INDURG TRIAL PROTOCOL: A RANDOMIZED CONTROLLED TRIAL USING INDOCYANINE GREEN DURING CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS.

INTRODUCTION: Laparoscopic cholecystectomy is one of the most common gastrointestinal surgeries, and bile duct injury is one of its main complications. The use of real-time indocyanine green fluorescence cholangiography allows the identification of extrahepatic biliary structures, facilitating the procedure and reducing the risk of bile duct lesions. A better visualization of the bile duct may help to reduce the need for conversion to open surgery, and may also shorten operating time. The main objective of this study is to determine whether the use of indocyanine green is associated with a reduction in operating time in emergency cholecystectomies. Secondary outcomes are the postoperative hospital stay, the correct intraoperative visualization of the Calot's Triangle structures with the administration of indocyanine green, and the intraoperative complications, postoperative complications and morbidity according to the Clavien-Dindo classification. METHODS: This is a randomized, prospective, controlled, multicenter trial with patients diagnosed with acute cholecystitis requiring emergency cholecystectomy. The control group will comprise 220 patients undergoing emergency laparoscopic cholecystectomy applying the standard technique. The intervention group will comprise 220 patients also undergoing emergency laparoscopic cholecystectomy for acute cholecystitis with prior administration of indocyanine green. CONCLUSION: Due to the lack of published studies on ICG in emergency laparoscopic cholecystectomy, this study may help to establish procedures for its use in the emergency setting.

Dietary supplementation with natural antioxidants: assessment of growth performance and meat quality in broiler chickens.

Exposure to air and light lowers the meat quality of chickens, which is mainly determined by the color alteration and accumulation of detrimental products from lipid oxidation. This study tests the effects of 2 supplements rich in polyphenols, Oxilem (OX) and OxiGem (OG), on broiler Ross 308 performance and meat quality in comparison to a control group (C). A total of 105 one-day-old Ross 308 male chicks were allocated to 21 pens and randomly assigned to 1 of the 3 treatments. The trial lasted 42 d. Individual live weight and feed intake per pen were recorded. Proximate analysis, color, cholesterol content and cholesterol oxidation products (COPs), fatty acids (FAs), volatile aldehydes profile, and secondary oxidation products of meat FAs were determined, with analyses for detecting oxidative alterations conducted on breast burgers preserved for 7 d at 4°C. Birds fed OG grew 7 g/d more than those receiving OX, reaching a higher final weight. After slaughtering, meat from the OX group had a higher yellow index compared to C. After 7 d of air and light exposure, the influence on the color parameters of the OG and OX burgers was significantly less pronounced than that of C. Secondary oxidation products of the FAs of the burgers were not significantly affected by the diet regimens. In addition, OX and OG burgers exhibited lower amounts of volatile aldehydes, triol and COPs. These results confirm the effectiveness of OX and OG supplementation against lipid oxidation at the inclusion level used in this trial.

Resultados del Registro Nacional de Politraumatismos español ¿Dónde estamos y a dónde nos dirigimos? / Results of the Spanish National Polytrauma Registry. Where are we and where are we heading?

Introducción: En 2017 se emprendió el Registro Nacional de Politraumatismos (RNP) a nivel estatal español, cuya finalidad residía en mejorar la calidad de la atención al paciente politraumatizado grave y evaluar el uso de recursos y estrategias de tratamiento. El objetivo de este trabajo es presentar los datos recogidos en el RNP hasta la actualidad. Métodos: Estudio observacional retrospectivo a partir de los datos recogidos prospectivamente en el RNP. Se incluyen pacientes mayores de 14 años, con ISS≥15 o mecanismo de trauma penetrante, atendidos en 17 hospitales de tercer nivel de España. Resultados: Del 1/1/17 al 1/1/22 se han registrado un total de 2.069 pacientes politraumatizados. El 76,4% son varones; edad media: 45 años; ISS medio: 22,8 y mortalidad: 10,2%. El mecanismo de lesión más frecuente es el cerrado (80%) con mayor incidencia de accidentes de moto (23%). Un 12% de los pacientes sufren un traumatismo penetrante, por arma blanca en el 84%. Un 16% de los pacientes ingresa hemodinámicamente inestable en el hospital. Activando el protocolo de transfusión masiva en el 14% de los pacientes e interviniendo quirúrgicamente a un 53%. La estancia hospitalaria mediana es de 11 días. Precisando ingreso en la UCI un 73,4% (estancia media: 5 días). Conclusiones: Los pacientes politraumatizados registrados en el RNP son mayoritariamente varones de mediana edad, que sufren traumatismos cerrados y presentan una elevada incidencia de lesiones torácicas. La detección y el tratamiento dirigido de este tipo de lesiones probablemente permitirá mejorar la calidad asistencial del politraumatizado en nuestro medio. (AU)

Introduction: In 2017 the Spanish National Polytrauma Registry (SNPR) was initiated in Spain, its goal was to improve the quality of severe trauma management and evaluate the use of resources and treatment strategies. The objective of this study is to present the information obtained with the SNPR since it was initiated. Methods: Observational study with prospective data collection from the SNPR. Trauma patients included are older than 14 yeas, with ISS ≥ 15 or penetrating mechanism. In total 17 hospitals from Spain have participated. Results: From 1/1/17 to 1/1/22, 2069 trauma patients were registered. The majority were men (76.4%); mean age: 45 years; mean ISS: 22.8 and mortality: 10.2%. The most common mechanism of injury was blunt trauma (80%), being motorbike accident the most frequent (23%). Penetrating trauma is presented in 12% of patients, being stab wound the most common (84%). Sixteen percent of patients are hemodynamically unstable on hospital arrival. Massive transfusion protocol is activated in 14% of patients and 53% are operated. Median hospital stay is 11 days. There is a 73.4% of patients who need intensive care unit (ICU) admission, with a median ICU stay of 5 days. Conclusions: Trauma patients registered in the SNPR are predominantly middle-aged males who experience blunt trauma with a high incidence of thoracic injuries. Early and addressed detection of these kind of injuries would probably improve trauma quality of care in our environment. (AU)

Linseed supplementation in the diet of fattening pigs: Effect on the fatty acid profile of different pork cuts.

Linseed supplementation improves the fatty acid (FA) profile of meat, primarily by increasing α-linolenic acid (ALA). Pork is one of the most consumed meats, though the high level of saturated FA, therefore, a change of the FA profile is needed to improve the health properties. The aim of this work was to study the influence of extruded linseed supplementation on the FA profile in 5 different pork cuts, increasing their nutraceutical properties. Sixty pigs were divided into two groups, which were fed two different diets: control (C) and experimental (L, 8% supplementation with extruded flaxseed). Five cuts were sampled: backfat (Bf), bacon (B), Boston shoulder (Bs), ham lean part (Hl) and ham fatty part (Hf). The L diet reduced fat content in Hf (-6%) and B (-11%), while the other cuts did not show differences. Moreover, L group showed a higher level of n-3 PUFA (approx. 9-fold), with a significant reduction in the n-6/n-3 from 20 to 2.5. In cuts rich in fat (Bf, B and Hf) of L group, the level of n-3 PUFA was higher than the thresholds set by EU to obtain the claim "Source of omega-3 fatty acids". In contrast, the lean cuts (Hl and Bs) did not exceed the threshold of n-3 PUFA required to obtain the claim, as consequence of the low level of fat. The results demonstrated that a diet with 8% extruded linseed enhanced the nutraceutical quality of pork meat.

A retrospective analysis of treatment patterns, drug discontinuation and healthcare costs in Crohn's disease patients treated with biologics.

BACKGROUND/AIMS: This real-world analysis evaluated the persistence and direct healthcare costs of Crohn's Disease (CD) patients treated with biologics in Italy. METHODS: A retrospective analysis on administrative databases of Italian healthcare entities, covering 10.4 million residents, was performed. Adult CD patients under biologics between 2015 and 2020 were included and attributed to first/second treatment line based on absence/presence of biologic prescriptions 5-years before index-date (first biologic prescription). RESULTS: Of 16,374 CD patients identified, 1,398 (8.5%) were biologic-treated: 1,256 (89.8%) in first line and 135 (9.7%) in second line. Kaplan-Meier curves estimated a higher persistence for ustekinumab-treated patients followed by vedolizumab, infliximab and adalimumab, in both lines. Considering baseline variables and adalimumab as reference, infliximab in first line (HR: 0.537) and ustekinumab in first (HR: 0.057) and second line (HR: 0.213) were associated with significantly reduced risk of drug-discontinuation. First line total/average healthcare direct-costs were €13,637, €11,201, €17,104 and €18,340 in patients persistent on adalimumab, infliximab, ustekinumab and vedolizumab, respectively. CONCLUSIONS: This real-world analysis showed differences in persistence over 12-months between biologic treatments, being higher in ustekinumab-treated group, followed by vedolizumab, infliximab and adalimumab. Patients' management was associated with comparable direct healthcare costs among treatment lines, mainly driven by drug-related expenses.

Results of the Spanish National Polytrauma Registry. Where are we and where are we heading?

INTRODUCTION: In 2017, the Spanish National Polytrauma Registry (SNPR) was initiated in Spain with the goal to improve the quality of severe trauma management and evaluate the use of resources and treatment strategies. The objective of this study is to present the data obtained with the SNPR since its inception. METHODS: We conducted an observational study with prospective data collection from the SNPR. The trauma patients included were over 14 years of age, with ISS ≥ 15 or penetrating mechanism of injury, from a total of 17 tertiary hospitals in Spain. RESULTS: From 1/1/17 to 1/1/22, 2069 trauma patients were registered. The majority were men (76.4%), with a mean age of 45 years, mean ISS 22.8, and mortality 10.2%. The most common mechanism of injury was blunt trauma (80%), the most frequent being motorcycle accident (23%). Penetrating trauma was presented in 12% of patients, stab wounds being the most common (84%). On hospital arrival, 16% of patients were hemodynamically unstable. The massive transfusion protocol was activated in 14% of patients, and 53% underwent surgery. Median hospital stay was 11 days, while 73.4% of patients required intensive care unit (ICU) admission, with a median ICU stay of 5 days. CONCLUSIONS: Trauma patients registered in the SNPR are predominantly middle-aged males who experience blunt trauma with a high incidence of thoracic injuries. Early addressed detection and treatment of these kind of injuries would probably improve the quality of trauma care in our environment.

Effect of Cooking with Superheated (SHS) vs. Standard Steam Oven on the Fatty Acids Profile of Different Kinds of Meat and Fish.

We compared the effect of two different kinds of steam oven-a standard (SO) and a superheated steam (SHS) oven-on four different kinds of samples: hamburgers, bovine steaks, pork steaks, and salmon fillets. Ten samples of each meat/fish were divided into three parts. Then samples were analyzed as (i) raw, (ii) cooked with SO, and (iii) cooked with SHS. For each sample, we determined the proximate composition, fatty acid composition and thiobarbituric acid reactive substances (TBARS). The results of fatty acid composition were processed both with a linear model and with a multivariate approach by using three complementary discriminant analysis techniques: canonical (CAN), stepwise (St) and discriminant (DA). SHS was effective in degreasing hamburgers but not the other kinds of samples. Cooking methods selectively affected the fatty acid profile of samples, SHS being higher in MUFA and lower in PUFA n-3 than SO. This result was also confirmed by the discriminant analysis. Finally, samples cooked with SHS showed a lower fatty acid oxidation extent than SO, as the TBARS value was significantly lower in the SHS than in the SO, irrespective of the type of meat/fish cooked.

Increase of continuous treatments and regional citrate anticoagulation during renal replacement therapy in the ICUs of the North-West of Italy from 2007 to 2015.

BACKGROUND: Few reports have addressed the change in renal replacement therapy (RRT) management in the Intensive care Units (ICUs) over the years in western countries. This study aims to assess the trend of dialytic practice in a 4.5-million population-based study of the northwest of Italy. METHODS: A nine-year survey covering all the RRT provided in the ICUs. Consultant nephrologists of the 26 Nephrology and Dialysis centers reported their activities in the years 2007, 2009, 2012, and 2015. RESULTS: From 2007 to 2015 the patients treated increased from 1042 to 1139, and the incidence of RRT from 254 to 263 cases/10^6 inhabitants. The workload for dialysis center was higher in the larger hub hospitals. RRT for acute kidney injury (AKI), continuation of treatment in chronically dialyzed patients, or extrarenal indications accounted for about the stable rate of 70, 25 and 5% of all RRT sessions, respectively. Continuous modality days increased from 2731 days (39.5%) in 2007 to 5076 (70.6%) in 2015, when the continuous+prolonged treatment days were 6880/7196 (95.6% of total days). As to RRT timing, in 2015 only the classical clinical criteria, and no K-DIGO stage were adopted by most Centers. As to RRT interruption, in 2015 urine volume was the first criterion. Implementation of citrate anticoagulation (RCA) for RRT patients significantly increased from 2.8% in 2007 to 30.9% in 2015, when it was applied in all 26 Centers. CONCLUSIONS: From 2007 to 2015, current practice has changed towards shared protocols, with increasing continuous modality and RCA implementation.

Alterations in tissue oxygen saturation measured by near-infrared spectroscopy in trauma patients after initial resuscitation are associated with occult shock.

PURPOSE: Persistent occult hypoperfusion after initial resuscitation is strongly associated with increased morbidity and mortality after severe trauma. The objective of this study was to analyze regional tissue oxygenation, along with other global markers, as potential detectors of occult shock in otherwise hemodynamically stable trauma patients. METHODS: Trauma patients undergoing active resuscitation were evaluated 8 h after hospital admission with the measurement of several global and local hemodynamic/metabolic parameters. Apparently hemodynamically stable (AHD) patients, defined as having SBP ≥ 90 mmHg, HR < 100 bpm and no vasopressor support, were followed for 48 h, and finally classified according to the need for further treatment for persistent bleeding (defined as requiring additional red blood cell transfusion), initiation of vasopressors and/or bleeding control with surgery and/or angioembolization. Patients were labeled as "Occult shock" (OS) if they required any intervention or "Truly hemodynamically stable" (THD) if they did not. Regional tissue oxygenation (rSO2) was measured non-invasively by near-infrared spectroscopy (NIRS) on the forearm. A vascular occlusion test was performed, allowing a 3-min deoxygenation period and a reoxygenation period following occlusion release. Minimal rSO2 (rSO2min), Delta-down (rSO2-rSO2min), maximal rSO2 following cuff-release (rSO2max), and Delta-up (rSO2max-rSO2min) were computed. The NIRS response to the occlusion test was also measured in a control group of healthy volunteers. RESULTS: Sixty-six consecutive trauma patients were included. After 8 h, 17 patients were classified as AHD, of whom five were finally considered to have OS and 12 THD. No hemodynamic, metabolic or coagulopathic differences were observed between the two groups, while NIRS-derived parameters showed statistically significant differences in Delta-down, rSO2min, and Delta-up. CONCLUSIONS: After 8 h of care, NIRS evaluation with an occlusion test is helpful for identifying occult shock in apparently hemodynamically stable patients. LEVEL OF EVIDENCE: IV, descriptive observational study. TRIAL REGISTRATION: ClinicalTrials.gov Registration Number: NCT02772653.

Dynamic use of fibrinogen under viscoelastic assessment results in reduced need for plasma and diminished overall transfusion requirements in severe trauma.

BACKGROUND: Despite advances in trauma management, half of trauma deaths occur secondary to bleeding. Currently, hemostatic resuscitation strategies consist of empirical transfusion of blood products in a predefined fixed ratio (1:1:1) to both treat hemorrhagic shock and correct trauma-induced coagulopathy. At our hospital, the implementation of a resuscitation protocol guided by viscoelastic hemostatic assays (VHAs) with rotational thromboelastometry has resulted in a goal-directed approach. The objective of the study is twofold, first to analyze changes in transfusion practices overtime and second to identify the impact of these changes on coagulation parameters and clinical outcomes. We hypothesized that progressive VHA implementation results in a higher administration of fibrinogen concentrate (FC) and lower use of blood products transfusion, especially plasma. METHODS: A total of 135 severe trauma patients (January 2008 to July 2019), all requiring and initial assessment for high risk of trauma-induced coagulopathy based on high-energy injury mechanism, severity of bleeding and hemodynamic instability were included. After 2011 when we first modified the transfusion protocol, a progressive change in transfusional management occurred over time. Three treatment groups were established, reflecting different stages in the evolution of our strategy: plasma (P, n = 28), plasma and FC (PF, n = 64) and only FC (F, n = 42). RESULTS: There were no significant differences in baseline characteristics among groups. Progressive implementation of rotational thromboelastometry resulted in increased use of FC over time ( p < 0.001). Regression analysis showed that group F had a significant reduction in transfusion of packed red blood cells ( p = 0.005), plasma ( p < 0.001), and platelets ( p = 0.011). Regarding outcomes, F patients had less pneumonia ( p = 0.019) and multiorgan failure ( p < 0.001), without significant differences for other outcomes. Likewise, overall mortality was not significantly different. However, further analysis comparing specific mortality due only to massive hemorrhage in the F group versus all patients receiving plasma, it was significantly lower ( p = 0.037). CONCLUSION: Implementing a VHA-based algorithm resulted in a plasma-free strategy with higher use of FC and a significant reduction of packed red blood cells transfused. In addition, we observed an improvement in outcomes without an increase in thrombotic complications. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

Study of the Fatty Acid Profile of Milk in Different Sheep Breeds: Evaluation by Multivariate Factorial Analysis.

A multivariate analysis was used to investigate the fatty acid (FA) profile in three different Italian sheep breeds: Comisana, Massese, and Sarda. A sample of 852 animals was considered: 118 Massese, 303 Comisana, 431 Sarda. Sarda sheep were divided into two groups, based on their breeding origin (298 and 133 reared in Sardinia and Tuscany, respectively). Sarda sheep, bred both in Sardinia and in Tuscany, were considered in different groups, both because in these two regions most of the sheep of this breed are reared, and because they differ in geographical characteristics and in the farming system. The individual milk FA composition of dairy ewes was analyzed with multivariate factor analysis. The extracted factors were representative of the following eight groups of fatty acids or functions: factor 1 (odd branched fatty acids and long-chain fatty acids), factor 2 (sn3_position), factor 3 (alternative biohydrogenation), factor 4 (SCD_1), factor 5 (SCD_2), factor 6 (SCD_3), factor 7 (fat secretion) and factor 8 (omega-3). A factor analysis suggested the presence of different metabolic pathways for de novo short- and medium-chain fatty acids and Δ9-desaturase products. The ANOVA of factor scores highlighted the significant effects of the breed. The results of the present study showed that breed is an important factor in defining the fatty acid profile of milk, combined with the effect of the diet. Breeds reared in the same farming system (Comisana, Massese and Sarda reared in Tuscany) showed significant differences for all the factors extracted. At the same time, we found differences between the Sarda sheep reared in Sardinia and Tuscany, two different regions of Italy.

Supplementation of Enriched Polyunsaturated Fatty Acids and CLA Cheese on High Fat Diet: Effects on Lipid Metabolism and Fat Profile.

Epidemiological studies have demonstrated a positive relationship between dietary fat intake and the onset of several metabolic diseases. This association is particularly evident in a diet rich in saturated fatty acids, typical of animal foods, such as dairy products. However, these foods are the main source of fatty acids with a proven nutraceutical effect, such as the ω-3 fatty acid α-linolenic acid (ALA) and the conjugated linoleic acid (CLA), which have demonstrated important roles in the prevention of various diseases. In the present study, the effect of a supplementation with cheese enriched with ω-3 fatty acids and CLA on the metabolism and lipid profiles of C57bl/6 mice was evaluated. In particular, the analyses were conducted on different tissues, such as liver, muscle, adipose tissue and brain, known for their susceptibility to the effects of dietary fats. Supplementing cheese enriched in CLA and ω-3 fats reduced the level of saturated fat and increased the content of CLA and ALA in all tissues considered, except for the brain. Furthermore, the consumption of this cheese resulted in a tissue-specific response in the expression levels of genes involved in lipid and mitochondrial metabolism. As regards genes involved in the inflammatory response, the consumption of enriched cheese resulted in a reduction in the expression of inflammatory genes in all tissues analyzed. Considering the effects that chronic inflammation associated with a high-calorie and high-fat diet (meta-inflammation) or aging (inflammaging) has on the onset of chronic degenerative diseases, these data could be of great interest as they indicate the feasibility of modulating inflammation (thus avoiding/delaying these pathologies) with a nutritional and non-pharmacological intervention.

Fatty acid metabolism in lambs supplemented with different condensed and hydrolysable tannin extracts.

Five groups of lambs (n = 9 each) were used to test the effect of plant extracts rich in hydrolysable (HT) or condensed tannin (CT) on animal performance, fatty acid composition of rumen content, liver and meat. The control group (CO) received a concentrate-based diet without tannins supplementation. The other groups received the same diet as the control lambs plus 4% chestnut (CH) and tara (TA) extracts as a source of HT and mimosa (MI) and gambier (GA) extracts as a source of CT. One-way ANOVA was used to assess the overall effect of dietary treatments, tannins supplementation (CO vs. CH+TA+MI+GA) and the effect of tannin type (HT vs. CT: CH+TA vs. MI+GA) on animal performance, rumen content, liver and intramuscular FA. Dietary CH negatively affected animal performance. The rumen content of the different groups showed similar levels of 18:3 c9c12c15, 18:2 c9c12, 18:2 c9t11, 18:1 t11 and 18:0, whereas 18:1 t10 was greater in CO. Also, 18:1 t10 tended to be lower in the rumen of HT than CT-fed lambs. These data were partially confirmed in liver and meat, where CO showed a greater percentage of individual trans 18:1 fatty acids in comparison with tannins-fed groups. Our findings challenge some accepted generalizations on the use of tannins in ruminant diets as they were ineffective to favour the accumulation of dietary PUFA or healthy fatty acids of biohydrogenation origin in the rumen content and lamb meat, but suggest a generalized influence on BH rather than on specific steps.

Transcriptome Adaptation of the Ovine Mammary Gland to Dietary Supplementation of Extruded Linseed.

Several dietary strategies were adopted to reduce saturated fatty acids and increase beneficial fatty acids (FA) for human health. Few studies are available about the pathways/genes involved in these processes. Illumina RNA-sequencing was used to investigate changes in the ovine mammary gland transcriptome following supplemental feeding with 20% extruded linseed. Comisana ewes in mid-lactation were fed a control diet for 28 days (control period) followed by supplementation with 20% DM of linseed panel for 28 days (treatment period). Milk production was decreased by 30.46% with linseed supplementation. Moreover, a significant reduction in fat, protein and lactose secretion was also observed. Several unsaturated FAs were increased while short and medium chain saturated FAs were decreased by linseed treatment. Around four thousand (1795 up- and 2133 down-regulated) genes were significantly differentially regulated by linseed supplementation. The main pathways affected by linseed supplementation were those involved in the energy balance of the mammary gland. Principally, the mammary gland of fed linseed sheep showed a reduced abundance of transcripts related to the synthesis of lipids and carbohydrates and oxidative phosphorylation. Our study suggests that the observed decrease in milk saturated FA was correlated to down-regulation of genes in the lipid synthesis and lipid metabolism pathways.

Novel Yeasts Producing High Levels of Conjugated Linoleic Acid and Organic Acids in Fermented Doughs.

Traditional fermented foods are obtained by a complex consortium of autochthonous microorganisms producing a wide variety of bioactive compounds, thus representing a reservoir of strains with new functional properties. Here, doughs obtained using five different wholegrain flours were singly fermented with selected yeast strains, which were evaluated for their functional traits. Lactate, volatile fatty acids and conjugated linoleic acid isomers produced by fermented doughs were detected by HPLC, while dough anti-inflammatory capacity was measured on human peripheral blood mononuclear cells by flow cytometry. Yeast potential probiotic activity was assessed by evaluating their resistance to simulated gastric and intestinal fluids. For the first time we report evidence of yeast strains producing high levels of the conjugated linoleic acid (CLA) isomer CLA 10-12tc and propionic acid, which are known for their specific health benefits. Moreover, such yeast strains showed an anti-inflammatory capacity, as revealed by a significantly decreased production of the strongly pro-inflammatory cytokine IL-1ß. All our Saccharomyces cerevisiae strains were remarkably resistant to simulated gastric and intestinal fluids, as compared to the commercial probiotic strain. The two strains S. cerevisiae IMA D18Y and L10Y showed the best survival percentage. Our novel yeast strains may be exploited as valuable functional starters for the industrial production of cereal-based innovative and health-promoting fermented foods.

Consecuencias de la toma de decisiones terapéuticas con base en el resultado del FAST en pacientes politraumáticos con fractura pélvica / Consequencies of therapeutic decision-making based on FAST results in trauma patients with pelvic fracture

Introducción: La exactitud del FAST disminuye notablemente en los pacientes politraumáticos con fractura pélvica. El objetivo es analizar las consecuencias de tomar decisiones terapéuticas basadas en el resultado del FAST en los pacientes politraumáticos con fractura de pelvis. Métodos: Estudio descriptivo de pacientes con politraumatismos mayores de 16 años que han ingresado en el área de críticos o que han fallecido previamente, con fractura pélvica. El resultado del FAST ha sido comparado con un valor realmente positivo o negativo según el resultado de la laparotomía o de la tomografía computarizada.Resultados: En 13 años, se ha incluido a 263 pacientes politraumáticos con fractura pélvica (ISS medio de 31; mortalidad 19%). El FAST tenía una sensibilidad del 65,2%, una especificidad del 69%, una tasa de falsos negativos del 34,8% y una tasa de falsos positivos del 30,9%. Los pacientes hemodinámicamente inestables tenían el doble de mortalidad que los pacientes estables (27% vs. 14%, p <0,05). Los pacientes con un FAST positivo tenían mayor mortalidad que los pacientes con FAST negativo (43% vs. 26%); 4 de 10 pacientes hemodinámicamente inestables con un FAST falsamente positivo que se sometieron a laparotomía exploradora innecesaria murieron por shock hipovolémico. La mortalidad se redujo del 60 al 20% asociando un packing preperitoneal. Conclusiones: La reducida eficacia del FAST en pacientes con fractura de pelvis nos obliga a cuestionarnos las consecuencias de la toma de decisiones terapéuticas con base en sus resultados. Los pacientes con FAST falsamente positivo tienen una mortalidad mayor, que se puede reducir aplicando un packing preperitoneal. (AU)

Introduction: FAST is essential to decide if trauma patients need laparotomy, but has a notably decrease in accuracy in patients with pelvic fracture. Our objective is to analyze the consequences of therapeutic decision-making based on the FAST results in trauma patients with pelvic fracture. Methods: Descriptive study that includes trauma patients older than 16 with a pelvic fracture admitted to the critical care area or who were fallecimiento. FAST result was compared with a true positive or negative value according to the results of laparotomy or abdominal CT. We recorded diagnosis and treatment of each injury and resolution of the case, detailing the cause of death, among all variables. Results: Over the 13–year period, we included 263 trauma patients with pelvic fracture, with a mean ISS of 31 and mortality of 19%. FAST had a sensitivity of 65.2%, specificity of 69%, false negative rate of 34.8% and false positive rate of 30.9%. Hemodynamically unstable patients died twice as many stable patients (27% vs. 14%, p <0.05). Patients with positive FAST died more than negative FAST (43% vs. 26%); and 4 of 10 hemodynamically unstable patients who underwent non therapeutic laparotomy after presenting a false positive FAST died from hypovolemic shock. The mortality rate fell from 60% to 20% when preperitoneal packing was performed before angio-embolization of the pelvis. Conclusion: FAST has low accuracy in polytraumatized patients with pelvic fracture. Patients with false positive FAST have higher mortality, which can be reduce notably applying a preperitoneal packing. (AU)

Consequencies of therapeutic decision-making based on FAST results in trauma patients with pelvic fracture.

INTRODUCTION: FAST is essential to decide whether trauma patients need laparotomy, but it has a notable decrease in accuracy in patients with pelvic fracture. Our objective is to analyze the consequences of therapeutic decision-making based on the FAST results in trauma patients with pelvic fracture. METHODS: Descriptive study that includes trauma patients older than 16 with a pelvic fracture admitted to the critical care area or who died. The FAST result was compared with a true positive or negative value according to the results of laparotomy or abdominal CT. We recorded diagnosis and treatment of each injury and resolution of the case, detailing the cause of death, among all variables. RESULTS: Over the 13-year period, we included 263 trauma patients with pelvic fracture, with a mean ISS of 31 and mortality of 19%. FAST had a sensitivity of 65.2%, specificity of 69%, false negative rate of 34.8% and false positive rate of 30.9%. Hemodynamically unstable patients died twice as many stable patients (27% vs 14%, P < .05). Patients with positive FAST died more than negative FAST (43% vs 26%); and 4 out of 10 hemodynamically unstable patients who underwent non-therapeutic laparotomy after presenting a false positive FAST died from hypovolemic shock. The mortality rate fell from 60% to 20% when preperitoneal packing was performed before angio-embolization of the pelvis. CONCLUSION: FAST has low accuracy in polytraumatized patients with pelvic fracture. Patients with false positive FAST have higher mortality, which can be reduced notably by applying preperitoneal packing.

Correlation of Breed, Growth Performance, and Rumen Microbiota in Two Rustic Cattle Breeds Reared Under Different Conditions.

The use of rustic cattle is desirable to face challenges brought on by climate change. Maremmana (MA) and Aubrac (AU) are rustic cattle breeds that can be successfully used for sustainable production. In this study, correlations between two rearing systems (feedlot and grazing) and the rumen microbiota, the lipid composition of rumen liquor (RL), and the growth performance of MA and AU steers were investigated. Bacterial community composition was characterized by high-throughput sequencing of 16S rRNA gene amplicons, and the RL lipid composition was determined by measuring fatty acid (FA) and the dimethyl acetal profiles. The main factor influencing bacterial community composition was the cattle breed. Some bacterial groups were positively correlated to average daily weight gain for the two breeds (i.e., Rikenellaceae RC9 gut group, Fibrobacter and Succiniclasticum in the rumen of MA steers, and Succinivibrionaceae UCG-002 in the rumen of AU steers); despite this, animal performance appeared to be influenced by short chain FAs production pathways and by the presence of H2 sinks that divert the H2 to processes alternative to the methanogenesis.

Histochemical Characterisation and Gene Expression Analysis of Skeletal Muscles from Maremmana and Aubrac Steers Reared on Grazing and Feedlot Systems.

This study aimed to characterise the fibre composition of Triceps brachii (TB) and Semimembranosus (SM) muscles from 20 Maremmana (MA) and 20 Aubrac (AU) steers, and the effect of grazing activity in comparison with feedlot system. The histochemical method was performed with the m-ATPase method with an acid pre-incubation, thus allowing to distinguish type I, IIA, and IIB fibres. Additionally, on total RNA extracted from SM muscle, the expressions of atp1a1, mt-atp6, and capn1 genes were evaluated, in order to find potential associations with muscle fibre histochemical characteristics. In SM muscle, the MA steers had the greater frequency of oxidative fibres (type I and IIA) and the higher atp1a1 expression, in comparison to AU steers. Conversely, AU steers had a greater frequency of type IIB fibres, and the higher capn1 expression. A similar histochemical pattern was observed in TB muscle. The grazing activity was probably insufficient to determine differences both for fibre proportion and size, and gene expressions, except for mt-atp6 expression that was surprisingly highest in feedlot MA in comparison to other steers. These findings further the knowledge of muscle properties belonging to these breeds, and the effect of voluntary physical activity since few studies were available in this regard.

Profile of fatty acid lipid fractions of omega-3 fatty acid-enriched table eggs.

The omega-3 fatty acid (FA) enrichment of yolk is a key means one of the main objectives to improve the nutraceutical properties of eggs. We evaluated the effect of the dietary inclusion of extruded linseed fed to laying hens on the fatty acid composition of the polar and non-polar lipid classes of the eggs. Two groups of 36 Lohmann White Leghorn layers (65 weeks old) were each fed one of two different diets for a period of 12 weeks. The two diets consisted of a conventional cereal-based diet concentrate (C) and a diet concentrate containing 5% linseed (L). The inclusion of linseed in the diet increased the content of α-linolenic (C18:3n-3), eicosapentaenoic (C20:5n-3) and docosahexaenoic (C22:6n-3) acids in neutral lipids, while a concomitant decrease in arachidonic acid (C20:4n-6) was observed. As regards the polar fraction, the fatty acid composition was slightly affected by the dietary treatments except for C18:0 (+1.14 fold), C18:2n-6 (+1.23 fold), C18:3n-3 (+2.8 fold) and C22:6n-3 (+1.41 fold). Principal component analysis demonstrated that very long-chain FAs were more representative of polar lipids, except for C20:5n-3, while neutral lipids were characterized by dietary n-3 FA (C18:3n-3).