Surgical checklist adherence across urology expertise levels impacts TURBT quality indicators

OBJECTIVES

To address the association of perioperative surgical checklist across variable surgical expertise with transurethral resection of bladder tumor (TURBT) accuracy and oncologic outcomes in non-muscle invasive bladder cancer (NMIBC).

MATERIALS AND METHODS

we relied on our prospective collaborative database of patients treated with TURBT between 2012 and 2017. Surgical experience was stratified into three groups: resident vs young vs expert consultants. The association of surgical experience with detrusor muscle (DM) presence and adherence to the standardized peri-procedural 9-items TURBT checklist was evaluated with logistic regression models. A Cox regression model was used to investigate the association of surgical experience with recurrence-free survival (RFS).

RESULTS

A total of 503 patients were available for analysis. TURBT was performed by expert consultants in 265 (52.7%) patients, by young consultants in 149 patients (29.6%) and by residents in 89 patients (17.7%). Residents were more likely to have DM in the TURBT specimen than expert consultants (OR: 1.75, 95%CI 1.03-2.99, p=0.04). Conversely, no differences in DM presence were observed between young vs expert consultants (OR: 1.09, 95%CI 0.71-1.70, p=0.69). The median checklist completion rate was higher for both residents and young consultants when compared to experts counterparts (56% and 56% vs 44%, p=0.009). When focusing on patients receiving a 2^nd look TURBT, the persistent disease was associated with resident status (OR: 4.24, 95%CI 1.14-17.70, p=0.037) at initial TURBT. Surgical experience was not associated with 5-years RFS.

CONCLUSION

Surgeon's experience in case of adequate perioperative surgical checklist implementation was inversely associated with the presence of DM in the specimen but directly linked to higher probability of persistent disease at Re-TURBT, although no 5-yr RFS differences were noted.

258 Intake, digestibility and rumen fermentation in sheep offered alfalfa silage alone or alfalfa and tall fescue-mixtures harvested after a killing frost

The objective of this study was to determine the effect of harvesting alfalfa and fescue after frost and ensiling mixtures of these forages on silage fermentation characteristics, intake, digestibility and ruminal fermentation by ewes. Forages were harvested in October of 2018, wilted, and blended as either alfalfa alone, 67% alfalfa +33% fescue, 33% alfalfa + 67% fescue, or 100% fescue. Twenty bins were lined with 2 plastic bags, packed (n = 5/trt), stored for 3 months, and then randomly assigned to ewes (n = 20; mean BW = 34.7 ± 6.65 kg) for ad libitum consumption, using 5 animals per treatment. Ewes were given 17 d of adaptation followed by 5 d of total feces and urine collection. Data were analyzed using PROC-MIXED of SAS and orthogonal polynomial trends were used to identify the effects of different proportions of fescue-to-alfalfa silage. Silage total acids, lactate, and acetate increased linearly (P < 0.01) while silage moisture and ammonia decreased linearly (P < 0.01) with increasing proportions of fescue in the diet. The proportions of lactate to total acids (mole/100 moles) increased linearly (P < 0.01) and quadratically (P < 0.05) by adding more fescue to alfalfa. Intake (g/kg BW), digestibility (%), and intake of digestible DM and OM (g/kg BW) decreased linearly (P < 0.05) as fescue proportion was increased in the silages. Ruminal acetate and butyrate (%) increased linearly (P < 0.01) with increasing fescue concentrations in the diet. Ensiling alfalfa with fescue may improve forage fermentation characteristics, but may reduce intake and digestibility in sheep compared to feeding alfalfa silage alone. This study was supported in part by USDA-ARS specific cooperative agreement 58-3655-4-052.

254 Digestibility of sheep offered tall fescue, meadow fescue and orchardgrass grasses ensiled with slurry or commercial urea fertilization

Silage intake by ruminants can be affected by both fertilization and forage type. The objective of this study was to evaluate digestion by sheep offered three different grasses fertilized with either urea (C) or dairy slurry (S). Plots of meadow fescue (MF), tall fescue (TF) or orchardgrass (OG) were planted on 25 July 2017, and first harvested on 29 June 2018. Plots were then fertilized with urea (52 kg N/ha) or slurry (71,150 L/ha). A second harvest was baled 6 August at approximately 57% moisture and wrapped in plastic. Eighteen lambs (59 ± 1.5 kg) were allocated randomly to one of the 6 treatment combinations to provide 3 lambs per treatment within each of 3 periods consisting of a 10-d adaptation and 7-d total fecal and urine collection. Data were analyzed as a 2 × 3 factorial arrangement using PROC MIXED of SAS. Dry matter (DM) and organic matter (OM) intakes (g/kg BW) were greater (P < 0.05) from MF fertilized with C than from the other forage-fertility combinations. Digestibility of DM and OM were greater (P < 0.05) from MF vs. OG, and OG vs. TF. Digestibility of OM also was greater (P < 0.05) from C vs. S. Digestible DM and OM intakes (g/kg BW) were greatest (P < 0.05) from MF fertilized with C. In addition, digestible DM intake (g/kg BW) was greater (P < 0.05) for MF fertilized with S compared to TF fertilized with C, and digestible OM intake was greater (P < 0.05) for MF fertilized with S compared to OG fertilized with S. Therefore, urea-fertilized meadow fescue may improve energy intake compared with that from orchardgrass or tall fescue, but fertilization of meadow fescue with slurry may reduce this advantage. The study was supported in part by USDA-ARS specific cooperative agreement 58-3655-4-052.

PSX-33 Effect of supplementing different proportions of sericea lespedeza with alfalfa silage on intake, digestibility, and nitrogen balance in sheep

Dietary manipulations to include tannins can change the proportion and amounts of N excreted in the urine and feces as well as improve N-use efficiency in ruminants. This study was conducted to investigate effects on animal digestion parameters of adding different proportions of sericea lespedeza hay (SL) to alfalfa silage. Alfalfa was harvested in June 2018 at 75% bloom, chopped, and then packed at 55% moisture into plastic-lined bins and allowed to ensile for 3 months. Alfalfa silage was either offered alone or mixed with 9, 18, or 27% SL on a DM basis. These diets were offered randomly for ad libitum consumption to 16 ewes (41.8 ± 4.61 kg BW) in a randomized complete block design experiment with 2 periods to provide 4 observations per treatment per experimental period, each consisting of a 14-d dietary adaptation period followed by 5 d of total fecal and urine collection. Data were analyzed using PROC MIXED of SAS and orthogonal linear and quadratic trend analyses were tested. Digestibility (%) of DM and OM and digestible DM and OM intake (g/kg BW) decreased linearly (P < 0.05) with increasing SL addition to the diet. Digestibility of NDF and ADF decreased linearly (P < 0.01) with increasing SL, and apparent absorption (%) of N decreased linearly (P < 0.05) with increasing SL in the diet. Urinary N excretions (g/d) tended (P = 0.10) to decrease linearly while fecal N (g/day) tended to increase (P = 0.10) linearly with increasing SL proportion in the diet. In this study, supplementation with sericea lespedeza as a tannin source to alfalfa silage decreased forage digestibility and digestible organic matter intake and did not positively influence nitrogen use. The study was supported in part by USDA-ARS specific cooperative agreement 58-3655-4-052 and by USDA NIFA grant 2018-67019-27804.

Voluntary intake and digestibility by sheep of alfalfa ensiled at different moisture concentrations following fertilization with dairy slurry

Dairy slurry is used commonly as an animal-sourced fertilizer in agronomic production. However, residual effects of slurry application on intake and digestibility of alfalfa (Medicago sativa L.) silage from subsequent harvests are not well known. The objective of this study was to determine if moisture concentration of alfalfa silage and timing of dairy slurry application relative to subsequent harvest affected intake and digestibility by sheep. Katahdin crossbred ewes (n = 18; 48 ± 5.3 kg) in mid-gestation were stratified by BW and allocated randomly in each of two periods to one of six treatments arranged in a two × three factorial arrangement. Treatments consisted of recommended (RM; 46.8%) or low (LM; 39.7%) moisture at baling after either no slurry application (NS), slurry application to stubble immediately after removal of the previous cutting (S0), or slurry application 14 d after removal of the previous cutting (S14). Silages were chopped through a commercial straw chopper, packed into plastic trash cans, and then offered to ewes within 4 d of chopping. Period 1 of the intake and digestion study consisted of a 14-d adaptation followed by a 7-d fecal collection period. Period 2 followed period 1 after a 4-d rest and consisted of an 11-d adaptation followed by 7 d of fecal collection. Ewes were housed individually in 1.4 × 4.3-m pens equipped with rubber mat flooring. Feces were swept from the floor twice daily, weighed, and dried at 50 °C. Ewes had ad libitum access to water and were offered chopped silage for a minimum of 10% refusal (DM). Blood samples were collected immediately prior to feeding, and 4 and 8 h after feeding on the day prior to the end of each period. Organic matter intake (g/kg BW) and OM digestibility tended (P < 0.10) to be, and digestible OM intake (g/kg BW) was reduced by slurry application. Lymphocytes (% of total white blood cells) were greater (P < 0.05) from LM vs. RM and from NS vs. S0 and S14. Red blood cell concentrations were greater (P < 0.05) from S14 vs. S0 and from S0 and S14 vs. NS. Serum urea N concentrations did not differ (P > 0.17) across treatments. Therefore, moisture concentration of alfalfa silage within the range used in this study may not affect voluntary intake or digestibility, but slurry application may have an effect on digestible OM intake. Also, moisture concentration of alfalfa silage and time of dairy slurry application may affect specific blood hemograms.

Feeding distillers' grains, soybean hulls, or a mixture of both to cows as a forage replacement: Effects on intake, digestibility, and ruminal fermentation characteristics

Coproduct feedstuffs offer a unique and potentially profitable avenue for cattle feeding strategies. However, research is lacking in the evaluation of varying coproducts on ruminal fermentation and digestive characteristics when included as the major component of the diet of cows. Our objective was to determine the effect of coproduct feedstuffs as a forage replacement on digestive and fermentative characteristics of cows. Eight ruminally fistulated cows (672 ± 32.0 kg initial BW and approximately 9 yr of age) were stratified by BW and randomly allocated to 1 of 4 diets (2 cows∙diet∙period) in a 2-period study: soybean hulls (SH), distillers' dried grains with solubles (DG), an isoenergetic mixture of soybean hulls and distillers' dried grains with solubles (MX), or ad libitum hay plus 0.9 kg/d of an isoenergetic mixture of soybean hulls and distillers' dried grains with solubles (HY). Diets were formulated to meet the ME requirements of a similar, companion study. Coproduct amounts were increased over a 14-d period. This was followed by a 14-d adaptation to diet and facilities and 5 d of total fecal collections. On the final day of fecal collections, rumen fluid was sampled immediately prior to feeding and 2, 4, 6, 8, 10 and 12 h after feeding for measurement of rumen VFA and ammonia concentrations. Intake of DM and OM was not different ( ≥ 0.28) among treatments, but digestibilities of DM, OM, NDF, and ADF were improved ( < 0.05) by coproduct feeding and by MX vs. the mean of SH and DG. Ruminal DM and OM fill were greater ( < 0.05) for cows offered HY than for cows offered the coproduct diets, greater for cows offered SH than for cows offered DG, and for the mean of SH and DG vs. MX. Ruminal retention time was greater ( < 0.05) for HY vs. the coproduct diets and for SH vs. DG. Apparent N absorption tended ( < 0.10) to be greater for cows offered the coproduct diets than for cows offered HY and greater for cows offered DG than for cows offered SH. Total VFA averaged across sampling times were greatest ( < 0.05) for cows offered SH, and ruminal ammonia N was greatest ( < 0.05) for cows offered either DG or MX at all sampling times. Based on these data, coproduct feedstuffs may be fed to meet the energy requirement of cows without negative effects on digestion or ruminal fermentation.

Effects of forage species and poultry litter application timing on forage preference by horses

Bermudagrass ( L.) is a familiar forage in the equine industry and teff () is gaining popularity as well. However, it is unclear if the application of poultry litter as a fertilizer affects palatability of these forages in horses. Therefore, the objective of this study was to determine if forage species and timing of litter application as a fertilizer has an effect on preference by horses. Hay treatments were arranged in a 2 × 3 factorial treatment arrangement consisting of teff and bermudagrass harvested after no poultry litter application (NL), poultry litter applied to stubble immediately after removal of the previous cutting (L0), or poultry litter applied 14 d after the previous cutting (L14). Mature, stock-type geldings ( = 5; 480 ± 52.9 kg) were used in this study arranged as a balanced incomplete block design. Horses were offered different combinations of 4 of the 6 total forages daily for 3 d in each of 3 evaluation periods that immediately followed a 10-d adaptation period. Each forage was offered at half of the total daily DMI as measured during the last 5 d of the 10-d adaptation period to encourage selection among the 4 forages. Each hay offered was randomly allocated to a corner and suspended in hay nets over muck buckets in the corners of each stall. Horses were individually housed in 3.6- by 3.6-m indoor stalls with sand bedding and access to 3.6- by 7.6-m outdoor runs. Along with hay, horses were offered oats twice daily at 0.125% of BW at each feeding. Dry matter intake was greater ( < 0.01) for bermudagrass than for teff and for NL and L0 treatments compared with L14 treatments. Horses spent more ( < 0.01) time consuming bermudagrass compared with teff. However, there were no differences ( ≥ 0.25) in time spent consuming hay across litter treatments. Therefore, horses may prefer bermudagrass to teff and later application of poultry litter may affect voluntary intake by horses. However, all forages were mature, which may have impacted total intake and preference.

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

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

Interferon consensus sequence binding protein and interferon regulatory factor-4/Pip form a complex that represses the expression of the interferon-stimulated gene-15 in macrophages

Interferon consensus sequence binding protein (ICSBP), a transcription factor of the interferon (IFN) regulatory factor (IRF) family, binds to the IFN-stimulated response element (ISRE) in the regulatory region of IFNs and IFN-stimulated genes (ISG). To identify target genes, which are deregulated by an ICSBP null-mutation in mice (ICSBP-/-), we have analyzed transcription of an ISRE-bearing gene, ISG15. We have found that although ISG15 expression is unchanged in B cells, it is upregulated in macrophages from ICSBP-/- mice. Three factors, ICSBP, IRF-2, and IRF-4/Pip interact with the ISRE in B cells, however only ICSBP and IRF-4/Pip were found to bind this sequence in macrophages of wild-type mice. Although IRF-4 was considered to be a lymphoid-specific factor, we provide evidence for its role in macrophage gene regulation. Our results suggest that the formation of cell-type-specific heteromeric complexes between individual IRFs plays a crucial role in regulating IFN responses.

Segmented gene conversion as a mechanism of correction of 18S rRNA pseudogene located outside of rDNA cluster in D. melanogaster

The peculiarities of the sequences of 18S rDNA included in a 90-kb DNA segment cloned in YAC vector are described. This heterochromatic segment is situated on the X chromosome distal to the main rDNA cluster. The pseudo 18S rDNA sequence comprised undamaged stretches of rDNA interspersed with segments characterized by high density of nucleotide substitutions and insertions/deletions. The observed patchwork arrangement of unaltered rDNA sequences was considered as evidence of segmented gene conversion events between the normal and damaged genes which are thought to constitute one of the mechanisms of rDNA array homogenization. The 18S rDNA fragment (510 bp) located nearby, homologous to the internal, undamaged part of pseudo 18S rDNA, carries comparable density of randomly distributed nucleotide substitutions with no evidence of correction.

The human and mammalian N-acetylmuramyl-L-alanine amidase: distribution, action on different bacterial peptidoglycans, and comparison with the human lysozyme activities

N-acetylmuramyl-L-alanine amidase (EC 3.5.1.28) specifically hydrolyzes the bacterial cell wall peptidoglycans (or mureins) and the muropeptides. The enzyme splits these molecules into two parts: the peptide subunits and the glycan strands or moieties. The bacterial peptidoglycans and their derived muropeptides display a number of biological properties. Removal of the glycosidic part of these molecules abolishes their beneficial as well as their detrimental properties. We report the high level of enzymatic activity found in all mammalian (including human) sera tested. The enzyme also occurred in human saliva, milk, cerebrospinal fluid, and synovial liquid. Mucosal tissue from different parts of the mammalian digestive tract exhibited enzymatic activity, but the enzyme was not detectable in the lumen content. The range of substrate specificity of the human enzyme was evaluated by measuring its action on the peptidoglycans extracted from several bacterial strains and representing different chemotypes and structures. Time course of the muramylalanine amidase and of the lysozyme (both of human origin) activities on some of these peptidoglycans are also reported, with the enzymes acting separately or together. From these data, we would speculate that a probable physiological role of the muramylalanine amidase is the maintenance of adequate ratios between the biologically active muropeptides and their inactive derivatives in the organism, the amidase activity antagonizing the production of biologically active molecules by lysozyme.

Phase determination and structure refinement by density and shift functions

Any crystal structure may be described in terms of a sublattice of points, each of which represents a certain fraction of the electron density. Multiplying this sublattice by a density function f(x) and applying a shift function s(x), which brings the atoms into the right positions, the correct crystal structure can be given in many different ways. It is shown that the shift function s(x) yields phase relations between the structure factors F(h), which may be evaluated directly, if the coefficients of the Fourier representation of s(x) converge rapidly. This behaviour is demonstrated for the case of a one-dimensional acentric model structure consisting of 50 atoms. Complete information on the structure may be obtained by routine methods with the aid of 5 given phases of the structure factor. This procedure may also be applied to three-dimensional structures, if the corresponding computer programs are available.