demography and movement, yet statistical models for these two data types have largely developed along parallel tracks. We present a hierarchical model in which both datasets are conditioned on a movement process for a clearly defined population. We fitted the model to data from 60 camera traps and 23,572 GPS telemetry locations collected on 17 male white-tailed deer in the Big Cypress National Preserve, Florida, USA during July 2015. Telemetry data were collected on a 3-4 h acquisition schedule, and we modeled the movement paths of all individuals in the region with a Ornstein-Uhlenbeck process that included individual-specific random effects. Two of the 17 deer with GPS collars were detected on cameras. An additional 20 male deer without collars were detected on cameras and individually identified based on their unique antler characteristics. Abundance was 126 (95% CI: 88-177) in the 228 km2 region, only slightly higher than estimated using a standard SCR model: 119 (84-168). The standard SCR model, however, was unable to describe individual heterogeneity in movement rates and space use as revealed by the joint model. Joint modeling allowed the telemetry data to inform the movement model and the SCR encounter model, while leveraging information in the camera data to inform abundance, distribution and movement. Unlike most existing methods for population-level inference on movement, the joint SCR-movement model can yield unbiased inferences even if non-uniform sampling is used to deploy transmitters. Potential extensions of the model include the addition of resource selection parameters, and relaxation of the closure assumption when interest lies in survival and recruitment. These developments would contribute to the emerging holistic framework for the study of animal ecology, one that uses modern technology and spatio-temporal statistics to learn about interactions between behavior and demography.

Cytoplasmic DNA: sources, sensing, and role in aging and disease.

Endogenous cytoplasmic DNA (cytoDNA) species are emerging as key mediators of inflammation in diverse physiological and pathological contexts. Although the role of endogenous cytoDNA in innate immune activation is well established, the cytoDNA species themselves are often poorly characterized and difficult to distinguish, and their mechanisms of formation, scope of function and contribution to disease are incompletely understood. Here, we summarize current knowledge in this rapidly progressing field with emphases on similarities and differences between distinct cytoDNAs, their underlying molecular mechanisms of formation and function, interactions between cytoDNA pathways, and therapeutic opportunities in the treatment of age-associated diseases.

Effects of Bait on Male White-Tailed Deer Resource Selection.

Bait is often used to increase wildlife harvest susceptibility, enhance viewing opportunities, and survey wildlife populations. The effects of baiting depend on how bait influences space use and resource selection at multiple spatial scales. Although telemetry studies allow for inferences about resource selection within home ranges (third-order selection), they provide limited information about spatial variation in density, which is the result of second-order selection. Recent advances in spatial capture-recapture (SCR) techniques allow exploration of second- and third-order selection simultaneously using non-invasive methods such as camera traps. Our objectives were to describe how short-term baiting affects white-tailed deer (Odocoileus virginianus) behavior and distribution. We fit SCR models to camera data from baited and unbaited locations in southwestern Georgia to assess the effects of short-term baiting on second- and third-order selection of deer during summer and winter surveys. We found little evidence of second-order selection during late summer or early winter surveys when camera surveys using bait are typically conducted. However, we found evidence for third-order selection, indicating that resource selection within home ranges is affected. Concentrations in space use resulting from baiting may enhance disease transmission, change harvest susceptibility, and potentially bias the outcome of camera surveys using bait.

Physiologic and blood gas effects of xylazine-ketamine versus xylazine-tiletamine-zolazepam immobilization of white-tailed deer before and after oxygen supplementation: a preliminary study.

OBJECTIVE: To compare oxygenation and ventilation in white-tailed deer (Odocoileus virginianus) anesthetized with two treatments with and without oxygen supplementation. STUDY DESIGN: Randomized, blinded, crossover study. ANIMALS: A total of eight healthy adult white-tailed deer weighing 49-62 kg. METHODS: Each deer was anesthetized twice intramuscularly: 1) treatment XK, xylazine (2 mg kg-1) and ketamine (6 mg kg-1) and 2) treatment XTZ, xylazine (2 mg kg-1) and tiletamine-zolazepam (4 mg kg-1). With the deer in sternal position, arterial and venous blood was collected before and at 30 minutes during administration of oxygen at 1 L minute-1 through a face mask. PaO2 and heart rate (HR) were compared using two-way repeated measures anova. pH, PaCO2 and lactate concentration were analyzed using mixed-effects linear models, p < 0.05. RESULTS: When breathing air, PaO2 was < 80 mmHg (10.7 kPa) in six and seven deer with XK and XTZ, respectively, and of these, PaO2 was < 60 mmHg (8.0 kPa) in three and five deer, respectively. With oxygen supplementation, PaO2 increased to 128 ± 4 and 140 ± 5 mmHg (17.1 ± 0.5 and 18.7 ± 0.7 kPa), mean ± standard error, with XK and XTZ, respectively (p < 0.001). PaO2 was not significantly different between treatments at either time point. HR decreased during oxygen supplementation in both treatments (p < 0.001). Lactate was significantly lower (p = 0.047) with XTZ than with XK (2.2 ± 0.6 versus 3.5 ± 0.6 mmol L-1) and decreased (p < 0.001) with oxygen supplementation (4.1 ± 0.6 versus 1.6 ± 0.6 mmol L-1). PaCO2 increased in XTZ during oxygen breathing. CONCLUSIONS AND CLINICAL RELEVANCE: Treatments XK and XTZ resulted in hypoxemia, which responded to oxygen supplementation. Both treatments are suitable for immobilization of white-tailed deer under the study circumstances.

The Effect of Maternal Antibodies on Clinical Response to Infection with Epizootic Hemorrhagic Disease Virus in White-Tailed Deer (Odocoileus virginianus) Fawns.

We investigated whether naturally acquired maternal antibodies to epizootic hemorrhagic disease virus serotype 2 (EHDV-2) would protect white-tailed deer (Odocoileus virginianus) fawns against infection and clinical disease following an EHDV-2 challenge. We compared viremia and clinical response in 27-47-d-old, experimentally infected fawns with and without maternally derived antibodies to EHDV-2. Mild to moderate clinical signs were observed in four seronegative (maternal antibody-negative) fawns, which were viremic from 3 to 14 d postinoculation. Individual peak blood virus titers for seronegative fawns ranged from 104.3 to 106.3 median tissue culture infective doses (TCID50)/mL. In contrast, clinical signs were not observed in seropositive (maternal antibody-positive) fawns and a transient low-level viremia (≤102.4 TCID50/mL) occurred in two of six fawns. Our results indicated that the presence of maternally derived EHDV-2 antibodies in fawns prevents or greatly reduces clinical disease and the level and duration of EHDV-2 viremia.

The first modified Delphi consensus statement on sleeve gastrectomy.

INTRODUCTION: Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide. Yet there is significant variation in practice concerning its various aspects. This paper report results from the first modified Delphi consensus-building exercise on SG. METHODS: We established a committee of 54 globally recognized opinion makers in this field. The committee agreed to vote on several statements concerning SG. An agreement or disagreement amongst ≥ 70.0% experts was construed as a consensus. RESULTS: The committee achieved a consensus of agreement (n = 71) or disagreement (n = 7) for 78 out of 97 proposed statements after two rounds of voting. The committee agreed with 96.3% consensus that the characterization of SG as a purely restrictive procedure was inaccurate and there was 88.7% consensus that SG was not a suitable standalone, primary, surgical weight loss option for patients with Barrett's esophagus (BE) without dysplasia. There was an overwhelming consensus of 92.5% that the sleeve should be fashioned over an orogastric tube of 36-40 Fr and a 90.7% consensus that surgeons should stay at least 1 cm away from the angle of His. Remarkably, the committee agreed with 81.1% consensus that SG patients should undergo a screening endoscopy every 5 years after surgery to screen for BE. CONCLUSION: A multinational team of experts achieved consensus on several aspects of SG. The findings of this exercise should help improve the outcomes of SG, the commonest bariatric procedure worldwide, and guide future research on this topic.

Cytoplasmic chromatin fragments-from mechanisms to therapeutic potential.

Senescent cells, damaged cells that permanently exit the cell cycle, play important roles in development, tissue homeostasis, and tumorigenesis. Although many of these roles are beneficial in acute responses to stress and damage, the persistent accumulation of senescent cells is associated with many chronic diseases through their proinflammatory senescence-associated secretory phenotype (SASP). SASP expression is linked to DNA damage; however, the mechanisms that control the SASP are incompletely understood. More recently, it has been shown that senescent cells shed fragments of nuclear chromatin into the cytoplasm, so called cytoplasmic chromatin fragments (CCF). Here, we provide an overview of the current evidence linking DNA damage to the SASP through the formation of CCF. We describe mechanisms of CCF generation and their functional role in senescent cells, with emphasis on therapeutic potential.