"I see it very much as an end-of-life food" - Barriers to oral nutritional supplement adherence, views from healthy older adults

Malnutrition affects approximately one quarter of UK adults aged 65 years and over. As the global demographic shift continues, malnutrition is expected to increase. Oral nutritional supplements (ONS) are used both to prevent and to treat malnutrition. However, their effectiveness is compromised by poor adherence, and it is not well understood what contributes to this. Therefore, the current research was designed to explore ONS adherence from the parallel perspectives of ONS as a prescribed "medication" and as a food supplement/substitute. Eighteen older adults (13F, 5M; mean age = 73.4 yr; range: 70-80 yr) participated in focus groups (three in-person and one online), to investigate experiences of taking prescribed medications, including dietary supplements, and what should be factors to consider in supporting regular intake of ONS for trial development, as well as any potential improvements to products. Focus group sessions were recorded and then transcribed. Thematic Analysis was applied to the transcripts by the first author, and themes were discussed in depth, using exemplar quotes from participants. Five dominant themes were identified from the data: Disgust, Palatability and Acceptance; End-of-Life Care; Resistance to Medicines; Rituals and Reminders; and Real Food Displacement. Nutritional supplements were characterised as "disgusting", "manufactured", and associated with serious, chronic illness, as well as end-of-life care, in contrast to probiotics which were linked with health and wellness. The sweet taste of ONS was identified as a barrier to intake, given that it is generally associated with a signal to stop eating, and low hunger. As a group, participants tried to "avoid taking medicines", and viewed the need to have them negatively, yet most regularly took prescribed medication and/or vitamin supplements. Participants identified several, rituals and reminders to take medicines, including meal-based, or time-of-day-based prompts (e.g., before, with or after meals). To improve adherence, savoury products were suggested, as well as a more person-centred approach to individual nutritional needs and preferences. Overall, the group discussion mainly identified barriers to intake, but that improving taste, adding to "real food" (not replacing meals), and offering variety of flavour and form (e.g., savoury soups as well as sweet drinks) could be included in future trials to improve appeal and therefore intake. Future work should continue to explore how best to formulate, market and/or prescribe ONS, and how this might vary for malnutrition prevention vs treatment strategies.

The bacillithiol pathway is required for biofilm formation in Staphylococcus aureus

Staphylococcus aureus is a major human pathogen that can cause infections that range from superficial skin and mucosal infections to life threatening disseminated infections. S. aureus can attach to medical devices and host tissues and form biofilms that allow the bacteria to evade the host immune system and provide protection from antimicrobial agents. To counter host-generated oxidative and nitrosative stress mechanisms that are part of the normal host responses to invading pathogens, S. aureus utilizes low molecular weight (LMW) thiols, such as bacillithiol (BSH). Additionally, S. aureus synthesizes its own nitric oxide (NO), which combined with its downstream metabolites may also protect the bacteria against specific host responses. We have previously shown that LMW thiols are required for biofilm formation in Mycobacterium smegmatis and Pseudomonas aeruginosa. Here, we show that the S. aureus bshC mutant strain, which is defective in the last step of the BSH pathway and lacks BSH, is impaired in biofilm formation. We also identify a possible S-nitrosobacillithiol reductase (BSNOR), similar in sequence to an S-nitrosomycothiol reductase found in M. smegmatis and show that the putative S. aureus bsnoR mutant strain has reduced levels of BSH and decreased biofilm formation. Our studies also show that NO plays an important role in biofilm formation and that acidified sodium nitrite severely reduces biofilm thickness. These studies provide insight into the roles of oxidative and nitrosative stress mechanisms on biofilm formation and indicate that BSH and NO are key players in normal biofilm formation in S. aureus.

Does social-norm messaging influence expected satiety and ideal portion-size selection?

A person's perception of how long a food will stave off hunger (expected satiety) and the ideal amount to consume (ideal portion size) are both influenced by food-to-mealtime norms. Here, we examine whether social norms can modulate this effect, in three experimental studies. In study 1 (n = 235) participants were exposed to a social norm suggesting most people enjoyed consuming pasta for breakfast. There was a main effect of food-to-mealtime congruence for expected satiety and ideal portion size (p < 0.001) - participants selected a smaller portion of pasta for breakfast (vs. lunch) - but there were no other main effects/interactions (p ≥ 0.15). Study 2 (n = 200) followed the same approach as study 1, but sought to examine whether the typical volume of food consumed at breakfast and lunch needed to be controlled. Again, there was a main effect of congruence (the same pattern) (p ≤ 0.02) but no other main effects/interactions (p ≥ 0.73). Study 3 (n = 208) followed the same approach as study 2, but the social-norm message was changed to suggest that most people who eat pasta for breakfast found it effectively reduced their hunger. Again, there was a main effect of congruence (the same pattern) (p < 0.001) but no other main effects/interaction (p ≥ 0.26). These studies provide further evidence for the food-to-mealtime effect, but do not provide any evidence that a single, simple social-norm statement can modulate expected satiety or ideal portion size, or interact with the food-to-mealtime effect.

Exposure to models' negative facial expressions whilst eating a vegetable decreases women's liking of the modelled vegetable, but not their desire to eat

Introduction

Food enjoyment can be conveyed through facial expressions. Observing others' enjoyment of food has been found to influence adults' desirability of liked and disliked food. Exposing adults to other eaters enjoying nutritious foods that are typically disliked (e.g., vegetables) could enhance the consumption of vegetables by young adults. However, this remains to be examined in young adult populations. This study examined the effect of models' facial expressions towards raw broccoli on young adult women's change in liking and change in desire to eat a modelled vegetable (raw broccoli) and a non-modelled vegetable (cucumber).

Methods

Young adult women (N = 205) were randomised to watch a video of unfamiliar adult models eating raw broccoli with a positive, negative, or neutral facial expression. Participants' change in liking and change in desire to eat the modelled and non-modelled vegetable was examined.

Results

Observing models conveying negative facial expressions whilst eating raw broccoli resulted in a statistically significant reduction in liking ratings of broccoli, but not cucumber. There was no effect of models' facial expressions on the change in desire to eat foods.

Discussion

These findings suggest that watching others express a negative facial expression whilst eating a raw vegetable reduces women's liking of the modelled vegetable, in the absence of a significant change to their desire to consume these foods. This highlights the power of others' negative facial expressions on food liking. Further work is needed to establish the effect of others' facial expressions on vegetable intake.

Can social media be used to increase fruit and vegetable consumption? A pilot intervention study

Background

Exposure to social norms about fruit and vegetable intake has been shown to increase individuals' consumption of these foods. Further, exposure to socially endorsed 'healthy' food posts can increase consumption of low energy-dense (LED), relative to high energy-dense (HED) foods. The current pilot study aimed to investigate whether exposure to healthy eating (vs. control) social media accounts can shift normative perceptions about what others eat, eating intentions and self-reported food consumption.

Methods

In a 2 (condition) × 2 (type of food consumed) mixed factorial design, 52 male and female students were asked to follow either healthy eating (intervention) or interior design (control) Instagram accounts over a two-week period. Baseline and post-intervention measures assessed normative perceptions of Instagram users' consumption of fruit and vegetables (LED foods), and energy dense snacks and sugar sweetened beverages (HED foods). Participants' intentions to consume, and self-reported consumption of these foods, were also measured.

Results

There were no significant changes in perceptions about what others eat, or participants' own eating intentions (ps > 0.05). However, the intervention increased participants' self-reported consumption of LED foods by 1.37 servings (per day) and decreased consumption of HED foods by 0.81 items (per day), compared to the control condition (ps < 0.05).

Conclusions

This novel pilot study demonstrates that a social norm-based social media intervention can successfully encourage healthier eating, with a large effect after two weeks. Certain social media platforms may therefore provide a viable tool for nudging healthy eating. Future work will aim to replicate these findings in a larger and more diverse sample.

Effects of cueing multiple memories of eating on people's judgments about their diet

Past research shows that recalling a single positive health-related experience, such as exercising, can encourage people's subsequent healthy behaviours. In contrast, we reasoned that attempting to recall many healthy experiences might elicit a metacognitive experience of difficulty that would lead people to perceive themselves as less healthy, and perhaps to make other health-related judgments based on this perception. In two pre-registered experiments (combined N = 729), participants recalled either "few" or "many" instances of eating either healthily or unhealthily, before rating the healthiness of their diets and completing measures of their eating preferences and choices. Contrary to our predictions, our pre-registered analyses provided minimal evidence that the number of memories people retrieved affected their judgments. However, exploratory mediation analyses suggested that two counteracting effects may have occurred, whereby retrieving more (un)healthy memories led people to identify as more (un)healthy, yet also created a sense of subjective difficulty that partially or wholly negated these effects. These findings suggest that whereas probing people's dietary memories might sometimes lead to healthier self-perceptions and dietary choices, we should also consider the possibility of backfire effects.

Online prediction tools for melanoma survival: A comparison

BACKGROUND

Breslow thickness, patient age and ulceration are the three most valuable clinical and pathological predictors of melanoma survival. A readily available reliable online tool that accurately considers these and other predictors could be valuable for clinicians managing melanoma patients.

OBJECTIVE

To compare online melanoma survival prediction tools that request user input on clinical and pathological features.

METHODS

Search engines were used to identify available predictive nomograms. For each, clinical and pathological predictors were compared.

RESULTS

Three tools were identified. The American Joint Committee on Cancer tool inappropriately rated thin tumours as higher risk than intermediate tumours. The University of Louisville tool was found to have six shortcomings: a requirement for sentinel node biopsy, unavailable input of thin melanoma or patients over 70 years of age and less reliable hazard ratio calculations for age, ulceration and tumour thickness. The LifeMath.net tool was found to appropriately consider tumour thickness, ulceration, age, sex, site and tumour subtype in predicting survival.

LIMITATIONS

The authors did not have access to the base data used to compile various prediction tools.

CONCLUSION

The LifeMath.net prediction tool is the most reliable for clinicians in counselling patients with newly diagnosed primary cutaneous melanoma regarding their survival prospects.

A Case of Heyde's Syndrome With Subvalvular Aortic Stenosis

Heyde's syndrome is a constellation of severe aortic stenosis, gastrointestinal arteriovenous malformations (AVMs), and an acquired von Willebrand type 2A coagulopathy resulting in moderate-to-severe gastrointestinal bleeding. Additional cardiac lesions have been observed to cause Heyde's syndrome including aortic regurgitation, mitral regurgitation, aortic/mitral valve prosthetic dysfunction, ventricular septal defects, hypertrophic cardiomyopathy, left ventricular assist devices, and extracorporeal life support devices. Repairing the cardiac lesion or removing the device decreases the incidence of gastrointestinal bleeding by normalizing the acquired von Willebrand coagulopathy and decreasing the amount of gastrointestinal AVMs likely to bleed. We describe a case of a 67-year-old woman found to have Heyde's syndrome arising from a subvalvular aortic membrane resulting in severe subaortic stenosis with no other significant cardiac lesion. She underwent successful resection of the membrane with septal myectomy, relieving the severe subaortic stenosis and resolving her anemia. Years later, she re-presented with severe gastrointestinal bleeding from gastrointestinal malformations. Early recognition of these cardiac lesions with gastrointestinal bleeds may help decrease the morbidity and mortality that Heyde's syndrome portends and provide evidence for early intervention.

The effect of intranasal insulin on appetite and mood in women with and without obesity: an experimental medicine study

BACKGROUND/OBJECTIVES

Intranasal (IN) administration of insulin decreases appetite in humans, but the underlying mechanisms are unclear, and it is unknown whether IN insulin affects the food intake of women with obesity.

SUBJECTS/METHODS

In a double-blind, placebo-controlled, crossover design, participants (35 lean women and 17 women with obesity) were randomized to receive 160 IU/1.6 mL of IN insulin or placebo in a counterbalanced order in the post prandial state. The effects of IN insulin on cookie intake, appetite, mood, food reward, cognition and neural activity were assessed.

RESULTS

IN insulin in the post prandial state reduced cookie intake, appetite and food reward relative to placebo and these effects were more pronounced for women with obesity compared with lean women. IN insulin also improved mood in women with obesity. In both BMI groups, IN insulin increased neural activity in the insula when viewing food pictures. IN insulin did not affect cognitive function.

CONCLUSIONS

These results suggest that IN insulin decreases palatable food intake when satiated by reducing food reward and that women with obesity may be more sensitive to this effect than lean women. Further investigation of the therapeutic potential of IN insulin for weight management in women with obesity is warranted.

Front-of-pack health imagery on both 'healthy' and 'unhealthy' foods leads people to misremember seeing health claims: Two memory experiments

Front-of-pack health imagery can shape people's inferences about food products' health benefits, even leading people to falsely remember reading health claims they never saw. However, research has typically examined these effects in situations where participants have little contextual information to guide their inferences about a product. The present research aimed to replicate the finding that front-of-pack health imagery leads participants to falsely remember reading health claims. It also extends that finding, by exploring whether this effect is moderated by the presence of contextual information signaling the product's actual 'healthiness'. In two pre-registered experiments, participants saw images of fictitious food products accompanied by written nutrition claims. Some of the products contained a health-related image whereas others did not. The supposed 'healthiness' of each product was manipulated by altering the color of the products' multiple traffic light (MTL) label (Experiment 1), or with an explicit healthiness statement (Experiment 2). Participants then attempted to remember the written claims that had appeared on each product's packaging. Health-related images increased participants' tendency to falsely remember reading health claims. But this was true regardless of whether or not participants saw contextual cues about the products' healthiness, either indirectly (Experiment 1) or directly (Experiment 2). These findings suggest that the presence of health imagery on a food product's package can lead consumers to infer health benefits, even when other, more direct cues indicate that the product is unhealthy. This research informs debates on safeguarding consumers from potentially misleading health claims, through the regulation of imagery in food marketing.

Validation of the P1vital® Faces Set for Use as Stimuli in Tests of Facial Emotion Recognition

BACKGROUND

Negative bias in facial emotion recognition is a well-established concept in mental disorders such as depression. However, existing face sets of emotion recognition tests may be of limited use in international research, which could benefit from more contemporary and diverse alternatives. Here, we developed and provide initial validation for the P1vital® Affective Faces set (PAFs) as a contemporary alternative to the widely-used Pictures of Facial Affect (PoFA).

METHODS

The PAFs was constructed of 133 color photographs of facial expressions of ethnically-diverse trained actors and compared with the PoFA, comprised of 110 black and white photographs of facial expressions of generally Caucasian actors. Sixty-one recruits were asked to classify faces from both sets over six emotions (happy, sad, fear, anger, disgust, surprise) varying in intensity in 10% increments from 0 to 100%.

RESULTS

Participants were significantly more accurate in identifying correct emotions viewing faces from the PAFs. In both sets, participants identified happy faces more accurately than fearful faces, were least likely to misclassify facial expressions as happy and most likely to misclassify all emotions at low intensity as neutral. Accuracy in identifying facial expressions improved with increasing emotion intensity for both sets, reaching peaks at 60 and 80% intensity for the PAFs and PoFA, respectively. The study was limited by small sizes and age-range of participants and ethnic diversity of actors.

CONCLUSIONS

The PAFs successfully depicted a range of emotional expressions with improved performance over the PoFA and may be used as a contemporary set in facial expression recognition tests.

Exposure to models' positive facial expressions whilst eating a raw vegetable increases children's acceptance and consumption of the modelled vegetable

Research has shown that seeing positive facial expressions (FEs) towards food increased children's desire to eat foods rated as disliked. However, the effect of adults' positive FEs whilst eating a raw vegetable on children's acceptance and intake of nutritious foods that are less preferred (e.g., vegetables) remains to be established. This study aimed to examine the effect of models' FEs eating raw broccoli on children's acceptance and intake of raw broccoli. 111 children aged 4-6 years (64 male, 47 female) were randomised to watch a video of unfamiliar adult models eating raw broccoli with a positive or neutral facial expression (FE), or a non-food control video. Children's acceptance and intake of raw broccoli was assessed. Data about parent and child characteristics was provided by parents. There was a main effect of FE type on children's frequency of tastes (p = .03) and intake of broccoli (p = .02). Children who were exposed to models eating broccoli with positive FEs had greater frequency of tastes (p = .04) and intake of broccoli (p = .03), than children in the control condition, but not compared to children in the neutral FE condition (p > .05). There was no effect of positive FEs on children's willingness to try broccoli (p > .05). These findings suggest that observing others enjoy a commonly disliked vegetable can encourage children's tastes and intake of the vegetable. Thus, exposing children to others enjoying vegetables could be a useful strategy for encouraging healthier eating in children. Further work is needed to determine whether a single exposure is sufficient and whether these effects are sustained over time.

Adjunct Use of Continuous Renal Replacement Therapy with Extracorporeal Membrane Oxygenation Achieves Negative Fluid Balance and Enhances Oxygenation Which Improves Survival in Critically Ill Patients without Kidney Failure

INTRODUCTION

Fluid overload in extracorporeal membrane oxygenation (ECMO) patients has been associated with increased mortality. Patients receiving ECMO and continuous renal replacement therapy (CRRT) who achieve a negative fluid balance have improved survival. Limited data exist on the use of CRRT solely for fluid management in ECMO patients.

METHODS

We performed a single-center retrospective review of 19 adult ECMO patients without significant renal dysfunction who received CRRT for fluid management. These patients were compared to a cohort of propensity-matched controls.

RESULTS

After 72 h, the treatment group had a fluid balance of -3840 mL versus + 425 mL (p ≤ 0.05). This lower fluid balance correlated with survival to discharge (odds ratio 2.54, 95% confidence interval 1.10-5.87). Improvement in the ratio of arterial oxygen content to fraction of inspired oxygen was also significantly higher in the CRRT group (102.4 vs. 0.7, p ≤ 0.05). We did not observe any significant difference in renal outcomes.

CONCLUSIONS

The use of CRRT for fluid management is effective and, when resulting in negative fluid balance, improves survival in adult ECMO patients without significant renal dysfunction.

Scurvy: A Case Report and Literature Review

Scurvy is a rare disease which can manifest in a variety of presentations. Classically, scurvy is associated with poor dentition and bleeding diatheses. Rarely, scurvy can present with life-threatening hemodynamical instability.

Herein, we report the case of a 69-year-old female with a history of hypertension and depression who presented with four months of weakness and a 20-pound weight loss. Her presentation was complicated by lower extremity bruising and myalgias over the last three weeks. The patient’s blood pressure in the emergency department was 86/54 mmHg. On further examination, she had poor dentition and extensive ecchymoses in different stages of resolution over her posterior thighs and calves. The patient was also noted to have perifollicular hemorrhages. An ascorbic acid level was checked and the result was 0.0 mg/dL (normal range: 0.4 to 2.0 mg/dL). During her admission, she slowly improved with a provided diet and multivitamins. Her blood pressure consistently remained over 120/65 mmHg. The patient was advised to adjust her diet and take supplemental ascorbic acid. On a follow-up visit two weeks later, the patient endorsed an improvement in pain and exercise tolerance and was noted to have marked improvement in skin findings. 

Ascorbic acid is an essential piece of multiple biochemical pathways. Humans are required to attain ascorbic acid from their diet. People who consume diets lacking in ascorbic acid develop scurvy.

Complications and survival after hybrid and fully minimally invasive oesophagectomy

Background

Minimally invasive oesophagectomy (MIO) is reported to produce fewer respiratory complications than open oesophagectomy. This study assessed differences in postoperative complications between MIO and hybrid MIO (HMIO) employing thoracoscopy and laparotomy, along with the influence of co-morbidities on postoperative outcomes.

Methods

Patients with oesophageal cancer undergoing three-stage MIO or three-stage HMIO between 1999 and 2018 were identified from a prospectively developed database, which included patient demographics, co-morbidities, preoperative therapies, and cancer stage. The primary outcome was postoperative complications in the two groups. Secondary outcomes included duration of operation, blood transfusion requirement, duration of hospital stay, and overall survival.

Results

There were 828 patients, of whom 722 had HMIO and 106 MIO, without significant baseline differences. Median duration of operation was longer for MIO (325 versus 289 min; P < 0.001), but with less blood loss (median 250 versus 300 ml; P < 0.001) and a shorter hospital stay (median 12 versus 13 days; P = 0.006). Respiratory complications were not associated with operative approach (31.1 versus 35.2 per cent for MIO and HMIO respectively; P = 0.426). Anastomotic leak rates (10.4 versus 10.2 per cent) and 90-day mortality (1.0 versus 1.7 per cent) did not differ. Cardiac co-morbidity was associated with more medical and surgical complications. Overall survival was associated with AJCC stage and co-morbidities, but not operative approach.

Conclusion

MIO had a small benefit in terms of blood loss and hospital stay, but not in operating time. Oncological outcomes were similar in the two groups. Postoperative complications were associated with pre-existing cardiorespiratory co-morbidities rather than operative approach.

Front-of-pack images can boost the perceived health benefits of dietary products

Images on dietary supplement packaging can help identify the products' supposed function. However, research shows that these images can also lead people to infer additional health benefits of consuming the products. The present research investigated the extent to which front-of-pack imagery affects people's perceptions of the health risks and benefits of fictional products. In three randomized experiments, participants saw fictitious dietary supplement packages. Some of the packages included a health-related image (e.g. a heart), whereas others did not. Participants were asked to infer the products' intended purpose and then to rate the perceived risks and benefits of consuming the product. In Experiment 1 (N = 546), the inclusion of a health-related image increased the perceived benefits of consuming the product, with minimal effect on the perceived risks. This finding was replicated in Experiment 2 (N = 164), but was contingent on whether each product's assumed health function was confirmed or disconfirmed. In Experiment 3 (N = 306), which used a pre-registered design and analysis plan, the inclusion of a health-related image increased the perceived benefits and decreased the perceived risks of consuming the product. Again, these effects were contingent on whether the assumed health functions were confirmed or disconfirmed. These findings indicate that health-related imagery could lead consumers to infer additional health properties from non-diagnostic information featured on a product's packaging, perhaps as a consequence of increased processing fluency. This research underscores the importance of regulating the use of imagery in health marketing, to protect consumers from the effects of potentially misleading claims.

Evaluation of later timepoints for split-time artificial insemination when using sex-sorted semen among beef heifers following the 14-d CIDR®-PG protocol

An experiment was designed to evaluate later timepoints for Split-Time AI (STAI), with the hypothesis that delaying AI may improve estrous response and pregnancy per AI when using sex-sorted semen. Timing of estrus was synchronized among 794 heifers using the 14-d CIDR®-PG protocol (1.38 g progesterone intravaginal insert from Day 0-14, followed by 25 mg dinoprost tromethamine on Day 30) with STAI performed based on estrous status. Heifers were blocked based on breed, source, sire, reproductive tract score (RTS), and BW and assigned within block to one of two approaches. In Approach 66, heifers that were estrual by 66 h after PG administration were inseminated at 66 h, and remaining heifers were inseminated 24 h later (90 h). In Approach 72, heifers that were estrual by 72 h were inseminated at 72 h, and remaining heifers were inseminated 24 h later (96 h). With both approaches, heifers that were non-estrual by the final timepoint were administered 100 μg gonadorelin acetate (GnRH). Within approach, heifers were pre-assigned to receive SexedULTRA 4M™ sex-sorted or conventional semen. The proportion of heifers estrual by the first timepoint was greater (P < 0.0001) with Approach 72 (76 %; 302/395) compared to Approach 66 (61 %; 242/399). The proportion of heifers pregnant as a result of AI differed (P = 0.0005) by semen type (59 % [240/404] for conventional compared with 48 % [187/390] for sex-sorted) but was not affected by approach or approach × semen type. In summary, pregnancy per AI of heifers receiving sex-sorted or conventional semen following the 14-d CIDR®-PG protocol did not differ when STAI was delayed 6 h. The proportion of estrual heifers prior to the first timepoint, however, was greater with later STAI.

Comparison of the 7 & 7 Synch protocol and the 7-day CO-Synch + CIDR protocol among recipient beef cows in an embryo transfer program

An experiment was designed to evaluate the effectiveness of the recently developed 7 & 7 Synch protocol to synchronize estrus among recipients prior to embryo transfer (ET). Postpartum beef cows (n = 1358) across thirteen locations were assigned to either the 7-d CO-Synch + CIDR protocol or the 7 & 7 Synch protocol prior to ET. Cows were preassigned to balanced treatments within location based on age and days postpartum, with body condition score recorded at ET. Cows assigned to the 7-d CO-Synch + CIDR protocol were administered gonadotropin-releasing hormone (GnRH; 100 μg gonadorelin acetate) on Day 7, an intravaginal controlled internal drug release (CIDR; 1.38 g progesterone) from Day 7 to Day 14, and prostaglandin F_2α (PGF_2α; 25 mg dinoprost tromethamine) coincident with CIDR removal on Day 14. Cows assigned to the 7 & 7 Synch protocol were administered PGF_2α (25 mg dinoprost tromethamine) coincident with CIDR insertion on Day 0, GnRH (100 μg gonadorelin acetate) on Day 7, and PGF_2α (25 mg dinoprost tromethamine) coincident with CIDR removal on Day 14. Cows were observed for visible signs of estrus, with GnRH (100 μg gonadorelin acetate) administered to cows failing to express estrus during the detection period. Embryo transfer was performed approximately seven days after estrus or GnRH administration. Presence of corpora lutea (CL) was determined via transrectal palpation by a single veterinarian blinded to treatment, and embryos were transferred only to cows with palpable CL. Embryo transfer was performed using either fresh or frozen embryos, with embryo stage and grade recorded for each recipient. The proportion of cows expressing estrus was increased (P < 0.0001) among cows assigned to the 7 & 7 Synch protocol (86% [529/615] vs 76% [488/640]). The proportion of cows expressing estrus and presenting with palpable CL at ET was greater (P < 0.0001) among cows following treatment with the 7 & 7 Synch protocol compared to the 7-d CO-Synch + CIDR protocol (76% [466/615] vs 65% [418/640]). Consequently, the proportion pregnant to ET was greater (P < 0.03) following the 7 & 7 Synch protocol (40% [263/653]) compared to the 7-d CO-Synch + CIDR protocol (34% [228/664]). In summary, the 7 & 7 Synch protocol involving administration of PGF_2α and treatment with a CIDR for 7 days prior to GnRH improved the likelihood of estrus expression in recipients, increased the proportion of cows eligible to receive an embryo, which resulted in a greater pregnancy rate to ET.

Treatment with prostaglandin F2α and an intravaginal progesterone insert promotes follicular maturity in advance of gonadotropin-releasing hormone among postpartum beef cows

An experiment was designed to evaluate treatments to promote ovarian follicular maturity in advance of administration of exogenous gonadotropin-releasing hormone (GnRH; 100 μg gonadorelin) for control of the bovine estrous cycle. We hypothesized prostaglandin F_2α (PGF_2α; 500 μg cloprostenol) followed by an intravaginal progesterone-releasing insert (CIDR; 1.38 g progesterone) would induce greater follicle size and serum estradiol at the time of GnRH administration. Postpartum cows (n = 194) in two locations were assigned to one of five treatments based on age, days postpartum, and body condition score. Cows in Treatment 1 were treated with the standard 7-d CO-Synch + CIDR protocol: administration of GnRH and CIDR insertion on Day -10, and administration of PGF_2α and CIDR removal on Day -3. Treatments 2-5 were designed in a 2 × 2 factorial arrangement, with Treatment 1 included as an additional reference. On Day -17, cows in Treatments 2-5 received a CIDR insert, either with (Treatments 2 and 3) or without (Treatments 4 and 5) administration of PGF_2α at CIDR insertion. On Day -10, all cows were administered GnRH, and CIDR inserts were either removed (Treatments 2 and 4) or remained in place until Day -3 (Treatments 3 and 5). Treatment with PGF_2α and CIDR in advance of GnRH (Treatments 2 and 3) resulted in increased diameter of the largest ovarian follicle (P < 0.001) and increased serum concentrations of estradiol (P < 0.0005) on Day -10. In addition, variation among cows in CL status (no CL vs. a single CL vs. multiple CL) on Day -3 tended to be decreased (P = 0.08), with cows more likely to have a single CL rather than no CL or multiple CL. Lastly, the proportion of cows expressing estrus prior to fixed-time artificial insemination tended (P = 0.08) to be improved. Results support the hypothesis that administration of PGF_2α and treatment with a CIDR for 7 days prior to GnRH promotes follicular maturity in advance of GnRH administration and may provide an approach by which to enhance response of postpartum beef cows to GnRH-based estrus synchronization programs.

Neural correlates of top-down guidance of attention to food: An fMRI study

We investigated the neural correlates of working memory guided attentional selection of food versus non-food stimuli in young women. Participants were thirty-two women, aged 20.6y (± 0.5) who were presented with a cue (food or non-food item) to hold in working memory. Subsequently, they had to search for a target in a 2-item display where target and distractor stimuli were each flanked by a picture of a food or a non-food item. The behavioural data showed that attention is particularly efficiently drawn to food stimuli when thinking about food. Using fMRI, we found that holding a non-food versus food stimulus in working memory was associated with increased activity in occipital gyrus, fusiform, inferior and superior frontal gyrus. In the posterior cingulum, retrosplenial cortex, a food item that re-appeared in the search array when it was held in memory led to a reduced response, compared to when it did not re-appear. The reverse effect was found for non-food stimuli. The extent of the reappearance effect correlated with the attentional capture of food as measured behaviourally. In conclusion, these results suggest that holding food in mind may bias attention because thinking of food facilitated neuronal responses to sensory input related to food stimuli and because holding food-related information in mind is less taxing on memory.

Baseline neutrophil-lymphocyte ratio holds no prognostic value for esophageal and junctional adenocarcinoma in patients treated with neoadjuvant chemotherapy

BACKGROUND

Several studies have reported that neutrophil-lymphocyte ratio (NLR) can predict survival in esophageal and gastroesophageal junction adenocarcinoma, as it reflects systemic inflammation. Hence, we aimed to determine whether baseline NLR holds prognostic value for esophageal adenocarcinoma patients treated with neoadjuvant chemotherapy (nCT) followed by surgery.

METHODS

We studied the data of 139 patients that received nCT before undergoing esophagectomy with curative intent, all identified from a prospectively maintained database (1998-2016). Pretreatment hematology reports were used to calculate the baseline NLR. A receiver operating characteristic curve (ROC-curve) was plotted to determine an optimal cutoff value. NLR quartiles were used to display possible differences between groups in relation to overall survival (OS) and disease-free survival (DFS) using the method of Kaplan-Meier. Cox regression analysis was performed to assess the prognostic value of NLR.

RESULTS

The median OS and DFS times were 46 months (interquartile range [IQR]: 19-166) and 30 months (IQR: 13-166], respectively, for the entire cohort. The ROC-curve showed that NLR has no discriminating power for survival status (area under the curve = 0.462) and therefore no optimal cutoff value could be determined. There were no statistically significant differences in median OS times for NLR quartiles: 65 (Q1), 32 (Q2), 45 (Q3), and 46 months (Q4) (P = 0.926). Similarly, DFS showed no difference between quartile groups, with median survival times of 27 (Q1), 19 (Q2), 36 (Q3), and 20 months (Q4) (P = 0.973). Age, pN, pM, and resection margin were independent prognostic factors for both OS and DFS. On the contrary, NLR was not associated with OS or DFS in univariable and multivariable analyses.

CONCLUSION

Baseline NLR holds no prognostic value for esophageal and gastroesophageal junction adenocarcinoma patients treated with nCT in this study, in contrast to other recently published papers. This result questions the validity of NLR as a reliable prognostic indicator and its clinical usefulness in these patients.

Comparison of long-term progestin-based protocols to synchronize estrus prior to natural service or fixed-time artificial insemination in Bos indicus-influenced beef heifers

This experiment was designed to evaluate breeding strategies involving natural service or fixed-time artificial insemination (FTAI) in Bos indicus-influenced beef heifers (n = 1456) when there were field-type management conditions. Body weights and reproductive tract scores (RTS; Scale 1-5) were obtained for heifers before assignment to one of five treatments: 1) Non-synchronized control exposed for natural service (NS), n = 299; 2) melengestrol acetate + natural service (MGA + NS; 0.5 mg/heifer/d), n = 295; 3) 14-d controlled internal drug release insert + natural service (CIDR + NS), n = 289; 4) 14-d MGA-prostaglandin F_2α (PG) + FTAI, n = 295; or 5) 14-d CIDR-PG + FTAI, n = 278. Fertile bulls were placed in pastures with heifers of the three NS treatment groups for a 65-day period which began 10 days after progestin treatments (MGA or CIDR) ended. Heifers in FTAI treatment groups were administered PG (25 mg, IM) 16 days after CIDR removal or 19 days following MGA withdrawal, respectively, and FTAI was performed at 66 (CIDR-PG) or 72 h (MGA-PG) after PG. Gonadotropin-releasing hormone (GnRH; 100 μg, i.m.) was administered at FTAI. Pregnancy status was determined at the end of a 65-day breeding period. Pregnancy rates on Days 21 and 65 of the breeding period differed among treatment groups based on pre-treatment pubertal status (P ≤ 0.02) and body weight (P ≤ 0.05) but did not differ by group. These data highlight the need for continued research efforts to improve reproductive management of Bos indicus-influenced females.

Assessing the effects of vegetable consumption on the psychological health of healthy adults: a systematic review of prospective research

BACKGROUND

To alleviate the immense health and economic burden of mental illness, modifiable targets to promote psychological health are required. Emerging evidence suggests that both fruit and vegetable (F&V) consumption may play an important role. However, the precise contribution of vegetable consumption, which may represent a more potent target than the consumption of fruit, has received little attention.

OBJECTIVES

This review aimed to synthesize and evaluate research investigating the effects of vegetable consumption on mental health and psychological well-being in nonclinical, healthy adult populations. We aimed to provide insight into the causal relation between vegetable consumption and these outcomes.

METHODS

Only studies with prospective or experimental data were included. The survey of the literature was last implemented on 1 February, 2019.

RESULTS

Ten eligible studies were identified, with a total sample size of n = 33,645, that measured vegetable intake separately from fruit, or combined this with fruit intake. Where studies explored the independent effects of fruit and vegetable consumption on psychological health (n = 3), 2 reported a preferential effect of vegetables (compared with fruit) on psychological well-being, whereas 1 reported a superior effect of fruit intake on odds reduction of symptoms of depression. More broadly, there was evidence that consuming the recommended amount of F&V (and exceeding this) was associated with increased psychological well-being. However, the effects of F&V consumption on mental health symptoms were inconsistent.

CONCLUSIONS

Increased F&V consumption has a positive effect on psychological well-being and there appears to be a preferential effect of vegetables (compared with fruit) from the limited data examined. The effect of F&V intake on mental health is less clear and, at present, there are no clear data to support a preferential effect of vegetable intake on mental health outcomes. Hence, additional research is warranted to investigate the influence of vegetables, compared with fruit, on psychological health in order to inform nutrition-based interventions. This review was registered at www.crd.york.ac.uk/prospero as CRD42017072880.

Using repeated visual exposure, rewards and modelling in a mobile application to increase vegetable acceptance in children

Children are not consuming the recommended amounts of fruit and vegetables. Repeated visual exposure, modelling, and rewards have been shown to be effective at increasing vegetable acceptance in young children. The aim of this study was to assess the effectiveness of an evidence-based mobile application (Vegetable Maths Masters) which builds on these principles to increase children's liking and acceptance of vegetables. Seventy-four children (37 male, 37 female) aged 3-6 years old were randomised to play with either the vegetable app or a similar control app that did not include any foods. Children played their allocated game for 10 min. Liking and acceptance of the vegetables used in Vegetable Maths Masters (carrot and sweetcorn) and other vegetables which were not used in the game (yellow pepper and tomato) were measured pre- and post-play in both groups. Parents provided data about their child's food fussiness and previous exposure to the foods being used. Children who played with the Vegetable Maths Masters app consumed significantly more vegetables after playing with the app and reported significant increases in their liking of vegetables, relative to the control group. The effect of the Vegetable Maths Masters app on the change in consumption of vegetables was mediated by the change in liking of vegetables. These findings suggest that evidence-based mobile apps can provide an effective tool for increasing children's liking and consumption of vegetables in the short-term. Further work is now required to establish whether these effects are maintained over time.

Prospective cohort study of ultrasound surveillance of regional lymph nodes in patients with intermediate-risk cutaneous melanoma

Background

For patients with intermediate‐thickness melanoma, surveillance of regional lymph node basins by clinical examination alone has been reported to result in a larger number of lymph nodes involved by melanoma than if patients had initial sentinel node biopsy and completion dissection. This may result in worse regional control. A prospective study of both regular clinical examination and ultrasound surveillance was conducted to assess the effectiveness of these modalities.

Methods

Between 2010 and 2014, patients with melanoma of thickness 1·2–3·5 mm who had under‐gone wide local excision but not sentinel node biopsy were recruited to a prospective observational study of regular clinical and ultrasound nodal surveillance. The primary endpoint was nodal burden within a dissected regional lymph node basin. Secondary endpoints included locoregional or distant relapse, progression‐free and overall survival.

Results

Ninety patients were included in the study. After a median follow‐up of 52 months, ten patients had developed nodal relapse as first recurrence, four had locoregional disease outside of an anatomical nodal basin as the first site of relapse and six had relapse with distant disease. None of the patients who developed relapse within a nodal basin presented with unresectable nodal disease. The median number of involved lymph nodes in patients undergoing lymphadenectomy for nodal relapse was 1 (range 1–2; mean 1·2).

Conclusion

This study suggests that ultrasound surveillance of regional lymph node basins is safe for patients with melanoma who undergo a policy of nodal surveillance.

YpdA, a putative bacillithiol disulfide reductase, contributes to cellular redox homeostasis and virulence in Staphylococcus aureus

The intracellular redox environment of Staphylococcus aureus is mainly buffered by bacillithiol (BSH), a low molecular weight thiol. The identity of enzymes responsible for the recycling of oxidized bacillithiol disulfide (BSSB) to the reduced form (BSH) remains elusive. We examined YpdA, a putative bacillithiol reductase, for its role in maintaining intracellular redox homeostasis. The ypdA mutant showed increased levels of BSSB and a lower bacillithiol redox ratio vs. the isogenic parent, indicating a higher level of oxidative stress within the bacterial cytosol. We showed that YpdA consumed NAD(P)H; and YpdA protein levels were augmented in response to stress. Wild type strains overexpressing YpdA showed increased tolerance to oxidants and electrophilic agents. Importantly, YpdA overexpression in the parental strain caused an increase in BSH levels accompanied by a decrease in BSSB concentration in the presence of stress, resulting in an increase in bacillithiol redox ratio vs. the vector control. Additionally, the ypdA mutant exhibited decreased survival in human neutrophils (PMNs) as compared with the parent, while YpdA overexpression protected the resulting strain from oxidative stress in vitro and from killing by human neutrophils ex vivo. Taken together, these data present a new role for YpdA in S. aureus physiology and virulence through the bacillithiol system.

Two observational studies examining the effect of a social norm and a health message on the purchase of vegetables in student canteen settings

There is some evidence from laboratory-based studies that descriptive social-norm messages are associated with increased consumption of vegetables, but evidence of their effectiveness in real-world settings is limited. In two observational field studies taking an ecological approach, a vegetable-related social norm (e.g. "Did you know that most students here choose to eat vegetables with their meal?"), and a health message (e.g. "Did you know that students who choose to eat vegetables have a lower risk of heart disease?") were displayed in two different student canteens. Purchases were observed during three stages: baseline, intervention (when the posters were displayed) and immediate post-intervention (when the posters had been removed). Study 1 (n = 7598) observed the purchase of meals containing a portion of vegetables and Study 2 (n = 4052) observed the purchase of side portions of vegetables. In Study 1, relative to baseline, the social-norms intervention was associated with an increase in purchases of vegetables (from 63% to 68% of meals; OR = 1.24, CI = 1.03-1.49), which was sustained post-intervention (67% of meals; OR = 0.96, CI = 0.80-1.15). There was no effect of the health message (75% of meals at baseline, and 74% during the intervention; OR = 0.98, CI = 0.83-1.15). In Study 2, relative to baseline, there was an effect of both the social norm (22.9% of meals at baseline, rising to 32.5% during the intervention; OR = 1.62, CI = 1.27-2.05) and health message (rising from 43.8% at baseline to 52.8%; OR = 0.59, CI = 0.46-0.75). The increase was not sustained post-intervention for the social norm intervention (22.1%; OR = 0.59, CI = 0.46-0.75), but was sustained for the health intervention (48.1%; OR = 0.83, CI = 0.67-1.02). These results support further testing of the effectiveness of such messages in encouraging healthier eating and indicate the need for larger-scale testing at multiple sites using a randomised-controlled design.

Evaluation of SexedULTRA 4M™ sex-sorted semen in timed artificial insemination programs for mature beef cows

An experiment was designed to compare fertility of SexedULTRA 4M™ sex-sorted semen and conventional, non-sex-sorted semen following either fixed-time artificial insemination (FTAI) or split-time artificial insemination (STAI) of mature suckled beef cows. Units of sex-sorted and conventional semen were produced using contemporaneous ejaculates from three commercially available sires. Units of conventional semen were generated with 25.0 × 10⁶ live cells per 0.25 ml straw prior to freezing, and units of sex-sorted semen were generated using the SexedULTRA^TM Genesis III sorting technology with 4.0 × 10⁶ live cells per 0.25 ml straw prior to freezing. Sex-sorted units were sorted to contain X chromosome-bearing sperm cells at an accuracy level of >90%. Cows (n = 1620) across four herds were treated with the 7-d CO-Synch + CIDR protocol [administration of gonadotropin-releasing hormone (GnRH) and insertion of a progesterone insert (CIDR) on Day -10, followed by administration of prostaglandin F_2α (PG) and removal of CIDR inserts on Day -3]. Cows were preassigned based on age, body condition score, and days postpartum to one of the following four treatments: FTAI with SexedULTRA 4M™ sex-sorted semen, FTAI with conventional semen, STAI with SexedULTRA 4M™ sex-sorted semen, or STAI with conventional semen. On Day -3, estrus detection aids (Estrotect^®) were applied. For cows in FTAI treatments, AI was performed on Day 0 at 66 h after PG administration and CIDR removal, and 100 μg GnRH was administered concurrent with AI. For cows in STAI treatments, AI was performed on either Day 0 or 1, at 66 or 90 h after PG administration and CIDR removal, based on timing of estrus expression. On Day 1 at 90 h after PG administration and CIDR removal, 100 μg GnRH was administered concurrent with AI to any STAI-treated cows that had failed to express estrus. Pregnancy rates to AI were affected (P = 0.04) by the interaction of bull and semen type. Greater pregnancy rates were obtained with conventional semen versus SexedULTRA 4M™ sex-sorted semen when using semen from Bull A (64% [176/277] versus 36% [100/278]; P < 0.0001) and Bull B (72% [200/277] versus 57% [156/276]; P < 0.01), whereas pregnancy rates to AI did not differ between conventional and SexedULTRA 4M™ sex-sorted semen when using semen from Bull C (58% [149/258] versus 52% [131/254]). Pregnancy rates did not differ significantly between cows inseminated using a STAI versus FTAI approach, regardless of whether insemination was performed with conventional semen (65% [265/409] versus 65% [260/403] or SexedULTRA 4M™ sex-sorted semen (50% [200/403] versus 48% [187/405]). However, due to the additional 24 h for potential estrus expression when performing STAI, total estrous response prior to AI was greater (P < 0.001) among cows receiving STAI (84%; 686/812) compared to FTAI (72%; 585/808), and greater pregnancy rates (P < 0.0001) were obtained among cows that expressed estrus prior to AI. In summary, the relative fertility of SexedULTRA 4M™ sex-sorted semen and conventional semen varied across bulls. Although overall pregnancy rates to timed AI did not differ between STAI and FTAI approaches, use of a STAI approach allowed for greater total estrous response prior to AI. Therefore, to achieve acceptable conception rates per unit and service the maximum number of cows with sex-sorted semen, one viable approach may be to use STAI to maximize total estrous response and restrict use of SexedULTRA 4M™ sex-sorted to only those cows expressing estrus.

The 5-HT2C receptor agonist meta-chlorophenylpiperazine (mCPP) reduces palatable food consumption and BOLD fMRI responses to food images in healthy female volunteers

RATIONALE

Brain 5-HT_2C receptors form part of a neural network that controls eating behaviour. 5-HT_2C receptor agonists decrease food intake by activating proopiomelanocortin (POMC) neurons in the arcuate nucleus of the hypothalamus, but recent research in rodents has suggested that 5-HT_2C receptor agonists may also act via dopaminergic circuitry to reduce the rewarding value of food and other reinforcers. No mechanistic studies on the effects of 5-HT_2C agonists on food intake in humans have been conducted to date.

OBJECTIVES

The present study examined the effects of the 5-HT_2C receptor agonist meta-chlorophenylpiperazine (mCPP) on food consumption, eating microstructure and blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) responses to food pictures in healthy female volunteers.

METHODS

In a double-blind, placebo-controlled, crossover design, participants were randomized immediately after screening to receive oral mCPP (30mg) in a single morning dose, or placebo, in a counterbalanced order. Test foods were served from a Universal Eating Monitor (UEM) that measured eating rate and fMRI BOLD signals to the sight of food and non-food images were recorded.

RESULTS

mCPP decreased rated appetite and intake of a palatable snack eaten in the absence of hunger but had no significant effect on the consumption of a pasta lunch (although pasta eating rate was reduced). mCPP also decreased BOLD fMRI responses to the sight of food pictures in areas of reward-associated circuitry. A post hoc analysis identified individual variability in the response to mCPP (exploratory responder-non-responder analysis). Some participants did not reduce their cookie intake after treatment with mCPP and this lack of response was associated with enhanced ratings of cookie pleasantness and enhanced baseline BOLD responses to food images in key reward and appetite circuitry.

CONCLUSIONS

These results suggest that 5-HT_2C receptor activation in humans inhibits food reward-related responding and that further investigation of stratification of responding to mCPP and other 5-HT_2C receptor agonists is warranted.

Interactions between metabolic, reward and cognitive processes in appetite control: Implications for novel weight management therapies

Traditional models of appetite control have emphasised the role of parallel homeostatic and hedonic systems, but more recently the distinction between independent homeostatic and hedonic systems has been abandoned in favour of a framework that emphasises the cross talk between the neurochemical substrates of the two systems. In addition, evidence has emerged more recently, that higher level cognitive functions such as learning, memory and attention play an important role in everyday appetite control and that homeostatic signals also play a role in cognition. Here, we review this evidence and present a comprehensive model of the control of appetite that integrates cognitive, homeostatic and reward mechanisms. We discuss the implications of this model for understanding the factors that may contribute to disordered patterns of eating and suggest opportunities for developing more effective treatment approaches for eating disorders and weight management.

The 9-d CIDR-PG protocol II: Characterization of endocrine parameters, ovarian dynamics, and pregnancy rates to fixed-time AI following use of long-term CIDR-based estrus synchronization among mature beef cows

An experiment was designed to evaluate endocrine parameters, ovarian dynamics, and pregnancy rates to fixed-time artificial insemination (FTAI) following the 9-d CIDR-PG protocol in comparison to the 14-d CIDR-PG protocol. While both are long-term protocols using CIDR treatment for presynchronization, the 9-d CIDR-PG protocol differs from the 14-d CIDR-PG protocol in that prostaglandin F_2α (PG) is administered at CIDR insertion and removal to facilitate a decreased length of progestin treatment and potentially enhance response to the presynchronization treatment. Estrus was synchronized for 393 mature beef cows across five locations. Treatments were represented in each location, and cows within each location were randomly assigned to one of the two protocols based on age, days postpartum (DPP), and body condition score (BCS). Cows assigned to the 14-d CIDR-PG treatment received a CIDR insert (1.38 g progesterone) on Day 0 with removal of CIDR on Day 14, and 25 mg PG 16 d after CIDR removal on Day 30. Cows assigned the 9-d CIDR-PG treatment received 25 mg PG and a CIDR insert (1.38 g progesterone) on Day 5; 25 mg PG and removal of CIDR on Day 14; and 25 mg PG 16 d after CIDR removal on Day 30. In both treatments, cows received FTAI on Day 33, 72 h after PG. All cows were administered 100 μg gonadotropin-releasing hormone (GnRH) concurrent with insemination. For a subset of animals in each treatment, ovarian ultrasound was performed and blood samples were collected for determination of serum estradiol concentrations at CIDR removal, PG administration, and FTAI. Protocols were compared on the basis of estrous response and pregnancy rate resulting from FTAI. Serum estradiol concentrations, follicle size, and estrous response did not differ based on treatment. However, cows assigned to the 9-d CIDR-PG protocol tended to achieve greater FTAI pregnancy rates than cows assigned to the 14-d CIDR-PG protocol (62% versus 52%; P = 0.07). Across treatments, greater pregnancy rates tended (P = 0.10) to be achieved by cows that expressed estrus prior to FTAI (69% for 9-d CIDR-PG, 58% for 14-d CIDR-PG) than by cows that failed to express estrus (55% for 9-d CIDR-PG, 47% for 14-d CIDR-PG). In summary, the 9-d CIDR-PG protocol is an effective protocol for synchronization of estrus among mature beef cows, and pregnancy rates to FTAI tended to be improved through use of the 9-d CIDR-PG compared to the 14-d CIDR-PG protocol.

Use of Allogeneic Bone Marrow Labeled with Neomycin Resistance Gene to Examine Bone Marrow-Derived Chimerism in Experimental Organ Transplantation

Posttransplant infusion of viable donor bone marrow cells (DBMC) has been shown in our previous studies to promote acceptance of incompatible kidney allografts in rhesus monkeys after treatment with polyclonal antithymocyte globulin to deplete peripheral T-lymphocytes. In this nonhuman primate model, the infusion of the DBMC is requisite for the induction of functional graft tolerance and specific MLR and CTLp unresponsiveness, although the relevant role and fate of bone marrow-derived chimeric cells is uncertain. Standard immunological and molecular techniques applied to this monkey model are unable to differentiate between chimeric cells derived from the infused DBMC and those derived from allograft-borne passenger leukocyte emigrants. To distinguish chimerism due to infused DBMC, we transduced DBMC with a functional neomycin resistance gene (Neor) using the retroviral vector pHSG-Neo. Neor-Mransduced BMC were infused into recipients approximately 2 wk after kidney transplantation and treatment with rabbit antithymocyte globulin. No maintenance immunosuppressive drugs were given. Genomic DNA isolated from peripheral blood leukocytes was used to monitor the presence of Neor-positive cells. Tissue samples obtained at necropsy also were assessed for Neor-positive chimeric cells. The presence of DBMC-derived chimerism was assessed by polymerase chain reaction using Neor sequence-specific primers (PCR-SSP). Chimerism was detectable in recipient tissues at various times for up to 6 mo after DBMC infusion. These studies using gene transduction methodology indicate that a stable genetic marker can provide capability to examine DBMC-derived chimerism for prolonged periods in a nonhuman primate model. This approach should facilitate future studies in preclinical models to study the role and type of chimeric cell lineages in relation to functional allograft tolerance.

Using a descriptive social norm to increase vegetable selection in workplace restaurant settings

Objective: Recent work has shown that exposure to social norm messages may enhance the consumption of vegetables. However, the majority of this work has been conducted in laboratories, often with student populations. Little is known about whether this approach can be successfully used in other contexts. In this study, a poster featuring a message based on social norms was tested to examine whether it could increase and maintain the purchase of meals with vegetables in workplace restaurants. Method: A pretest–posttest design with 3 phases was used in 3 workplace restaurants in the United Kingdom. The first 2 weeks formed the preintervention phase, the second 2 weeks the intervention phase, and the last 2 weeks the postintervention phase. During the intervention phase only, posters containing a social norm message relaying information about vegetable purchases of other diners were placed in each restaurant. The main outcome measure was the percentage of meals purchased with vegetables, which was analyzed using Pearson’s chi-squared test. Results: Participants were judged to be male (57%), not overweight (75%), and under the age of 60 (98%). The intervention was positively associated with the percentage of meals purchased with vegetables: baseline versus intervention (60% vs. 64% of meals purchased with vegetables; p < .01); intervention versus postintervention (64% vs. 67% of meals purchased with vegetables; p < .01); and baseline versus postintervention (60% vs. 67% of meals purchased with vegetables; p < .001). Conclusions: Social norm messages may increase the purchase of vegetables in workplace settings.

Effective use of SexedULTRA™ sex-sorted semen for timed artificial insemination of beef heifers

An experiment was designed to evaluate the relative fertility of SexedULTRA^TM sex-sorted semen compared to conventional, non-sex-sorted semen when used among beef heifers in conjunction with split-time AI following the 14-d CIDR-PG protocol. Units of conventional semen were generated with 25.0 × 10⁶ live cells per 0.5 ml straw prior to freezing, and units of sex-sorted semen were generated using the SexedULTRA^TM Genesis III sorting technology with 4.0 × 10⁶ live cells per 0.25 ml straw prior to freezing. Sex-sorted units were sorted to contain X chromosome-bearing sperm cells at an accuracy level of >90%. Estrus was synchronized in 851 heifers at four locations using the 14-d CIDR-PG protocol: controlled internal drug release (CIDR) insert (1.38 g progesterone) on Day 0, CIDR removal on Day 14, and administration of prostaglandin F_2α (PG; 25 mg im) on Day 30. Estrus detection aids were applied at PG on Day 30 to evaluate estrous response rate, and split-time AI was performed based on estrous response. At 66 h after PG (Day 33), heifers having expressed estrus received timed AI. Heifers failing to express estrus by 66 h received timed AI 24 h later (90 h after PGF_2α on Day 34). Heifers failing to express estrus by 90 h were administered gonadotropin-releasing hormone (GnRH; 100 μg im) concurrent with AI. Heifers were preassigned to treatment (insemination with either conventional or SexedULTRA^TM sex-sorted semen), and treatments were balanced within each location based on source, reproductive tract score, and weight. Heifers were exposed for natural service beginning 14 d after AI for the remainder of a 60 d breeding season. Pregnancy rates to AI across locations tended to be higher (P = 0.09) for heifers inseminated with conventional semen (60%; 257/429) compared to sex-sorted semen (52%; 218/422). Higher pregnancy rates to AI (P < 0.0001) were obtained among heifers that expressed estrus prior to AI than among heifers that failed to express estrus prior to AI at 90 h. Total pregnancy rates at the end of the 60 d breeding season did not differ between heifers that received sex-sorted semen at AI (89%; 376/422) and heifers that received conventional semen at AI (89%; 382/429). In summary, the pregnancy rates observed suggest that SexedULTRA^TM sex-sorted semen can be used effectively for timed AI of beef heifers when split-time AI is performed following the 14-d CIDR-PG protocol.

[Specificity of communication in general practice]

Beyond its scientific and ethical competencies, a good doctor is characterized by his communication skills. The ability to listen is fundamental. During an interview, the physician must keep in mind a bio-psycho-social approach while being able to hear the unspeakable and inaudible. Knowledge of patients and their relatives, which seems to be a specific knowledge for general practitioners, offers a lot of information. Among the main sensitive topics that the clinician must identify are: intrafamily violence, domestic violence, substance abuse and anxiety-depressive disorders. In order to improve, the practitioner can use tools such as the Calgary-Cambridge guide and techniques used in Motivational Maintenance.

[Communicating with elderly patients]

As with other adults, communication with elderly patients will be based on the three pillars of the person-centered approach, on motivational interviewing and on the Calgary Cambridge guide. The particularity of communication with the elderly lies in the consideration of obstacles such as visual, auditory and cognitive deficits. In addition, caregivers who accompany the patient sometimes monopolize the discussion, which could prevent him from expressing himself or even making decisions about his health. Humanity and Validation are a set of tools for communicating more effectively with the very elderly or those suffering from dementia.

Flowers and Wild Megachilid Bees Share Microbes

Transmission pathways have fundamental influence on microbial symbiont persistence and evolution. For example, the core gut microbiome of honey bees is transmitted socially and via hive surfaces, but some non-core bacteria associated with honey bees are also found on flowers, and these bacteria may therefore be transmitted indirectly between bees via flowers. Here, we test whether multiple flower and wild megachilid bee species share microbes, which would suggest that flowers may act as hubs of microbial transmission. We sampled the microbiomes of flowers (either bagged to exclude bees or open to allow bee visitation), adults, and larvae of seven megachilid bee species and their pollen provisions. We found a Lactobacillus operational taxonomic unit (OTU) in all samples but in the highest relative and absolute abundances in adult and larval bee guts and pollen provisions. The presence of the same bacterial types in open and bagged flowers, pollen provisions, and bees supports the hypothesis that flowers act as hubs of transmission of these bacteria between bees. The presence of bee-associated bacteria in flowers that have not been visited by bees suggests that these bacteria may also be transmitted to flowers via plant surfaces, the air, or minute insect vectors such as thrips. Phylogenetic analyses of nearly full-length 16S rRNA gene sequences indicated that the Lactobacillus OTU dominating in flower- and megachilid-associated microbiomes is monophyletic, and we propose the name Lactobacillus micheneri sp. nov. for this bacterium.

Comparing strategies to synchronize estrus before fixed-time artificial insemination in primiparous 2-year-old beef cows

Two experiments evaluated controlled internal drug release (CIDR)-based protocols to synchronize estrus in primiparous 2-year-old beef cows. In each experiment, treatments were balanced according to body condition score and days postpartum. Experiment 1 compared the 14-day CIDR-PG (14-d) and 7-day CO-Synch + CIDR (7-d) protocols on the basis of estrous response, pregnancy rates after fixed-time artificial insemination (FTAI), and final pregnancy rate. Cows assigned to 14-d (n = 355) received a CIDR insert on Day 0 with removal on Day 14. Cows assigned to 7-d (n = 349) received gonadotropin releasing hormone (GnRH) and a CIDR insert on Day 23. On Day 30, CIDRs were removed from 7-d cows, and PGF_2α was administered to all cows in each treatment. On Day 33, GnRH was administered concurrent with FTAI at 66 and 72 hours after PGF_2α for 7-d and 14-d treated cows, respectively. Estrous response before FTAI was higher for 7-d compared with 14-d cows (74% vs. 43%, respectively; P < 0.0001); however, pregnancy rates resulting from FTAI were similar (14-d 63%; 7-d 64%; P = 0.52). Ovarian follicular dynamics and serum estradiol-17β concentrations were evaluated among a subset of cows assigned to each protocol. Dominant follicle diameter was smaller at PGF_2α (P = 0.04) and FTAI (P = 0.002) among 14-d cows compared with 7-d cows; however, estradiol-17β at PGF_2α (P = 0.06) and FTAI (P = 0.001) was greater for 14-d versus 7-d treated cows. Experiment 2 compared estrous response and pregnancy rates in 2-year-old beef cows after FTAI- or split-time artificial insemination (STAI) following synchronization of estrus with the 14-day protocol. Cows assigned to FTAI (n = 266) were inseminated at a fixed time concurrent with GnRH at 72 hours after PGF_2α regardless of estrus expression, whereas cows assigned to STAI (n = 257) were inseminated based on estrus expression as determined by activation of an estrus detection aid. Cows assigned to STAI that exhibited estrus by 72 hours were inseminated; however, AI was delayed until 24 hours after GnRH (96 hours after PGF_2α) for nonestrous cows. Total estrous response was increased for STAI- versus FTAI-treated cows (STAI 64%; FTAI 42%; P < 0.0001); pregnancy rates resulting from AI were similar (STAI 55%; FTAI 56%; P = 0.60). In summary, the 14-day CIDR-PG and 7-day CO-Synch + CIDR protocols can be used effectively to synchronize estrus before FTAI in primiparous 2-year-old beef cows. Although expression of estrus was increased using STAI in conjunction with the 14-day protocol, this approach did not increase pregnancy rates compared with FTAI.

Patterns of disease relapse in primary extremity soft-tissue sarcoma

Background

Extremity soft-tissue sarcomas comprise a range of distinct histological subtypes. This study aimed to characterize the patterns of disease relapse in patients undergoing resection of primary extremity soft-tissue sarcoma.

Methods

All patients who had resection of primary extremity soft-tissue sarcoma at the Royal Marsden Hospital between January 2004 and January 2014 were identified from an institutional database.

Results

In the period examined, 556 patients underwent resection. The most common histological subtypes were undifferentiated pleomorphic sarcoma (169 patients, 30·4 per cent), well differentiated liposarcoma (63, 11·3 per cent), myxoid liposarcoma (62, 11·2 per cent), myxofibrosarcoma (54, 9·7 per cent) and leiomyosarcoma (39, 7·0 per cent). Local recurrence-free survival (LRFS) did not differ significantly between histological subtypes (P = 0·222). Distant metastasis-free survival (DMFS) and disease-specific survival (DSS) were found to differ significantly between subtypes (P &lt; 0·001 for both DMFS and DSS), with the worst outcomes in patients with undifferentiated pleomorphic sarcoma (5-year survival rate: 56·8 (95 per cent c.i. 52·5 to 61·1) per cent for DMFS; 60·1 (55·6 to 64·6) per cent for DSS). However, on multivariable analysis, histological subtype was not found to be independently prognostic for LRFS, DMFS or DSS. Metastatic disease developed in 149 patients, with the lungs being the most common site of first metastasis (120 patients, 80·5 per cent). The site of first metastasis differed between subtypes, with extrapulmonary metastases predominant in myxoid liposarcoma (11 of 13 patients; P &lt; 0·001).

Conclusion

Although histological subtype was not found to be an independent prognostic factor for oncological outcomes, the site of first metastasis differed significantly between subtypes.

The Effects of Liking Norms and Descriptive Norms on Vegetable Consumption: A Randomized Experiment

There is evidence that social norm messages can be used to promote the selection of fruit and vegetables in low habitual consumers of these foods but it is unclear whether this effect is sustained over time. It is also unclear whether information about others' liking for a food (liking norm) could have the same effect. Using a 2 × 5 × 2 experimental design we investigated the effects of exposure to various messages on later intake from a food buffet and whether any effects were sustained 24 h after exposure in both low and high consumers of vegetables. There were three factors: delay (immediate food selection vs. food selection 24 h after exposure), message type (liking norm, descriptive norm, health message, vegetable variety condition, and neutral control message), and habitual consumption (low vs. high). The buffet consisted of three raw vegetables, three energy-dense foods, and two dips. For vegetables and non-vegetables there were no main effects of message type, nor any main effect of delay. There was a significant message × habitual vegetable consumption interaction for vegetable consumption; however, follow up tests did not yield any significant effects. Examining each food individually, there were no main effects of message type, nor any main effect of delay, for any of the foods; however, there was a message × habitual vegetable consumption interaction for broccoli. Consumption of broccoli in the health message and descriptive norm conditions did not differ from the control neutral condition. However, habitually low consumers of vegetables increased their consumption of broccoli in the vegetable variety and liking norm conditions relative to habitual low vegetable consumers in the neutral control condition (p < 0.05). Further, investigation of the effects of the liking norm and vegetable variety condition on vegetable intake is warranted. This trial is listed as NCT02618174 at clinicaltrials.gov.

Outcome following resection of retroperitoneal sarcoma

Background

Retroperitoneal sarcoma comprises a range of different histological subtypes with dissimilar behaviour and biology. This study sought to characterize the morbidity and mortality associated with multivisceral resection and oncological outcomes according to subtype.

Methods

All patients undergoing resection of primary retroperitoneal sarcoma at the Royal Marsden Hospital between January 2005 and December 2014 were identified from a database.

Results

Some 362 patients underwent resection, with 292 requiring multivisceral resection. The 30-day mortality rate was 1·4 per cent (5 patients), the 30-day morbidity rate was 15·7 per cent (57 patients), and 27 patients required a return to theatre. Age over 75 years was predictive of 30-day mortality (hazard ratio 1·37, 95 per cent c.i. 1·13 to 1·65). The overall disease-specific survival rate at 3 years was 81·2 per cent. For well differentiated liposarcoma, dedifferentiated liposarcoma and leiomyosarcoma, 3-year local recurrence-free survival rates were 98 (95 per cent c.i. 83 to 99), 56·7 (45·7 to 66·2) and 80 (67 to 89) per cent respectively. At 3 years the distant metastasis-free survival rate was 100, 85·9 (77·4 to 91·4) and 65 (49 to 77) per cent, and the disease-specific survival rate was 97 (89 to 99), 78·5 (74·6 to 82·4) and 79 (63 to 85) per cent for well differentiated liposarcoma, dedifferentiated liposarcoma and leiomyosarcoma respectively.

Conclusion

Resection of retroperitoneal sarcoma was associated with a 30-day mortality rate of less than 2 per cent and a morbidity rate of 15·7 per cent. The overall 3-year disease-specific survival rate was 81·2 per cent.

Effects of awareness that food intake is being measured by a universal eating monitor on the consumption of a pasta lunch and a cookie snack in healthy female volunteers

To date, there have been no studies that have explicitly examined the effect of awareness on the consumption of food from a Universal Eating Monitor (UEM - hidden balance interfaced to a computer which covertly records eating behaviour). We tested whether awareness of a UEM affected consumption of a pasta lunch and a cookie snack. 39 female participants were randomly assigned to either an aware or unaware condition. After being informed of the presence of the UEM (aware) or not being told about its presence (unaware), participants consumed ad-libitum a pasta lunch from the UEM followed by a cookie snack. Awareness of the UEM did not significantly affect the amount of pasta or cookies eaten. However, awareness significantly reduced the rate of cookie consumption. These results suggest that awareness of being monitored by the UEM has no effect on the consumption of a pasta meal, but does influence the consumption of a cookie snack in the absence of hunger. Hence, energy dense snack foods consumed after a meal may be more susceptible to awareness of monitoring than staple food items.

Surgical treatment of gastrointestinal stromal tumour of the rectum in the era of imatinib

BACKGROUND

Gastrointestinal stromal tumours (GISTs) of the rectum often require radical surgery to achieve complete resection. This study investigated the management and outcome of surgery for rectal GISTs and the role of imatinib.

METHODS

A cohort study was undertaken of patients identified from a database at one tertiary sarcoma referral centre over a continuous period, from January 2001 to January 2013.

RESULTS

Over 12 years, 19 patients presented with a primary rectal GIST. Median age was 57 (range 30-77) years. Neoadjuvant imatinib was used in 15 patients, significantly reducing mean tumour size from 7·6 (95 per cent c.i. 6·1 to 9·0) to 4·1 (2·8 to 5·3) cm (P < 0·001). Nine of these patients underwent surgical resection. Imatinib therapy enabled sphincter-preserving surgery to be undertaken in seven patients who would otherwise have required abdominoperineal resection or pelvic exenteration for tumour clearance. Neoadjuvant imatinib treatment also led to a significant reduction in mean(s.d.) tumour mitotic count from 16(16) to 4(9) per 50 high-power fields (P = 0·015). Imatinib was used only as adjuvant treatment in two patients. There were three deaths, all from unrelated causes. Eleven of the 13 patients who underwent resection were alive without evidence of recurrence at latest follow-up, with a median disease-free survival of 38 (range 20-129) months and overall survival of 62 (39-162) months.

CONCLUSION

The use of neoadjuvant imatinib for rectal GISTs significantly decreased both tumour size and mitotic activity, which permitted less radical sphincter-preserving surgery.

Satiation attenuates BOLD activity in brain regions involved in reward and increases activity in dorsolateral prefrontal cortex: an fMRI study in healthy volunteers

BACKGROUND

Neural responses to rewarding food cues are significantly different in the fed vs. fasted (>8 h food-deprived) state. However, the effect of eating to satiety after a shorter (more natural) intermeal interval on neural responses to both rewarding and aversive cues has not been examined.

OBJECTIVE

With the use of a novel functional magnetic resonance imaging (fMRI) task, we investigated the effect of satiation on neural responses to both rewarding and aversive food tastes and pictures.

DESIGN

Sixteen healthy participants (8 men, 8 women) were scanned on 2 separate test days, before and after eating a meal to satiation or after not eating for 4 h (satiated vs. premeal). fMRI blood oxygen level-dependent (BOLD) signals to the sight and/or taste of the stimuli were recorded.

RESULTS

A whole-brain cluster-corrected analysis (P < 0.05) showed that satiation attenuated the BOLD response to both stimulus types in the ventromedial prefrontal cortex (vmPFC), orbitofrontal cortex, nucleus accumbens, hypothalamus, and insula but increased BOLD activity in the dorsolateral prefrontal cortex (dlPFC; local maxima corrected to P ≤ 0.001). A psychophysiological interaction analysis showed that the vmPFC was more highly connected to the dlPFC when individuals were exposed to food stimuli when satiated than when not satiated.

CONCLUSIONS

These results suggest that natural satiation attenuates activity in reward-related brain regions and increases activity in the dlPFC, which may reflect a "top down" cognitive influence on satiation. This trial was registered at clinicaltrials.gov as NCT02298049.