Local Regrowth and the Risk of Distant Metastases Among Patients Undergoing Watch-and-Wait for Rectal Cancer: What Is the Best Control Group? Multicenter Retrospective Study.

BACKGROUND: A proportion of rectal cancer patients who achieve a clinical complete response may develop local regrowth. Although salvage appears to provide appropriate local control, the risk of distant metastases is less known. OBJECTIVE: To compare the risk of distant metastases between patients who achieve a clinical complete response (watch-and-wait strategy) and subsequent local regrowth and patients managed by surgery after chemoradiation. DESIGN: Retrospective multicenter cohort study. SETTINGS: This study used data of patients from 3 institutions who were treated between 1993 and 2019. PATIENTS: Patients with initial clinical complete response (after neoadjuvant therapy) followed by local regrowth and patients with near-complete pathological response (≤10%) after straightforward surgery after chemoradiation were included. MAIN OUTCOME MEASURES: Univariate and multivariate analyses were performed to identify risk factors for distant metastases. Kaplan-Meier curves were created (log-rank test) to compare survival outcomes. Analyses were performed using time zero as last day of radiation therapy or as date of salvage resection in the local regrowth group. RESULTS: Twenty-one of 79 patients with local regrowth developed distant metastases, whereas only 10 of 74 after upfront total mesorectal excision following neoadjuvant chemoradiation therapy ( p = 0.04). Local regrowth and final pathology (ypT3-4) were the only independent risk factors associated with distant metastases. When using date of salvage resection as time zero, distant metastases-free survival rates were significantly inferior for patients with local regrowth (70% vs 86%; p = 0.01). LIMITATIONS: Small number of patients, many neoadjuvant therapies, and selection bias. CONCLUSIONS: Patients undergoing watch-and-wait strategy who develop local regrowth are at higher risk for development of distant metastases compared to patients with near-complete pathological response managed by upfront surgery after chemoradiation. See Video Abstract. NUEVO CRECIMIENTO LOCAL Y EL RIESGO DE METSTASIS A DISTANCIA ENTRE PACIENTES SOMETIDOS A OBSERVACIN Y ESPERA POR CNCER DE RECTO CUL ES EL MEJOR GRUPO DE CONTROL ESTUDIO RETROSPECTIVO MUTICNTRICO: ANTECEDENTES:Una proporción de pacientes que logran una respuesta clínica completa pueden desarrollar un nuevo crecimiento local. Si bien el rescate parece proporcionar un control local apropiado, el riesgo de metástasis a distancia es menos conocido.OBJETIVO:Comparar el riesgo de metástasis a distancia entre los pacientes que logran una respuesta clínica completa (estrategia de observación y espera) y el nuevo crecimiento local posterior con los pacientes tratados con cirugía después de la quimiorradiación.DISEÑO:Estudio de cohorte multicéntrico retrospectivo.CONFIGURACIÓN:Este estudio utilizó datos de pacientes de 3 instituciones que fueron tratados entre 1993 y 2019.PACIENTES:Pacientes con respuesta clínica completa inicial (después de la terapia neoadyuvante) seguida de crecimiento local nuevo y pacientes con respuesta patológica casi completa (≤10 %) después de cirugía directa después de quimiorradiación.PRINCIPALES MEDIDAS DE RESULTADO:Se realizó un análisis univariante/multivariante para identificar los factores de riesgo de metástasis a distancia. Se crearon curvas de Kaplan-Meier (prueba de rango logarítmico) para comparar los resultados de supervivencia. El análisis se realizó utilizando el tiempo cero como último día de radioterapia (1) o como fecha de resección de rescate (2) en el grupo de recrecimiento local.RESULTADOS:Veintiuno de 79 pacientes con recrecimiento local desarrollaron metástasis a distancia, mientras que solo 10 de 74 después de una cirugía sencilla (p = 0,04). El recrecimiento local y la patología final (ypT3-4) fueron los únicos factores de riesgo independientes asociados con las metástasis a distancia. Cuando se utilizó la fecha de la resección de rescate como tiempo cero, las tasas de supervivencia sin metástasis a distancia fueron significativamente inferiores para los pacientes con recrecimiento local (70 frente a 86 %; p = 0,01).LIMITACIONES:Pequeño número de pacientes, muchas terapias neoadyuvantes, sesgo de selección.CONCLUSIONES:Los pacientes sometidos a observación y espera que desarrollan un nuevo crecimiento local tienen un mayor riesgo de desarrollar metástasis a distancia en comparación con los pacientes con una respuesta patológica casi completa manejados con cirugía por adelantado después de la quimiorradiación. (Traducción-Dr. Xavier Delgadillo ).

Nutrient profile of packaged foods according to the degree of processing.

An increased consumption of ultra-processed foods (UPF) leads to a rising prevalence of chronic noncommunicable diseases. This study aims to characterise the nutrient profile of white-label pre-packaged foods and bakery products available in a market leader Portuguese food retail chain, according to the extent of processing proposed by NOVA classification system. The nutrient profile (energy, sugar, total fat, saturated fat and sodium) according to processing degree was analysed using non-parametric tests. UPF were the most energy dense (278 kcal/100 g, p < .001) and the highest in sugar (15.9 g/100 g, p < .001). Processed foods were the highest in sodium (538 mg/100 g, p < .001). Processed and UPF showed significantly higher total (12.4 and 10.8 g/100 g, respectively) and saturated fat content (6.10 and 4.61 g/100 g, respectively) than unprocessed/minimally processed foods (p < .001). Regarding the variation of the nutritional value across the extent of processing, different results were observed for some categories suggesting the importance of a stratified analysis. The consumption of less processed foods and the manufacture of processed/UPF with better nutrient profile should be promoted.

Soybean oil, linoleic acid source, in lamb diets: carcass traits and meat quality.

We developed a study to determine the ideal level of inclusion of soybean oil (SBOil) in the diet without affecting the quantitative and qualitative parameters of the carcass and meat of lambs in a feedlot system; therefore, determining the ideal level of inclusion. Forty male lambs (Santa Inês breed) were used. The initial body weight and age averaged 34.88 ± 3.19 kg and 5 months, respectively. Experimental units (lambs) were randomly distributed in 5 different diets: inclusion levels of SBOil: 0, 30, 60, 90, and 120 g/kg of dry matter (DM). The SOil inclusion reduced the DM intake (P < 0.001), Total digestible nutrients (P = 0.004), and crude protein (P < 0.001). Total weight gain (P < 0.001) decreased with the SBOil inclusion and subcutaneous fat thickness (P = 0.017) showed the same behaviour. The final body weight decreased by 42.9 g/kgDM until the inclusion level of 30 g/kgDM; from this level it was reduced by 145 g/kgDM. The hot and cold carcass weights (P = 0.013) decreased by 36.6 g/kgDM after including 30 g/kgDM of SBOil. Meat physicochemical composition was not altered (P > 0.05). Lower meat tenderness values ​​were obtained at the levels of 60 and 90 g/kgDM. The inclusion above 30 g/kgDM decreased meat tenderness. It is concluded that soybean oil should be included up to 30 g/kgDM in diets. It is important to note that with diets with 60% concentrate, SBOil levels greater than 30 g/kgDM promote yield losses.

Levels of leucaena hay associated with cactus pear in diets for crossbred steers.

Our hypothesis is that the total replacement of ground corn grain (GCG) by cactus pear (CP) in association with 70% of leucaena hay (LH) increases dry matter (DM) intake and digestibility and nitrogen metabolism and maintains the feeding behavior of cattle. The objective was to evaluate the effects of inclusion of these feeds on the nutritional parameters and nitrogen metabolism of cattle. Eight steers, average age of 12 months, weight of 267.5 ± 15 kg, were distributed into two simultaneous 4 × 4 Latin squares according to a 2 × 2 factorial scheme, in which the first factor evaluated was different proportions of inclusion of LH (50 or 70% DM basis), and the second factor was the total replacement of GCG with CP. There was lower DM intake in animals fed with 70% LH. There was an interaction between the factors for DM digestibility, in which the animals fed CP did not differ regardless of the inclusion of LH, but for animals without CP, the greater inclusion of LH decreases DM digestibility. The inclusion of CP decreased free water intake. There was an interaction for total water intake (WI), in which the animals fed without CP presented similarity for this, while in the inclusion of CP, the animals fed 70% of LH presented higher WI. Also, lower values of chewing were observed for animals fed with CP. The replacement of GCG with CP improves the efficiency of nitrogen utilization in the rumen. The inclusion of 70% LH depresses intake.

Proportions of concentrate and rehydrated ground grain corn silage at different storage times for better use of starch by lambs.

This study aimed to evaluate the nutritional and bioeconomic potential of rehydrated ground grain corn silage (RGGCS), at different storage times associated with proportions of concentrates for better starch utilization by lambs. Forty Dorper-Santa Inês crossbred lambs were used, with an average body weight of 24 ± 3.9 kg, and an average age of 90 days. The lambs were feedlot for 63 days in experiment design completely randomized, with eight repetitions and five experimental diets: Diet 1: 850 g/kg concentrate including dry ground corn; diet 2: 850 g/kg concentrate including RGGCS ensiled for 45 days; diet 3: 650 g/kg concentrate including RGGCS ensiled for 90 days; diet 4: 650 g/kg concentrate including RGGCS ensiled for 45 days; diet 5: 850 g/kg concentrate including RGGCS ensiled for 45 days. As roughage, silage corn whole plant. Starch intake was higher (P < 0.05) with the dry ground corn diet; however, digestibility was lower (P < 0.05) for most nutrients compared to the RGGCS diet. A smaller amount of starch in the feces of animals that received the RGGCS diet was found. A diet with 850 g/kg of concentrate, including RGGCS ensiled for 45 days, generates higher net income, increases nutrient intake, and could be an alternative during the fluctuation of corn prices.

Laparoscopic colorectal surgery and discharge within 24 h-who is at risk for readmission?

AIM: The aim was to describe risk factors for hospital readmission in patients undergoing laparoscopic colorectal procedures and being discharged in ≤24 h. METHOD: All consecutive patients undergoing minimally invasive colorectal surgery between 2010 and 2019 from a single institution were retrospectively reviewed. All patients were included in an enhanced recovery programme. Patients who met criteria for hospital discharge were compared according to the need for readmission in a 45-day follow-up. RESULTS: In all, 664 patients underwent minimally invasive colorectal surgery during the study period and 237 (35.7%) were discharged in ≤24 h. Readmission was required in 16 (6.8%) patients discharged in ≤24 h and no postoperative mortality was observed in this group. Patients discharged in ≤24 h were more likely to have benign disease (P < 0.001), fewer associated procedures (P < 0.025) and intracorporeal anastomoses (P < 0.001). The type of surgical procedure (abdominoperineal resection), low rectal tumour, malignant disease, older age and longer operating time were associated with readmission. Age (OR 1.06; P = 0.037), malignant disease (OR 4.39; P = 0.05) and operating time (OR 1.03; P < 0.001) were identified as independent predictive factors for readmission amongst patients being discharged in ≤24 h. CONCLUSION: Highly selected patients undergoing minimally invasive procedures in colorectal surgery may be safely discharged within 24 h following the procedure. High-risk features for readmission include older age, malignant disease and longer operating time.

High-protein intake and early exercise in adult intensive care patients: a prospective, randomized controlled trial to evaluate the impact on functional outcomes.

BACKGROUND: We evaluated the efficacy of high protein intake and early exercise versus standard nutrition care and routine physiotherapy on the outcome of critically ill patients. METHODS: We randomized mechanically ventilated patients expected to stay in the intensive care unit (ICU) for 4 days. We used indirect calorimetry to determine energy expenditure and guide caloric provision to the patients randomized to the high protein and early exercise (HPE) group and the control group. Protein intakes were 1.48 g/kg/day and 1.19 g/kg/day medians respectively; while the former was submitted to two daily sessions of cycle ergometry exercise, the latter received routine physiotherapy. We evaluated the primary outcome physical component summary (PCS) score at 3 and 6 months) and the secondary outcomes (handgrip strength at ICU discharge and ICU and hospital mortality). RESULTS: We analyzed 181 patients in the HPE (87) and control (94) group. There was no significant difference between groups in relation to calories received. However, the amount of protein received by the HPE group was significantly higher than that received by the control group (p < 0.0001). The PCS score was significantly higher in the HPE group at 3 months (p = 0.01) and 6 months (p = 0.01). The mortality was expressively higher in the control group. We found an independent association between age and 3-month PCS and that between age and group and 6-month PCS. CONCLUSION: This study showed that a high-protein intake and resistance exercise improved the physical quality of life and survival of critically ill patients. TRIAL REGISTRATION: Research Ethics Committee of Hospital São Domingos: Approval number 1.487.683, April 09, 2018. The study protocol was registered in ClinicalTrials.gov ( NCT03469882 , March 19,2018).

Acupuncture for pain, mandibular function and oral health-related quality of life in patients with masticatory myofascial pain: A randomised controlled trial.

BACKGROUND: Masticatory myofascial pain is the most prevalent muscular temporomandibular disorders (TMD). It primarily affects masseter and temporal muscles. Several treatments, including acupuncture, have been recommended. However, systematic reviews have highlighted gaps in studies and absence of conclusive results. OBJECTIVES: We performed a randomised controlled clinical trial to evaluate the effectiveness of acupuncture in improving pain, mandibular function and oral health-related quality of life in women with masticatory myofascial pain. METHODS: Thirty-six patients diagnosed with masticatory myofascial pain according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were divided into the following two groups: acupuncture and control (non-penetrating acupuncture).Treatment was performed weekly for 5 weeks, and pain, mandibular function and oral health-related quality of life were evaluated one week before treatment, one week after treatment and one month after treatment. Non-parametric and parametric tests were used for comparisons between times and treatment groups (significance level of P ≤ .05). RESULTS: The acupuncture group showed a significant reduction in pain (P ≤ .01), which was not observed in the control group. Pain intensity was reduced by 61% and 84% at 1 week and 1 month after treatment, respectively. Both groups showed significant improvements in mandibular function and oral health-related quality of life over time (P ≤ .01). Statistical analysis did not show a significant difference between the groups for any other evaluated outcome (P > .05). CONCLUSION: Although acupuncture was effective in pain reduction, non-specific factors may have influenced mandibular function and oral health-related quality of life improvements in both groups, and this needs to be further addressed.

Impact of high-concentrate diets with cottonseed associated with calcium lignosulfonate on the metabolic, productive, and carcass characteristics of feedlot lambs.

This study aimed to evaluate the metabolic, productive, and carcass parameters of feedlot lambs fed high-concentrate diets with cottonseed associated with calcium lignosulfonate. Treatments consisted of diets including whole cottonseed, crushed cottonseed, whole cottonseed with lignosulfonate (100 g/kg), crushed cottonseed with lignosulfonate (100 g/kg), and a control diet without cottonseed. Thirty ½ Dorper ½ Santa Inês, non-castrated male lambs with an average live weight of 24.9 ± 3.6 kg and an average age of 3.5 months were evaluated in a completely randomized design. There was no effect (P > 0.05) on the intakes of dry matter, organic matter, crude protein, and non-fibrous carbohydrates. The crushing of cottonseed and association with lignosulfonate increased (P < 0.01) the intake and digestibility of ether extract. No effect was observed (P > 0.05) for the concentrations of urine and plasma urea N, which averaged 616.2 and 108.6 mg/dL, respectively. There was a change (P < 0.01) in nitrogen balance for digested N in g/day. There was no effect (P > 0.05) on the urinary concentration of purine derivatives, except for uric acid excretions (P < 0.05). Lignosulfonate associated with cottonseed provided an average daily gain of 0.293 kg/day, which was higher than the 0.226 kg/day obtained without lignosulfonate, but lower than control (0.302 kg/day), which also showed higher values of carcass yield. High-concentrate diets formulated without cottonseed improve lamb production performance. The use of high-concentrate diets with cottonseed associated with calcium lignosulfonate provides greater weight gains in lambs.

Negative pressure wound therapy for skin graft closure in complex pilonidal disease.

Pilonidal disease occurs in 26 in 100 000 people, affecting mainly men aged 20-30 years. It is treated by a variety of surgical techniques; however, there is a lack of consensus on the optimal choice of treatment for complex pilonidal disease. In addition, there is no consensus regarding care of the wound after surgery. Negative pressure wound therapy applied to open wounds following pilonidal disease surgery has been suggested as a way to decrease healing times and costs and is an emerging option for complex and or recurrent pilonidal disease. This study describes a case of complex pilonidal disease managed with local excision and negative pressure wound therapy followed by a split-thickness skin graft.

Borrelia burgdorferi BBI39 Paralogs, Targets of Protective Immunity, Reduce Pathogen Persistence Either in Hosts or in the Vector.

Borrelia burgdorferi genome harbors several paralogous gene families (pgf) that can encode immunogenic proteins of unknown function. Protein-protein interaction assays using a transmission-blocking vaccine candidate, BBA52, as bait identified an interacting partner in spirochetes-a member of pgf 54, annotated as BBI39. We show that BBI39 is a surface-exposed membrane antigen that is immunogenic during spirochete infection, despite the gene being primarily transcribed in the vector with a transient expression in the host only at tick-bite sites. Immunization of rodents with BBI39, or a diverse paralog, BBI36, or their combination impaired pathogen acquisition by the vector, transmission from ticks to hosts, or induction of disease. High-titer BBI39 immunoglobulin G antibodies, which have borreliacidal properties, could be generated through routine subcutaneous or oral immunization, further highlighting use of BBI39 proteins as novel Lyme disease vaccines that can target pathogens in the host or in ticks.

Assessment of the water quality monitoring network of the Piabanha River experimental watersheds in Rio de Janeiro, Brazil, using autoassociative neural networks.

Water quality monitoring is a complex issue that requires support tools in order to provide information for water resource management. Budget constraints as well as an inadequate water quality network design call for the development of evaluation tools to provide efficient water quality monitoring. For this purpose, a nonlinear principal component analysis (NLPCA) based on an autoassociative neural network was performed to assess the redundancy of the parameters and monitoring locations of the water quality network in the Piabanha River watershed. Oftentimes, a small number of variables contain the most relevant information, while the others add little or no interpretation to the variability of water quality. Principal component analysis (PCA) is widely used for this purpose. However, conventional PCA is not able to capture the nonlinearities of water quality data, while neural networks can represent those nonlinear relationships. The results presented in this work demonstrate that NLPCA performs better than PCA in the reconstruction of the water quality data of Piabanha watershed, explaining most of data variance. From the results of NLPCA, the most relevant water quality parameter is fecal coliforms (FCs) and the least relevant is chemical oxygen demand (COD). Regarding the monitoring locations, the most relevant is Poço Tarzan (PT) and the least is Parque Petrópolis (PP).

Feeding behavior of finishing goats fed diets containing detoxified castor meal, co-product of the biodiesel industry.

An investigation was made into the feeding behavior of goats to evaluate the effects of a detoxified castor bean meal in the diet of goats. Thirty-six ½ crossbred Boer goats were used, with an average weight of 20 ± 3.2 kg. A completely randomized design was used with four treatments (diets with of 0, 100, 200, and 300 g detoxified castor bean meals/kg dry matter) and nine replicates. Castor bean meal was detoxified using calcium oxide. Diets were formulated to be isonitrogenous, and the forage:concentrate ratio was 50:50. The feeding behavior was observed on the 17th, 45th, and 70th days of the experiment. For the evaluation of feeding behavior (feeding, idle, and rumination times), the animals were observed in 5-min intervals for 24 h. The addition of detoxified castor bean meal did not change (P > 0.05) the evaluated behavioral variables. Linear reduction was observed (P < 0.05) in the efficiencies of feeding and rumination, expressed in g dry matter/h. The variables related to the time series discretization of the feeding behavior of goats did not change (P > 0.05) with the inclusion of detoxified castor bean meal. The inclusion of detoxified castor bean meal in growing goats' diets does not change the feeding, rumination, and idle times, however, decreases intake, feeding, and rumination efficiencies of dry matter.

Crude glycerin combined with sugar cane silage in lamb diets.

This study aimed to evaluate the effect of the level of crude glycerin (CG) on in vitro fermentation kinetics (0, 20, 40, 60, and 80 g/kg DM of sugar cane silage), on in vitro neutral detergent fiber (NDF) degradation (0, 30, 60, and 90 g/kg DM of sugar cane silage), and intake and digestibility of nutrients and nitrogen balance (0, 20, 55, 82, and 108 g/kg DM of sugar cane silage) in lambs. The in vitro trials were conducted in a completely randomized design with three repetitions. The in vivo trial was conducted in a Latin square design with five repetitions (5 × 5). For variables in which the F test was considered significant, the statistical interpretation of the effect of CG substitution levels was carried out through regression analyses. Kinetic parameters were not affected by CG inclusion. On in vitro NDF degradation, a significant effect of CG levels was observed on the potentially degradable fraction of NDF, the insoluble potentially degradable fraction of NDF, and the undegradable NDF fraction. The intake and digestibility of nutrients and nitrogen balance were not affected by CG inclusion. The CG levels change in vitro NDF degradability parameters; however, there were no changes in animal intake, digestibility, and nitrogen balance with the inclusion levels used.

Nitrogen metabolism in lambs fed diets containing peach palm meal.

The objective of this study was to evaluate the nitrogen metabolism of lambs fed diets containing peach palm meal substituting maize (0, 10, 40, 60, and 85 % DM). Thirty Santa Inês uncastrated lambs with an average initial body weight of 21.6 ± 0.87 kg were distributed in a completely randomized design with five diets and six replicates. The nitrogen (N) intake (g/day, %BW) and the fecal N decreased linearly as the peach palm meal was added to the concentrate. The urinary N, however, responded quadratically, with maxima at the level of 29.97 and 40.44 % of substitution of maize for peach palm meal when expressed in g/day and %BW, respectively. The substitution of maize for peach palm meal reduced the retention of nitrogen and the microbial protein synthesis in the lambs.

Intake, digestibility and performance of lambs fed diets containing peach palm meal.

The aim of this study was to evaluate the intake and apparent digestibility of nutrients, performance, and plasma glucose concentration of ram lambs fed diets containing peach palm meal substituting maize (0, 10, 40, 60, and 85 % dry matter (DM)). Thirty Santa Inês rams with an average initial body weight of 21.6 ± 0.87 kg were distributed in a completely randomized design with five diets and six replicates. The substitution of the maize for the peach palm meal affected (P < 0.05) the intakes of DM, organic matter (OM), crude protein (CP), neutral detergent fiber corrected for ash and protein (NDFap), total carbohydrates (TC), total digestible nutrients (TDN), and metabolizable energy (ME), which decreased linearly (P < 0.05); the intake of ether extract (EE), however, fit an increasing linear equation (P < 0.05). The apparent digestibility coefficients of DM, OM, NDFap, and TC decreased linearly (P < 0.05) as the level of peach palm meal in the concentrate was increased. The total weight gain and the average daily gain decreased by 0.09 and 0.001 kg with each level of substitution of the maize for peach palm meal, respectively. It is recommended to substitute 40 % of the maize for peach palm meal.

Silage or fresh by-product of peach palm as roughage in the feeding of lambs.

The objective of this study was to evaluate intake and apparent digestibility of agro-industrial by-product of peach palm in diets for lambs. Twenty castrated, crossbred Santa Ines lambs, with average age of 150 days and body weight of 22.4 ± 3.4 kg, were distributed in a completely randomized design with four experimental diets composed of the following: fresh by-product of peach palm enriched with urea + ammonia sulfate (FU); fresh peach palm by-product + concentrate (FP); silage of peach palm by-product + concentrate (SP); and silage of peach palm by-product enriched with 15% of cornmeal + concentrate (SPC). Intake was recorded daily, and the digestibility coefficients were estimated with the internal marker indigestible acid detergent fiber (iADF). Diet FU resulted in the lowest intake and digestibility of the nutrients evaluated. Animals receiving diet FP showed higher intakes of dry matter (DM), organic matter (OM), crude protein (CP), neutral detergent fiber (NDF), total digestible nutrients (TDN), and digestible energy (DE) in relation to animals fed diets SP and SPC. Diets SP and SPC showed higher coefficients of digestibility of DM, OM, CP, and NDF than diet FP. Diet SP reduced the intakes of DM, OM, ether extract (EE), non-fibrous carbohydrate (NFC), TDN, and DE and the digestibility coefficients of DM, OM, and NFC as compared with diet SPC. Feedlot lambs fed a diet with fresh peach palm by-product + concentrate (diet FP) have higher nutrient intake.