Pharmacokinetics of amikacin after intravenous, intra-articular, and combined intravenous and intra-articular administration in healthy neonatal foals

BACKGROUND

Pharmacokinetics of amikacin administered IV to neonatal foals are described, but little data are available regarding the plasma concentrations contributed by concurrent intra-articular (IA) administration.

HYPOTHESIS/OBJECTIVES

Compare the pharmacokinetics of amikacin when the total dose is administered IV compared to being divided between IV and IA routes of administration in neonatal foals and predict the plasma concentrations from various combined IV and IA dosing regimens.

ANIMALS

Eight healthy neonatal foals.

METHODS

Foals received 3 amikacin treatment protocols: (1) IV-only (25 mg/kg q24h IV), (2) concurrent IV and IA (16.7 mg/kg q24h IV and 8.3 mg/kg q24h into 1 tarsocrural joint), and (3) IA-only (8.3 mg/kg q24h into 1 tarsocrural joint). Protocols were administered for 3 days beginning at 7, 14, and 21 days of age. Plasma concentrations ≥53 μg/mL at 30 minutes were considered therapeutic for isolates with intermediate susceptibility.

RESULTS

Foal age was a significant variable. The IV-only protocol met or exceeded the 30-minute plasma concentrations considered therapeutic (mean μg/mL [95% confidence interval, CI]) in 7- to 9-day-old (54.0 [52.2-56.9]), 14- to 16-day-old (58.1 [55.2-61.0]), and 21- to 23-day-old (66.6 [63.7-69.6]) foals. Concurrent IV and IA protocol did not reach the 30-minute concentration considered therapeutic in 7- to 9-day-old foals (46.5 [43.6-49.4]) but did in 14- to 16-day-old (62.9 [60.0-65.8]) and 21-to 23-day-old (62.6 [59.7-65.6]) foals.

CONCLUSIONS AND CLINICAL IMPORTANCE

Concurrent IV and IA administration of amikacin produces 30-minute plasma concentrations considered therapeutic in foals 14 to 23 days old, but concentrations observed in younger foals might be below those considered therapeutic for isolates with intermediate susceptibility to amikacin.

Navicular bone fracture and severe deep digital flexor tendinopathy after palmar digital neurectomy in two horses

Background

Navicular syndrome is a common cause of forelimb lameness in horses. Beyond changes to the navicular bone itself, horses with a clinical diagnosis of navicular syndrome often have pathology associated with other components of the navicular apparatus, including the navicular bursa, deep digital flexor (DDF) tendon, collateral sesamoidean ligaments, and impar ligament. Palmar digital neurectomy (PDN) is often used as a salvage procedure for horses diagnosed with navicular syndrome that become unresponsive to medical management. There are many potential complications associated with PDN, some of which are debilitating.

Case Description

This report describes two cases of navicular bone fracture with severe DDF tendinopathy and distal interphalangeal joint subluxation/hyperextension that occurred 12 and 19 weeks after bilateral forelimb PDN.

Conclusion

These two cases highlight the importance of proper patient selection before PDN due to the high incidence of undiagnosed soft tissue pathology in conjunction with radiographic evidence of navicular syndrome. Advanced imaging of the digit is recommended to identify and characterize any soft tissue pathology associated with the navicular apparatus before pursuing PDN to avoid disease progression and catastrophic injury.

Partial ceratohyoidectomy as surgical treatment for horses with temporohyoid osteoarthropathy: 10 cases (2010-2021)

OBJECTIVE

To describe outcomes of horses with temporohyoid osteoarthropathy (THO) treated with partial ceratohyoidectomy.

ANIMALS

10 client-owned horses.

PROCEDURES

Medical records from 2 institutions were examined for records of horses with THO treated with partial ceratohyoidectomy between 2010 and 2021. History, signalment, clinical signs, diagnostics, medications, and surgery-related details were recorded. Horses with a minimum of 6 months follow-up were recruited for neurologic and imaging examinations in the hospital or field where radiography of the basihyoid-ceratohyoid articulation were performed along with CT, when available.

RESULTS

10 horses with THO were included (9 unilateral; 1 bilateral). Nine planned partial ceratohyoidectomies were performed in 8 horses, whereas 2 horses had preoperatively planned complete ceratohyoidectomies transitioned to partial ceratohyoidectomies during surgery due to intraoperative complications. Postoperative complications occurred mostly in transitioned surgeries (obstructed airway, tongue mobility issues, and incisional hemorrhage), whereas only 1 horse with a planned ceratohyoidectomy had postoperative complication of rhabdomyolysis. All complications resolved before hospital discharge. Neurologic signs improved in all 10 horses, with 2 showing complete resolution. Nine horses were available for radiographic follow-up, 6 of which also had head CT scans. A space between the ceratohyoid and basihyoid bones was measurable on radiography in all 9 horses, and was confirmed on CT. Three horses demonstrated proliferation of either ceratohyoid or basihyoid bones. The 9 horses with unilateral disease returned to previous work, and the horse with bilateral disease was retired.

CLINICAL RELEVANCE

Partial ceratohyoidectomy is a surgical option for treatment of THO that provides similar clinical outcomes to published reports on ceratohyoidectomy.

Adaptive Synthesis of a Rough Lipopolysaccharide in Geobacter sulfurreducens for Metal Reduction and Detoxification

The ability of some metal-reducing bacteria to produce a rough (no O-antigen) lipopolysaccharide (LPS) could facilitate surface interactions with minerals and metal reduction. Consistent with this, the laboratory model metal reducer Geobacter sulfurreducens PCA produced two rough LPS isoforms (with or without a terminal methyl-quinovosamine sugar) when growing with the soluble electron acceptor fumarate but expressed only the shorter and more hydrophilic variant when reducing iron oxides. We reconstructed from genomic data conserved pathways for the synthesis of the rough LPS and generated heptosyltransferase mutants with partial (ΔrfaQ) or complete (ΔrfaC) truncations in the core oligosaccharide. The stepwise removal of the LPS core sugars reduced the hydrophilicity of the cell and increased outer membrane vesiculation. These changes in surface charge and remodeling did not substantially impact planktonic growth but disrupted the developmental stages and structure of electroactive biofilms. Furthermore, the mutants assembled conductive pili for extracellular mineralization of the toxic uranyl cation but were unable to prevent permeation and mineralization of the radionuclide in the cell envelope. Hence, not only does the rough LPS promote cell-cell and cell-mineral interactions critical to biofilm formation and metal respiration but it also functions as a permeability barrier to toxic metal cations. In doing so, the rough LPS maximizes the extracellular reduction of soluble and insoluble metals and preserves cell envelope functions critical to the environmental survival of Geobacter bacteria in metal-rich environments and their performance in bioremediation and bioenergy applications. IMPORTANCE Some metal-reducing bacteria produce an LPS without the repeating sugars (O-antigen) that decorate the surface of most Gram-negative bacteria, but the biological significance of this adaptive feature was not previously investigated. Using the model representative Geobacter sulfurreducens strain PCA and mutants carrying stepwise truncations in the LPS core sugars, we demonstrate the importance of the rough LPS in the control of cell surface chemistry during the respiration of iron minerals and the formation of electroactive biofilms. Importantly, we describe hitherto overlooked roles for the rough LPS in metal sequestration and outer membrane vesiculation that are critical for the extracellular reduction and detoxification of toxic metals and radionuclides. These results are of interest for the optimization of bioremediation schemes and electricity-harvesting platforms using these bacteria.

Freshwater diatom persistence on clothing II: Further analysis of species assemblage dynamics over investigative timescales

Diatoms are a useful form of environmental trace evidence, yielding a circumstantial link between persons and scenes of forensic interest. A developing empirical research base has sought to understand those factors affecting the transfer and persistence of freshwater diatoms on clothing and footwear surfaces. Although an initial study has demonstrated that diatoms can persist on clothing following weeks of wear, no previous research has explored the temporal dynamics of a persistent species assemblage over timescales pertinent to forensic investigations. This study therefore aimed to determine if: (1) valve morphology (size and shape) influences diatom persistence, (2) the relative abundance of taxa within an assemblage affects retention, and (3) a persistent diatom assemblage retrieved from clothing after one month can reliably be compared to the site of initial transfer. To build on previous research findings which highlighted the impact of substrate and environmental seasonality on diatom transfer and persistence, here, nine clothing materials were tested in spring before a seasonal comparison in the winter. Fabric swatches were immersed in a freshwater river, worn attached to clothing, and subsamples retrieved at regular intervals (hours, days, weeks) up to one month post-immersion. Diatoms were extracted using a H2O2 technique and analysed via microscopy. The results indicated that smaller diatoms (< 10 µm) are retained in significantly greater abundance, with no statistically significant difference between centric and pennate diatom loss over time. Although a persistent species assemblage was relatively stable over the one month of wear, significant differences were identified between clothing substrate in the spring and between the seasonal samples. The most abundant environmental taxa were consistently identified in the forensic samples, with greater variability attributed to the retention of relatively less common species. The findings suggest that, despite a loss in the abundance and species-richness of diatoms retrieved from clothing over time, a persistent assemblage may provide a useful circumstantial link to the site of initial transfer. The complex relationships between clothing type, environmental seasonality, and time since wear on retention, emphasise the need for diatom trace evidence to be carefully interpreted within an exclusionary framework, and the significance of any casework findings to be determined with reference to empirical evidence bases.

Massively parallel sequencing is unlocking the potential of environmental trace evidence

Massively parallel sequencing (MPS) has revolutionised the field of genomics enabling substantial advances in human DNA profiling. Further, the advent of MPS now allows biological signatures to be obtained from complex DNA mixtures and trace amounts of low biomass samples. Environmental samples serve as ideal forms of contact trace evidence as detection at a scene can establish a link between a suspect, location and victim. Many studies have applied MPS technology to characterise the biodiversity within high biomass environmental samples (such as soil and water) to address questions related to ecology, conservation, climate change and human health. However, translation of these tools to forensic science remains in its infancy, due in part to the merging of traditional forensic ecology practices with unfamiliar DNA technologies and complex datasets. In addition, people and objects also carry low biomass environmental signals which have recently been shown to reflect a specific individual or location. The sensitivity, and reducing cost, of MPS is now unlocking the power of both high and low biomass environmental DNA (eDNA) samples as useful sources of genetic information in forensic science. This paper discusses the potential of eDNA to forensic science by reviewing the most explored applications that are leading the integration of this technology into the field. We introduce novel areas of forensic ecology that could also benefit from these tools with a focus on linking a suspect to a scene or establishing provenance of an unknown sample and discuss the current limitations and validation recommendations to achieve translation of eDNA into casework.

The affect of personality traits and decision-making style on postoperative quality of life and distress in patients undergoing pelvic exenteration

AIM

Our aim was to identify whether personality traits and decision-making styles affect quality of life (QoL) outcomes and levels of psychological distress following pelvic exenteration (PE).

METHOD

Patients undergoing PE between 2008 and 2015 were identified from a prospectively maintained database at a single quaternary referral centre. Patients were invited to complete two validated questionnaires, with the Big Five inventory being used to assess personality traits and the Melbourne Decision Making Questionnaire to determine decision-making style. Data on QoL outcomes and distress from the prospectively established database were utilized. QoL with respect to both physical and mental health components was measured using Short Form 36 version 2 (SF-36v2) and the Functional Assessment of Cancer Therapy - Colorectal (FACT-C). Distress was measured using the Distress Thermometer. Postoperative pain scores were also measured using SF-36v2.

RESULTS

Of the 93 patients eligible for participation, 42 returned the study questionnaire. On multivariate analysis, neuroticism was the most significant predictor of poorer QoL and increased levels of distress, consistent across all of the measures utilized and at the different time points used. Other personality traits showed an isolated statistically significant impact upon QoL. There were no significant findings with respect to decision-making style. Apart from neuroticism, the most significant predictor of QoL was the number of major complications for the patient.

CONCLUSION

Patients demonstrating neurotic personality traits show poorer QoL outcomes and higher levels of distress following PE. Identification of these patients would allow targeted pre- and postoperative intervention to improve outcomes following PE.

The effects of flunixin meglumine and hoof trimming on lying behavior, locomotion, and milk production in lame and nonlame lactating dairy cows

Hoof trimming is used to prevent and treat lameness in dairy cows; however, hoof trimming itself increases daily time spent lying down, possibly due to discomfort. We hypothesized that treatment of lame and nonlame cows with an anti-inflammatory analgesic drug at the time of hoof trimming would mitigate discomfort, thereby improving locomotion scores and reducing post-trimming increases in lying time. We further hypothesized that drug treatment would improve post-trimming milk production. Our objective was to determine the effects of treatment with the nonsteroidal anti-inflammatory drug flunixin meglumine (2.2 mg/kg of BW) at the time of hoof trimming on locomotion, lying times, and milk production in lame and nonlame lactating dairy cows. All cows were filmed for locomotion scoring 1 d before and 1, 8, and 28 d after hoof trimming. Daily time spent standing and lying was recorded for 4 d before and 4 wk after hoof trimming, and daily milk production was recorded for 1 wk before and 8 wk after trimming. Thirty minutes before hoof trimming, an intravenous injection of flunixin meglumine (n = 34) or isotonic sterile saline solution (n = 34) was administered to each cow. Then, all cows had their hooves trimmed using the Dutch method. The same treatment was repeated 24 h after hoof trimming. Cows were categorized using baseline locomotion scores as lame (score ≥3/5) or nonlame (score <3/5). Drug treatment did not affect post-trimming changes in locomotion scores, daily lying times, or milk production. In both treatment groups, most cows had the same lameness status (lame or nonlame) at baseline and after treatment, and there was no difference between groups in the number of cows that changed lameness status over time. Lame cows (n = 21) had no significant changes in lying times over the course of the study, whereas nonlame cows (n = 47) had mean daily lying times that were significantly higher than baseline all 4 wk after trimming. Hoof trimming in nonlame cows should be scheduled for a time when increased lying behavior after trimming can be accommodated.

Efficacy of orally administered gabapentin in horses with chronic thoracic limb lameness

OBJECTIVE

To evaluate the analgesic effects of orally administered gabapentin on horses with chronic thoracic limb lameness.

STUDY DESIGN

Randomized, crossover design.

ANIMALS

A total of 14 adult horses with chronic thoracic limb lameness.

METHODS

Following baseline measurement of lameness, horses were administered each of four treatments orally in grain: treatment G, gabapentin (20 mg kg^-1) twice daily for 13 doses; treatment F, firocoxib (171 mg once, then 57 mg once daily for six doses); treatment GF, gabapentin and firocoxib at previously stated doses and frequencies; or treatment C, grain only as a control. Treatments were administered in a randomized, crossover design, separated by 2 weeks. Subjective lameness score (SLS), inertial sensor vector sum (VS) calculations, peak vertical ground reaction force (PVGRF) measurements and vertical impulse (VI) calculations were determined immediately prior to each initial treatment dose and 2-4 hours after the final treatment dose for each treatment. Mean change in SLS, VS, PVGRF and VI for each treatment were compared among treatments.

RESULTS

The rank change in SLS of treatment GF was significantly greater than that of treatments C (p = 0.01) and G (p = 0.01) but not of treatment F (p = 0.08). No differences in VS (p = 0.4), PVGRF (p = 0.4) or VI (p = 0.1) were observed among treatments.

CONCLUSIONS AND CLINICAL RELEVANCE

Gabapentin, as administered here, did not improve subjective or objective measures of lameness in horses with chronic thoracic limb musculoskeletal pain. Although subjective evaluation identified an improvement in lameness with treatment GF, it was not different from that observed with treatment F. Higher oral dosing and longer treatment regimens of gabapentin may be indicated for the treatment of chronic musculoskeletal pain in horses.

Pushing the boundaries of pelvic exenteration by maintaining survival at the cost of morbidity

BACKGROUND

Pelvic exenteration (PE) provides a potentially curative option for advanced or recurrent malignancy confined to the pelvis. A clear (R0) resection margin is the strongest prognostic factor predicting long-term survival, driving most technical advances in PE surgery. The aim of this cohort study was to describe changing trends in extent of resection, postoperative complications, mortality and overall survival after PE surgery.

METHODS

Consecutive patients who underwent PE for advanced or recurrent pelvic malignancy at a single institution in Sydney, Australia, were identified. The cohort was divided into three groups based on time periods reflecting annual surgical volume: 1994-2006 (20 or fewer procedures per year), 2007-2013 (21-50 procedures per year) and 2014-2017 (over 50 procedures per year). Primary outcomes were extent of resection, postoperative complications, 60-day mortality and 3-year overall survival. Secondary outcomes were patient characteristics, receipt of neoadjuvant therapy and duration of hospital stay.

RESULTS

There were increases over time in rates of lateral and posterior compartment resections (P < 0·001), and bony pelvis (P = 0·002) and neurovascular (P < 0·001) excision. For patients undergoing reconstruction, the proportion receiving vertical rectus abdominus myocutaneous flaps increased significantly (P = 0·005). Rates of wound infection, dehiscence, and abdominal and pelvic collections increased over the study interval. Short-term mortality decreased, and 1- and 3-year survival rates improved.

CONCLUSION

Technical and surgical advancements have led to more complex PE resections, with R0 and mortality rates improving with higher annual volume. There were associated increases in intraoperative blood loss and postoperative morbidity.

Subtourniquet pressures generated by application of wide-rubber tourniquets in standing, sedated horses

OBJECTIVE

To determine the influence of location and movement on subtourniquet pressure (STP) generated by application of a wide-rubber tourniquet (WRT) on equine limbs.

STUDY DESIGN

Randomized experimental cross-over design.

ANIMALS

Six standing, sedated horses.

METHODS

Horses were sedated with detomidine hydrochloride (0.2 μg/kg IV), and 4 investigators applied WRTs to the antebrachium (AB), gaskin (GK), and midmetacarpus (MC) of each horse in a predetermined, randomized order. Subtourniquet pressure was consequently measured at 10-minute intervals (T0, T10, T20, T30) for 30 minutes. Indirect systolic blood pressure (SBP) was measured presedation, postsedation, and throughout the tourniquet application period. Target STP was established as SBP + 100 mm Hg. Limb movements at each location were classified as none, low, moderate, or high, on the basis of counts and magnitude.

RESULTS

Mean STP did not change with time (P = .93) and exceeded SBP by 163 mm Hg (95% CI 122-205), 185 mm Hg (95% CI 156-214), and 402 mm Hg (95% CI 351-454) at the AB, GK, and MC, respectively. Mean STP at each location exceeded the target STP in 59 of 70 (81%) of the trials. Limb movements affected STP generated by tourniquets at the AB (P = .04) and MC (P < .0001) but not at the GK (P = .67).

CONCLUSION

Wide-rubber tourniquets applied at the AB, GK, and MC generated STP >100 mm Hg above SBP for 30 minutes in standing, sedated horses.

CLINICAL SIGNIFICANCE

Wide-rubber tourniquets as applied in this study can achieve and maintain the current recommended STP (SBP + 100 mm Hg) for equine IV regional limb perfusion. Number and magnitude of limb movement can decrease STP over time, potentially reducing the efficacy of a WRT.

Gum chewing aids bowel function return and analgesic requirements after bowel surgery: a randomized controlled trial

AIM

The aim was to compare the effectiveness of chewing sugar-free gum after bowel resection on bowel function and length of stay.

METHOD

This was a randomized controlled trial of patients undergoing elective open or laparoscopic bowel surgery, who were allocated into two groups: a chewing gum group (CG); or a nonchewing gum group (NG). Primary outcomes were time to discharge (length of hospital stay [LOS]), time to first flatus (TFF) and time to first bowel motion (TBM). Secondary outcomes were complication rates, pain and total morphine equivalent (TMEq) medication for 7 days after the procedure.

RESULTS

Between 2010 and 2013, 162 patients were randomized; four were excluded, leaving 158 in the study (82 in the CG and 76 in the NG). There was no difference in LOS between the CG (5.8 days) and the NG (6.1 days) (P = 0.403) or in the median TFF between the CG (42.0 h) and the NG (58.0 h) (P = 0.076). The median TBM was lower in the CG (40.0 h) than in the NG (90.0 h) (P = 0.002). There was no difference in intra-operative complications between the CG (9%) and the NG (9%) (P = 0.901) or in early postoperative complications (44% for CG and 55% for NG) (P = 0.131). There was no difference in TMEq at 24 h postprocedure, but the CG had reduced TMEq from days 2 to 7 post procedure and for the 7-day total. Pain was higher among patients in the NG on day 3.

CONCLUSION

Chewing sugar-free gum resulted in an earlier return to bowel function and decreased analgesic requirements. There was no decrease in overall LOS or postoperative complications.

Effect of lower-energy, higher-fiber diets on pigs divergently selected for residual feed intake when fed higher-energy, lower-fiber diets

Residual feed intake (RFI) is the difference between observed and predicted feed intake of an animal, based on growth and maintenance requirements. In Yorkshire pigs, divergent selection for increased (Low RFI) and decreased (High RFI) RFI was carried out over 10 generations (G) while feeding a corn- and soybean-meal-based, higher-energy, lower-fiber (HELF) diet. In G8 to G10, representing 4 replicates, barrows and gilts (n = 649) of the RFI lines were fed the HELF diet and a diet incorporating coproducts that were lower in energy and higher in dietary fiber (LEHF). The diets differed in ME, 3.32 vs. 2.87 Mcal/kg, and in neutral detergent fiber (NDF), 9.4% vs. 25.9%, respectively. The impact of the LEHF diet on 1) performance and growth, 2) diet digestibility, 3) genetic parameter estimates, and 4) responses to selection for RFI, when fed the HELF, was assessed. In general, the LEHF diet reduced the performance of both lines. When fed the HELF diet, the Low RFI pigs had lower (P < 0.05) ADFI (-12%), energy intake (-12%), ADG (-6%), and backfat depth (-12%); similar (P > 0.05) loin muscle area (LMA; +5%); and greater (P < 0.05) feed efficiency (i.e., 8% higher G:F and 7% lower RFI) than the High RFI line. These patterns of line differences were still present under the LEHF diet but differences for ADFI (-11%), energy intake (-10%), G:F (+2%), and RFI (-6%) were reduced compared to the HELF diet. Apparent total tract digestibility (ATTD) of the HELF and LEHF diets was assessed using 116 barrows and gilts from G8. When fed the HELF diet, ATTD of DM, GE, N, and NDF were similar between lines (P ≥ 0.27), but when fed the LEHF diet, the Low RFI pigs had greater digestibility (7%, 7%, 10%, and 32%) than the High RFI line (P ≤ 0.04). To measure responses to selection for RFI and estimate genetic parameters, data from all 10 generations were used (HELF; n = 2,310; LEHF, n = 317). Heritability estimates of performance traits ranged from 0.19 to 0.63, and genetic correlations of traits between diets were high and positive, ranging from 0.87 (RFI) to 0.99 (LMA). By G10, RFI in the Low RFI line was 3.86 and 1.50 genetic SD lower than in the High RFI line when fed the HELF and LEHF diets, respectively. Taken together, the results of this study demonstrate that responses to selection for RFI when fed a HELF diet are not fully realized when pigs are fed an extremely LEHF diet. Thus, feeding diets that differ from those used for selection may not maximize genetic potential for feed efficiency.

A randomized controlled trial of four different regimes of biofeedback programme in the treatment of faecal incontinence

AIM

Biofeedback is an established, effective and non-invasive treatment for faecal incontinence (FI). The aim was to compare the effectiveness of four different biofeedback treatment regimes.

METHOD

This was a randomized control trial of patients with FI, stratified into two groups (metropolitan and rural) and then randomized into two subgroups (groups 1 and 2 within metropolitan, groups 3 and 4 within rural) with varying face-to-face and telephone biofeedback components. All patients received standardized counselling and education, dietary modification and the use of anti-diarrhoeal medications. Group 1 received four monthly face-to-face biofeedback treatments, groups 2 and 3 received one face-to-face biofeedback followed by telephone biofeedback and group 4 received a one-off face-to-face biofeedback treatment. Primary outcomes were patient-assessed severity of FI and quality of life as assessed by the 36-item Short Form Health Survey and direct questioning of objectives. Secondary outcomes included St Mark's incontinence score, anxiety, depression and anorectal physiology measures (resting, squeeze pressures; isotonic, isometric fatigue times).

RESULTS

Between 2006 and 2012, 351 patients were recruited. One patient died leaving 350 for analysis. 332 (95%) were women. Mean age was 60 (SD = 14). All groups had significant improvements in FI, quality of life, incontinence score and mental status (P < 0.001 each). There were no differences in improvements in FI between groups although patient satisfaction was less with reduced face-to-face contact. There were modest improvements in isotonic and isometric fatigue times suggesting improved sphincter endurance (both P < 0.001).

CONCLUSION

Biofeedback is effective for FI. Although face-to-face and telephone biofeedback is not necessary to improve FI, it is important for patient satisfaction.

Short communication: Behavioral evaluation of the analgesic effect of flunixin meglumine in lame dairy cows

The objective of this study was to evaluate the effect of flunixin meglumine treatment on lameness pain in dairy cows. Twenty-four lactating Holstein cows were enrolled in the study based on visual observation of abnormal locomotion. The primary measurement endpoint was weight-shifting between the rear limbs. Weight-shifting was calculated as the standard deviation of the weight borne on the rear limbs over a 15 min period; this value correlates directly with lameness pain in dairy cows. After collecting baseline weight-bearing data, we randomly assigned cows to 1 of 2 treatment groups: 2.2 mg/kg body weight flunixin meglumine (2 mL/45 kg) or an equivalent volume of isotonic sterile saline solution. Weight-bearing data were collected from each cow at 2, 6, 12, and 24 h after a single intravenous drug treatment. Mean locomotion scores over the 2 d before treatment were 2.38/5 in the flunixin-treated group and 2.43/5 in the saline-treated control group; these values were not significantly different. Weight-shifting values were also not significantly different on either pretreatment day. Cows treated with flunixin meglumine showed significantly less weight-shifting between the rear limbs at 6, 12, and 24 h after treatment compared with saline-treated controls, providing evidence that flunixin meglumine alleviates lameness-associated pain.

Genomewide association analysis of sow lactation performance traits in lines of Yorkshire pigs divergently selected for residual feed intake during grow-finish phase

Lactation is an economically and biologically important phase in the life cycle of sows. Short generation intervals in nucleus herds and low heritability of traits associated with lactation along with challenges associated with collecting accurate lactation performance phenotypes emphasize the importance of using genomic tools to examine the underlying genetics of these traits. We report the first genomewide association study (GWAS) on traits associated with lactation and efficiency in 2 lines of Yorkshire pigs that were divergently selected for residual feed intake during grow-finish phase. A total of 862 farrowing records from 2 parities were analyzed using a Bayesian whole genome variable selection model (Bayes B) to locate 1-Mb regions that were most strongly associated with each trait. The GWAS was conducted separately for parity 1 and 2 records. Marker-based heritabilities ranged from 0.03 to 0.39 for parity 1 traits and from 0.06 to 0.40 for parity 2 traits. For all traits studied, around 90% of genetic variance came from a large number of genomic regions with small effects, whereas genomic regions with large effects were found to be different for the same trait measured in parity 1 and 2. The highest percentage of genetic variance explained by a 1-Mb window for each trait ranged from 0.4% for feed intake during lactation to 4.2% for back fat measured at farrowing in parity 1 sows and from 0.2% for lactation feed intake to 5.4% for protein mass loss during lactation in parity 2 sows. A total of thirteen 1-Mb nonoverlapping windows were found to explain more than 1.5% of genetic variance for either a single trait or across multiple traits. These 1-Mb windows were on chromosomes 2, 3, 6, 7, 8, 11, 14, 15, 17, and 18. The major positional candidate genes within 1 Mb upstream and downstream of these windows were , (SSC2), (SSC6) (SSC7), (SSC8), (SSC11), (SSC14), (SSC17). Further validation studies on larger populations are required to validate these findings and to improve our understanding of the biology and complex genetic architecture of traits associated with sow lactation performance.

Effect of selection for residual feed intake during the grow/finish phase of production on sow reproductive performance and lactation efficiency

As feed costs continue to rise and efficiency during finishing is emphasized, the impact of selecting for more efficient grow/finish pigs on reproductive performance and feed efficiency of sows must be evaluated. Therefore, the objectives of this study were to evaluate correlated responses for sow reproductive performance and lactation feed efficiency to selection for residual feed intake (RFI) during the grow/finish phase of production (RFI) in 2 selection lines of pigs developed at Iowa State University (Ames, IA) and to estimate heritabilities of these traits. One line was selected over 7 generations for decreased RFIG/F (low RFI [LRFI] line) and the other line was randomly selected for 5 generations and then selected for increased RFIG/F (high RFI [HRFI] line). After 7 generations of selection, LRFI sows had 1.0 more piglets farrowed ( = 0.11) compared with HRFI sows, 1.3 more pigs born alive ( < 0.05), similar farrowing survival, 0.4 fewer mummies ( < 0.01), and more piglets weaned, both by litter (1.6 more; < 0.01) and by sow (1.1 more; < 0.01). Low RFI sows consumed 25 kg less feed and lost 9.8 kg more BW, 7.0 kg more fat mass, and 3.1 mm more backfat than HRFI sows ( < 0.001) during lactation. Although LRFI sows had a greater negative energy balance (-19.8 vs. -8.0 MJ ME/d; < 0.001), they had better RFI during lactation (-28.6 vs. 8.2 kg; < 0.0001), and the trend was for LRFI sows to have better lactation efficiency (61.3 vs. 57.8%; = 0.47) than HRFI sows. Heritabilities for sow weights, sow body composition, sow maintenance requirements (estimated from BW), and piglet birth weight were high ( > 0.4, SE < 0.07). Traits pertaining to piglet growth during lactation and mobilization of body tissue of the sow were moderately heritable (0.2 < < 0.4, SE < 0.07). In conclusion, selection for decreased RFI has favorably affected piglet performance and lactation efficiency but has unfavorably affected sow body condition loss and energy balance during lactation. These results indicate that pigs selected for increased efficiency during grow-finish are better able to direct resources where needed during other life history phases, that is, reproduction and lactation.

Cost-effectiveness of pelvic exenteration for locally advanced malignancy

Background

The rising cost of healthcare is well documented. The purpose of this study was to determine the cost-effectiveness of pelvic exenteration (PE).

Methods

Consecutive patients referred for consideration of PE between 2008 and 2011 were recruited into a prospective non-randomized study that compared quality of life (QoL) between patients who did or did not undergo PE. Information on QoL and cost (in Australian dollars, AUD) was collected at baseline, during admission and up to 24 months after discharge. QoL data were converted into a utility-based measure. Quality-adjusted life-years (QALYs) were calculated. Bottom-up costing was performed. The incremental cost-effectiveness ratio (ICER) was calculated per life-year saved and per QALY.

Results

There were 174 patients with sufficient data for analysis. Of these, 139 underwent PE. R0 was achieved in 78·4 per cent of patients. The survival rate at 24 months after PE was 74·8 per cent compared with 43 per cent in those without exenteration (P = 0·001). Treatment costs were significantly higher for patients who had PE compared with those who did not (mean AUD 137 407 versus 79 174; P &lt; 0·001). The ICER was AUD 124 147 (95 per cent c.i. 71 585 to 261 876) per life-year saved and AUD 227 330 (109 974 to 1 100 449) per QALY. Curative PE (R0) was found to be more cost-effective than non-curative PE (R1/R2), with an ICER of AUD 101 518 (60 105 to 200 428) versus 390 712 (74 368 to 82 256 739) per life-year saved.

Conclusion

Treatment of advanced pelvic cancers is expensive regardless of the treatment intent. For a cost difference of only AUD 58 000 (€38 264), PE offers a chance of cure, and improves survival and QoL.

Assessing peripheral blood cell profile of Yorkshire pigs divergently selected for residual feed intake

The cost of feed is a serious issue in the pork industry, contributing about 65 to 75% of the total production cost. To prevent economic losses and decreased productivity of the herd, it is important to select for animals that eat less for the same lean gain, or more efficient animals. Residual feed intake (RFI) is the difference between observed feed intake and expected feed intake based on estimated maintenance and production requirements. Selection for decreased RFI, or more efficient animals, is a potential solution to higher feed costs in pig production. However, animals that are highly selected for decreased RFI may have reduced energy input to the immune system and fail to withstand diseases and stressors after infection that negatively impact profitability. The objective of this study was to evaluate differences in circulating blood cell profiles at a young age between 2 lines of Yorkshire pigs that were divergently selected for RFI as well as the heritability of these traits, to investigate effects of selection for RFI on immune system parameters, and to identify potential biomarkers for feed efficiency. Previous work has shown that the 2 lines had diverged for IGF-1 in serum in young pigs and, therefore, this stage was investigated for other potential physiological differences. Blood samples were drawn for a complete blood count (CBC) analysis from 517 gilts and barrows, ages 35 to 42 d, across the 2 lines. In general, the low-RFI line had lower numbers of specific types of white blood cells but higher hemoglobin concentration and red blood cell volume compared to the high-RFI line. No significant correlations were found between CBC traits and RFI across and within the lines (0.05 < < 0.1). Of the 15 CBC traits that were measured, 3 were highly heritable (0.56 < < 0.62), 9 were moderately heritable (0.12 < < 0.47), and 3 were lowly heritable ( < 0.12), suggesting a substantial genetic component for CBC traits and that selection for CBC traits could be effective. Our results also show that selection for RFI has significantly impacted the number of circulating blood cells. In this experiment, we studied only healthy animals that were not under known pathogen challenge; therefore, our results cannot be directly applied to a disease challenge situation. Future work will be to challenge the animals and determine the effect of challenge on CBC levels.

Composition and quality characteristics of carcasses from pigs divergently selected for residual feed intake on high- or low-energy diets

The objective was to determine the extent to which feeding low-energy, high-fiber (LEHF) and high-energy, low-fiber (HELF) diets impacts meat quality and carcass composition of pigs divergently selected for residual feed intake (RFI). Two experiments were conducted in the divergently selected Iowa State University RFI lines: Exp. 1 evaluated carcasses of generation (G) 8 pigs fed on commercial feeders; Exp. 2 evaluated composition, pork quality, sensory, and postmortem proteolysis of pigs fed on electronic single-space feeders in G 8 and 9. Pigs (N = 177) in Exp. 1 were randomly assigned a pen (mixed sex and line; N = 8). Groups (n = 3) of pigs were slaughtered at a mean BW of 121.5 kg. Pigs in Exp. 2 (G8: n = 158; G9: n = 157) were randomly assigned to 1 of 6 pens of each diet per G. Pigs from G8 were slaughtered at a mean BW of 122.5 kg and G9 at a mean of 128.4 kg. Data were analyzed using the mixed procedure of SAS. Fixed effects were line, diet, sex, and all appropriate interactions. Random effects were group, pen, litter, and sire and covariate of off-test BW. For Exp. 2, G was added as a fixed effect and sensory day was added as a random effect when applicable. In Exp. 1, carcasses from low RFI (LRFI) pigs were leaner and had less fat depth (P < 0.01). Carcasses from pigs fed the LEHF diet had a lighter HCW and greater estimated percent lean than pigs fed HELF diet (P < 0.01). In Exp. 2, LRFI pigs on the HELF diet had the greatest loin depth (P < 0.01). Chops from HRFI pigs had greater drip loss, color scores, lean tissue a*, and percent lipid and lesser percent moisture than LRFI ( P< 0.05). Chops from pigs on the LEHF diet had lesser muscle L* values and greater percent moisture than chops from pigs fed the HELF diet (P < 0.05). Chops from LRFI pigs were juicer than those from HRFI pigs (P < 0.05). Protein extracted at d 2 postmortem from LRFI pigs on the LEHF diet had a greater 38 kDa desmin degradation product than protein from LRFI pigs fed the HELF diet (P < 0.05). Day 5 postmortem extracted protein from HRFI pigs had greater 38 kDa desmin degradation product than LRFI (P = 0.05). Pigs fed LEHF (P < 0.01) had adipose with a greater iodine value than adipose from HELF fed pigs. Pork sensory quality from pigs differentially selected for residual feed intake was not influenced by energy content of the diet the pigs were fed.

Fermentation of glycerol into ethanol in a microbial electrolysis cell driven by a customized consortium

The in situ generation of ethanol from glycerol-containing wastewater shows promise to improve the economics of the biodiesel industry. Consequently, we developed a microbial electrolysis cell (MEC) driven by the synergistic metabolisms of the exoelectrogen Geobacter sulfurreducens and the bacterium Clostridium cellobioparum, which fermented glycerol into ethanol in high yields (90%) and produced fermentative byproducts that served as electron donors for G. sulfurreducens. Syntrophic cooperation stimulated glycerol consumption, ethanol production, and the conversion of fermentation byproducts into cathodic H2 in the MEC. The platform was further improved by adaptively evolving glycerol-tolerant strains with robust growth at glycerol loadings typical of biodiesel wastewater and by increasing the buffering capacity of the anode medium. This resulted in additional increases in glycerol consumption (up to 50 g/L) and ethanol production (up to 10 g/L) at rates that greatly exceeded the capacity of the anode biofilms to concomitantly remove the fermentation byproducts. As a result, 1,3-propanediol was generated as a metabolic sink for electrons not converted into electricity syntrophically. The results highlight the potential of consortia to process glycerol in MECs and provide insights into genetic engineering and system design approaches that can be implemented to further improve MEC performance to satisfy industrial needs.

Patient and clinician preferences for surgical and medical treatment options in ulcerative colitis

AIM

When treating patients with refractory ulcerative colitis (UC), the choice between escalating medical management or surgery can be difficult. The aim of this study was to quantify the preferences of patients and clinicians for the treatment options in UC.

METHOD

Ulcerative colitis outpatients were interviewed to measure their preferences for five scenarios examining the management of acute and chronic UC, using a prospective measure of preference method that generates two utility scores: willingness and amount of expected life to trade or gamble. A self-administered questionnaire was mailed to Australian and New Zealand colorectal surgeons and gastroenterologists.

RESULTS

Fifty-five patients (26 medical and 29 surgical), 91 surgeons and 78 gastroenterologists were surveyed. In the acute setting, 89% of patients, 69% of gastroenterologists and 55% of surgeons were willing to trade part of their life expectancy to avoid a permanent stoma, while for chronic disease 71% of patients were prepared to trade to avoid an operation with a permanent stoma compared with 55% for an operation with a pouch (P = 0.01). Both patients and gastroenterologists were more prepared to gamble or trade to avoid any surgery than were colorectal surgeons. All groups were aligned in their decision to undergo yearly colonoscopy surveillance rather than to undergo definitive surgery that would result in a stoma.

CONCLUSION

Patient preferences for the treatment of UC were more aligned to those of gastroenterologists than those of colorectal surgeons. Despite postoperative studies revealing an equal quality of life for pouch and stoma patients, this study confirmed that a pouch is the preferred surgical option.

Quality of life and other patient-reported outcomes following exenteration for pelvic malignancy

BACKGROUND

Pelvic exenteration is highly radical surgery offering the only potential cure for locally advanced pelvic cancer. This study compared quality of life and other relevant patient-reported outcomes over 12 months for patients who did and those who did not undergo pelvic exenteration.

METHODS

Consecutive patients referred for consideration of pelvic exenteration completed clinical and patient-reported outcome assessments at baseline, hospital discharge (exenteration patients only), and 1, 3, 6, 9 and 12 months. Outcomes included cancer-specific quality of life (Functional Assessment of Cancer Therapy - Colorectal; FACT-C), physical and mental health status (Short Form 36 version 2), psychological distress (Distress Thermometer), and pain (study-specific composite) scores. Linear mixed modelling compared trajectories between exenteration and no-exenteration groups.

RESULTS

Among 182 patients, 148 (81.3 per cent) proceeded to exenteration. There were no baseline differences between the two groups. Among patients who had exenteration, the mean FACT-C score at baseline of 93.0 had reduced by 14·4 points at hospital discharge, but increased to 86·7 at 1 month after surgery and continued to improve, returning to baseline by 9 months. For patients in the no-exenteration group, FACT-C scores decreased between baseline and 1 month, increased slowly to 6 months and then began to decline at 9 months. There were few statistically or clinically significant differences in any patient-reported outcomes between the groups.

CONCLUSION

Quality of life and related patient-reported outcomes improve rapidly after pelvic exenteration surgery. For 9 months after surgery, these outcomes are comparable with those of similar do patients who do not have surgery; thereafter, there is a decline in patients who do not have exenteration. Pelvic exenteration can be performed with acceptable quality of life and patient-reported outcomes.

Identifying indicators of colorectal cancer care coordination: a Delphi study

AIM

Care coordination is an important aspect of the quality of cancer care but is difficult to evaluate due to the lack of valid and reliable measures. This study was conducted to identify a set of objective measures of colorectal cancer care coordination that could be included in a medical record audit tool.

METHOD

A two-stage Delphi study was conducted to gain consensus among a national panel of experts about the validity of 41 potential indicators of colorectal cancer care coordination that had been identified during a literature review. The expert panel comprised 20 members from the National Health and Medical Research Colorectal Cancer Guidelines Working Party plus representatives from cancer nursing/coordination, general practice and cancer consumers.

RESULTS

Consensus was reached on the validity of 15 of 41 potential indicators, including those that focused on practical aspects of communication (legibility, clarity, content and timeliness of hospital discharge letters, documentation of outcomes of multidisciplinary team meetings) and appropriateness (documentation of preoperative consultation with a stoma therapist, discussions and referrals for adjuvant therapy for appropriate patients, and treatment by an experienced colorectal surgeon). There was lack of consensus on the validity of indicators relating to access to and efficiency of services.

CONCLUSION

The study has identified a core set of measures considered to be valid indicators of colorectal cancer care coordination. A medical record audit based on these measures could be used to monitor adequacy of cancer care coordination and will complement subjective measures based on self-reported experiences of patients and carers.

Technical note: validation of electronic feeding stations as a swine research tool

Electronic feeding stations (EFS) were developed to automate data collection of individual animals housed in a group environment. In order for scientists to use EFS, such as feed intake recording equipment (FIRE), in research, data recorded electronically cannot differ from data recorded on calibrated scales. The objectives of 2 studies were to determine if data recorded by 2 FIRE stations (FIRE1 and FIRE2) were different from the same data recorded by calibrated scales and determine differences between the 2 independent FIRE stations. Body weight of pigs recorded by the platform scales of both FIRE stations did not differ (P > 0.6) from calibrated scales during a 21-d comparison (study 1). The weight of calibrated check weights recorded by the platform scale of FIRE1 tended to be less (P = 0.1) than the weight of check weights during a 126-d comparison (study 2). Feed disappearance recorded by FIRE1 was greater (P < 0.01) than recorded by calibrated scales during study 2. Feed dispensed to the FIRE trough and compared with calibrated scales did not differ (P ≥ 0.17) for either FIRE station during study 2. There were no differences (P ≥ 0.15) between FIRE1 and FIRE2 for any measured variables. The FIRE stations were not recalibrated during study 1. The platform scale of FIRE2 was recalibrated during study 2 when the percentage error between calibrated check weights and the weight recorded by FIRE exceeded 2.5%. The trough scales of FIRE1 and FIRE2 were recalibrated during study 2 when the percentage error between true weight of dispensed feed and the average recorded FIRE weight exceeded 4%. Establishing more stringent criteria for recalibration may have reduced differences among weights recorded by calibrated scales and weights recorded by FIRE. These data suggest that FIRE stations can be used in research; however, adequate verification procedures and recalibration criteria must be followed to ensure accuracy of data.

Assessment of abdominoperineal resection rate as a surrogate marker of hospital quality in rectal cancer surgery

Background

Rates of abdominoperineal resection (APR) have been suggested as a solitary surrogate marker for comparing overall hospital quality in rectal cancer surgery. This study investigated the value of this marker by examining the associations between hospital APR rates and other quality indicators.

Methods

Hospital-level correlations between risk-adjusted APR rates for low rectal cancer and six risk-adjusted outcomes and six care processes were performed (such as 30-day mortality, complications, timely treatment). The ability of APR rates to discriminate between hospitals' performance was examined by means of hospital variance results in multilevel regression models and funnel plots.

Results

A linked population-based data set identified 1703 patients diagnosed in 2007 and 2008 who underwent surgery for rectal cancer. Some 15·9 (95 per cent confidence interval (c.i.) 14·2 to 17·6) per cent of these patients had an APR. Among 707 people with low rectal cancer, 38·2 (34·6 to 41·8) per cent underwent APR. Although risk-adjusted hospital rates of APR for low rectal cancer varied by up to 100 per cent, only one hospital (1 per cent) fell outside funnel plot limits and hospital variance in multilevel models was not very large. Lower hospital rates of APR for low rectal cancer did not correlate significantly with better hospital-level outcomes or process measures, except for recording of pathological stage (r = −0·55, P = 0·019). Patients were significantly more likely to undergo APR for low rectal cancer if they attended a non-tertiary metropolitan hospital (adjusted odds ratio 2·14, 95 per cent c.i. 1·11 to 4·15).

Conclusion

APR rates do not appear to be a useful surrogate marker of overall hospital performance in rectal cancer surgery.

Mechanism of the sex difference in neuronal ischemic cell death

BACKGROUND

Stroke risk and outcome are different in men and women. We hypothesized that this is partly due to an inherent difference in susceptibility to ischemia between neurons from male vs. female brains. We tested whether neurons from male rodents are more susceptible to in-vitro ischemia than cells from females, and if this is related to increased expression of soluble epoxide hydrolase (sEH). sEH contributes to neuronal cell death by inactivating neuroprotective epoxyeicosatrienoic acids (EETs).

METHODS

Rodent cortical neurons were cultured, and exposed to oxygen-glucose deprivation (OGD); then cell death was measured. EETs levels were determined by LC-MS/MS. Expression of sEH-encoding ephx2 was determined by qRT-PCR. Western blotting, immunocytochemistry, and hydrolase activity assay assessed protein expression and activity.

RESULTS

Cell death after OGD was higher in neurons from males vs. females, which correlated with higher ephx2 mRNA and stronger sEH immunoreactivity. However, EETs levels were similar in both sexes and pharmacological inhibition of the hydrolase domain of sEH did not abolish the sex difference in cell death. Genetic knockout of sEH in mice abolished the sex difference observed in neurons isolated from these mice after OGD.

CONCLUSIONS

Cultured cortical neurons from females are more resistant to ischemia than neurons from males. Neurons from females have less sEH activity compared to neurons from males at baseline, although sEH levels were not measured after OGD. While pharmacological inhibition of the hydrolase domain of sEH does not affect cell death, knockout of the gene encoding sEH eradicates the sex difference seen in wild-type neurons, suggesting a role for further study of the lesser-known phosphatase domain of sEH and its role in sexual dimorphism in neuronal sensitivity to ischemia.

Activin B is produced early in antral follicular development and suppresses thecal androgen production

Little is known about the role of activin B during folliculogenesis. This study investigated the expression levels of activin/inhibin subunits (βA, βB, and α), steroid enzyme, and gonadotrophin receptors in theca (TC) and granulosa cells (GC) by QPCR and activin A and B and inhibin A protein levels in follicular fluid (FF) of developing sheep follicles during estrus and anestrus. The effect of activin B on androgen production from primary TC cultures in vitro was also assessed. During folliculogenesis, in anestrus and estrus, FF activin B concentrations and thecal and GC activin βB mRNA levels decreased as follicle diameter increased from 1–3 to >6 mm regardless of estrogenic status. Estrogenic preovulatory follicles had reduced concentrations of FF activins B and A, and TC and GCs expressed higher levels of activin βA mRNA at 3–4 mm, and TCs more inhibin α mRNA at >4 mm stages of development compared with nonestrogenic follicles. Activin B decreased androstenedione production from primary TCs in vitro, an effect blocked by inhibin A. Thus, sheep follicles 1–3 mm in diameter contained high FF levels of activin B, which decreased as the follicle size increased, and, like activin A, suppressed thecal androgen production in vitro, an effect blocked by inhibin. Furthermore, the theca of large estrogenic follicles expressed high levels of inhibin α and activin βA mRNA suggesting local thecal derived inhibin A production. This would inhibit the negative effects of thecal activins B and A ensuring maximum androgen production for enhanced estradiol production by the preovulatory follicle(s).

Inhibin removes the inhibitory effects of activin on steroid enzyme expression and androgen production by normal ovarian thecal cells

Activin and inhibin are important local modulators of theca cell steroidogenesis in the ovary. Using a serum-free primary theca cell culture system, this study investigated the effects of inhibin on theca cell androgen production and expression of steroidogenic enzymes. Androstenedione secretion from theca cells cultured in media containing activin, inhibin and follistatin was assessed by RIA over 144 h. Activin (1-100 ng/ml) suppressed androstenedione production. Inhibin (1-100 ng/ml) blocked the suppressive effects of added activin, but increased androstenedione production when added alone, suggesting it was blocking endogenous activin produced by theca cells. Addition of SB-431542 (activin receptor inhibitor) and follistatin (500 ng/ml) increased androstenedione production, supporting this concept. Infection of theca cells with adenoviruses expressing inhibitory Smad6 or 7 increased androstenedione secretion, confirming that the suppressive effects of activin required activation of the Smad2/3 pathway. Activin decreased the expression levels of steroidogenic acute regulatory protein (STAR), whereas STAR expression was increased by inhibin and SB-431542, alone and in combination. CYP11A was unaffected. The expression of CYP17 encoding 17α-hydroxylase was unaffected by activin but increased by inhibin and SB-431542, and when added in combination the effect was further enhanced. The expression of 3β-hydroxysteroid dehydrogenase (3β-HSD) was significantly decreased by activin, while inhibin alone and in combination with SB-431542 both potently increased the expression of 3β-HSD. In conclusion, activin suppressed theca cell androstenedione production by decreasing the expression of STAR and 3β-HSD. Inhibin and other blockers of activin action reversed this effect, supporting the concept that endogenous thecal activin modulates androgen production in theca cells.

Quantifying postdischarge unmet supportive care needs of people with colorectal cancer: a clinical audit

AIM

There are limited data concerning the unmet needs experienced by patients with colorectal cancer. The aim of this study was to identify unmet supportive care needs of people with colorectal cancer following discharge from hospital.

METHOD

Health service utilization was used as a measure of expressed unmet need. A retrospective case note review was conducted of 521 patients surgically treated for colorectal cancer at Royal Prince Alfred Hospital, Sydney, between 1 January 2004 and 31 December 2007. Case notes maintained by a cancer nurse specialist were reviewed to identify postdischarge occasions-of-service where unmet need was expressed. Logistic regression was conducted to investigate predictors of unmet need.

RESULTS

Of 521 patients, 219 (42%) patients had unmet supportive care needs, of which 50% of all needs was found in the physical domain. Twenty-six per cent of unmet needs was expressed within the first week following discharge from hospital after cancer surgery; however, 21% persisted after 6 months. Multivariate analysis indentified that in this cohort, younger age predicted the expression of an unmet need (AOR, 0.97; 95% CI, 0.96-0.99). People with rectal cancer remained significantly more likely to require more than one contact with the nurse to satisfy a need (AOR, 2.80; 95% CI, 1.60-5.01) and to report a physical need (AOR, 3.56; 95% CI, 2.03-6.27).

CONCLUSION

This study has shown that auditing the interactions of a cancer nurse with patients can provide information about unmet supportive care needs, which can be used to develop relevant supportive care services or interventions for people with colorectal cancer.

Efficacy and safety of leuprolide acetate 6-month depot for suppression of testosterone in patients with prostate cancer

Background:

This open-label study evaluated the efficacy and safety of a new leuprolide acetate 45 mg 6-month depot formulation in 151 men with prostate cancer who received 2 intramuscular injections administered 24 weeks apart.

Methods:

The primary efficacy measurement was the proportion of patients achieving suppression of serum testosterone to ⩽50 ng dl⁻¹ from week 4 through week 48. Adverse events (AEs) and hormonal and safety laboratory values were monitored.

Results:

The primary efficacy end point was achieved in 93.4% of subjects (95% confidence interval (89.2%, 97.6%)). There were nine escapes from testosterone suppression during the study, none of which were accompanied by a rise in PSA. By week 4, mean testosterone concentration was suppressed below castrate levels to 15.9 ng dl⁻¹; suppression was maintained for the entire 24-week duration of each depot injection. No mean increase in testosterone was observed after the second injection. Mean PSA levels were maintained below 3 ng ml⁻¹ from week 14 through the 48-week treatment period. The most frequent AE was flushing (58.3%). Injection site reactions were reported in 24.5% of patients.

Conclusions:

Leuprolide acetate 45 mg 6-month depot demonstrated rapid and sustained testosterone suppression through 12 months and was well tolerated. This 6-month leuprolide acetate depot will decrease the number of annual injections in the treatment of prostate cancer.

Elemental and non-elemental olfactory learning in Drosophila

Brain complexity varies across many orders of magnitude between animals, and it is often assumed that complexity underpins cognition. It is thus important to explore the cognitive capacity of widely used model organisms such as Drosophila. We systematically investigated the fly's ability to learn discriminations involving compound olfactory stimuli associated with shock. Flies could distinguish binary mixtures (AB+ CD-), including overlapping mixtures (AB+ BC-). They could learn positive patterning (AB+A- B-) but could not learn negative patterning (A+ B+ AB-) or solve a biconditional discrimination task (AB+ CD+ AC- BD-). Learning about the elements of a compound (AB+) was not affected by prior conditioning of one of the elements (A+ AB+): flies do not exhibit blocking in this task. We compare these results with the predictions from simulation of several well-known theoretical models of learning, and find none are fully consistent with the overall pattern of observed behaviour.

What is important in cancer care coordination? A qualitative investigation

Although it is widely recognised that better coordination of cancer care holds considerable potential to improve patients' experience of care and their outcomes, there is no agreed definition of the term 'care coordination' or consensus as to what it entails. An explorative descriptive qualitative study was undertaken to explore the views and experiences of key stakeholders to identify the key components of cancer care coordination. We conducted semi-structured individual and focus groups interviews with patients (n= 20) who have been treated for any cancer and carers (n= 4) as well as clinicians (n= 29) involved in cancer care, using open-ended questions. Data were collected until saturation of concepts was reached. A phenomenological approach based on grounded theory was used to explore the participants' experiences and views. Seven key components were identified: organisation of patient care, access to and navigation through the healthcare system, the allocation of a 'key contact' person, effective communication and cooperation among the multidisciplinary team and other health service providers, delivery of services in a complementary and timely manner, sufficient and timely information to the patient and needs assessment. The components of cancer care coordination identified provide an empirical basis for the development of metrics and interventions to improve this aspect of cancer care.

Effect of selection for residual feed intake on feeding behavior and daily feed intake patterns in Yorkshire swine

Residual feed intake (RFI) is a measure of feed efficiency defined as the difference between observed and predicted feed intake based on average requirements for growth and maintenance. The objective of this study was to evaluate the effect of selection for decreased RFI on feeding behavior traits and to estimate their relationships with RFI. Three data sets from the 4th and 5th generations of a selection experiment with a line selected for reduced RFI (LRFI) and a randomly selected control line (CTRL) were analyzed. Lines were mixed in pens of 16 and evaluated for feeding behavior traits obtained from a single-space electronic feeder over a growing period of ~3 mo before ~115 kg. The following traits were evaluated as averages over the entire test period and over the first and second half of the test period: number of visits per day and hour; occupation time per day, visit, and hour; feed intake (FI) per day, visit, and hour; and FI rate per visit. Models used included fixed effects of line and feeder, covariates of on-test age and FI per day, and random effects of pen, on-test group, sire, and litter. Repeated measures models were used to analyze feeding patterns during the day. The LRFI pigs had significantly less FI per day than CTRL pigs for all 3 data sets. With adjustment for FI per day, line differences of all traits were in the same direction for all 3 data sets but differed in significance and size. Feed intake per visit and hour and visits per day and hour did not differ between lines, but the trend was for LRFI pigs to have fewer visits, in particular during peak eating times. The LRFI pigs had a greater feeding rate and less occupation time per day, visit, and hour than CTRL pigs, but this was not significant for all data sets. Correlations of RFI with FI per day and visit and visits per day were positive. Average daily gain was positively correlated with FI per day and visit and occupation time per visit but negatively correlated with visits per day. Feed intake per day was positively correlated with backfat. In conclusion, feed efficiency may be affected by FI behavior because selection for decreased RFI has resulted in pigs that spend less time eating and eat faster.

Theca: the forgotten cell of the ovarian follicle

Theca cells function in a diverse range of necessary roles during folliculogenesis; to synthesize androgens, provide crosstalk with granulosa cells and oocytes during development, and provide structural support of the growing follicle as it progresses through the developmental stages to produce a mature and fertilizable oocyte. Thecal cells are thought to be recruited from surrounding stromal tissue by factors secreted from an activated primary follicle. The precise origin and identity of these recruiting factors are currently not clear, but it appears that thecal recruitment and/or differentiation involves not just one signal, but a complex and tightly controlled combination of multiple factors. It is clear that thecal cells are fundamental for follicular growth, providing all the androgens required by the developing follicle(s) for conversion into estrogens by the granulosa cells. Their function is enabled through the establishment of a vascular system providing communication with the pituitary axis throughout the reproductive cycle, and delivering essential nutrients to these highly active cells. During development, the majority of follicles undergo atresia, and the theca cells are often the final follicular cell type to die. For those follicles that do ovulate, the theca cells then undergo hormone-dependent differentiation into luteinized thecal cells of the corpus luteum. While the theca is an essential component of follicle development and ovulation, we do not yet fully understand the control of recruitment and function of theca cells, an important consideration since their function appears to be altered in certain causes of infertility.

Structure of the adult central complex in Drosophila: organization of distinct neuronal subsets

The central complex (CX) is a defined set of neuropils located on the midline of the protocerebrum in several arthropods and has been implicated in a number of behaviors. To investigate the function of the CX further it is imperative to know the neuroarchitecture of this structure and to ensure all known neuron types conform to a common nomenclature system. Several types of CX neuron have been identified but it is not known if these exist singly or as components of isomorphic sets. We used an enhancer trap approach to study the adult structure, connectivity, and polarity of CX neurons in Drosophila. We observed several isomorphic sets of small-field neurons including pontine and fb-eb neurons, and also isomorphic sets of large-field neurons including R neurons and F neurons. We found that several types of large-field F neurons existed in isomorphic sets of approximately eight (four per hemisphere) and found evidence for small-field neuron types existing as isomorphic sets of 16. Small-field neurons were observed in clearly organized layers. This study provides a novel insight into CX structure and connectivity and provides a set of characterized enhancer trap lines that will be valuable for future study.

Legitimacy is an essential concept of the International Code of Nomenclature of Prokaryotes - a major revision of the Code is called for

Tindall [Int J Syst Evol Microbiol 58 (2008), 1979-1986] claimed that the International Code of Nomenclature of Prokaryotes (the Code) creates a paradox in the application of the term 'legitimate' in relation to valid publication, that the term is dispensable and that the paradox would be resolved by revising the Code to avoid its use. Although it is not clearly explained in the Code, the concept of legitimacy is central to the proposal of names. Discarding the concept would fundamentally alter the conceptual structure of the Code and obscure significant distinctions in formal nomenclature. The text of the Code itself is not clear and a careful reading suggests that it would be enhanced by a critical overview involving textual revision and restructuring of some sections. The Judicial Commission is asked not to accept Tindall's suggested revision and it is proposed that the Editorial Board of the International Committee on Systematics of Prokaryotes re-examine the Code from first principles and make such revisions as will avoid in future the confusion, ambiguities and uncertainties indicated here.

Family history? The forgotten question in high-risk colorectal cancer patients

AIM

The aim of the study was to investigate the frequency and detail of family history recorded for patients diagnosed with potentially high-risk colorectal cancer, and to determine the proportion of these patients referred to a high-risk assessment clinic.

METHOD

Medical records of patients diagnosed with colorectal cancer under the age of 50 admitted to a major Sydney teaching hospital were reviewed. The proportion of records containing information about family history was calculated. Associations between recording of family history and demographic and clinical characteristics of patients were investigated. Logistic regression modelling was performed to identify significant, independent predictors of study outcomes.

RESULTS

Of 113 patients with colorectal cancer diagnosed under the age of 50 years, 61 (54%, 95% CI: 44-63%) had an entry in their hospital medical record about family history. Family history was significantly less likely to be recorded for females, for those admitted via the Emergency Department, and for those with shorter lengths of stay. A significant family history was found in 51% of the 61 patients who had a family history recorded. Records of patients attending specialist colorectal surgeons were significantly more likely to contain information about family history than those who attended other specialists (P = 0.04). Only 14 patients (12%, 95% CI: 7-20%) were formally referred for further genetic assessment.

CONCLUSION

These results suggest that family history is still being neglected in routine clinical practice, and high-risk assessment services are underutilized, implying the need for further dissemination of guidelines with regard to the recognition and management of hereditary colorectal cancer.

Plant-pathogenic bacteria as biological weapons - real threats?

At present, much attention is being given to the potential of plant pathogens, including plant-pathogenic bacteria, as biological weapons/bioterror weapons. These two terms are sometimes used interchangeably and there is need for care in their application. It has been claimed that clandestine introduction of certain plant-pathogenic bacteria could cause such crop losses as to impact so significantly on a national economy and thus constitute a threat to national security. As a separate outcome, it is suggested that they could cause serious public alarm, perhaps constituting a source of terror. Legislation is now in place to regulate selected plant-pathogenic bacteria as potential weapons. However, we consider it highly doubtful that any plant-pathogenic bacterium has the requisite capabilities to justify such a classification. Even if they were so capable, the differentiation of pathogens into a special category with regulations that are even more restrictive than those currently applied in quarantine legislation of most jurisdictions offers no obvious benefit. Moreover, we believe that such regulations are disadvantageous insofar as they limit research on precisely those pathogens most in need of study. Whereas some human and animal pathogens may have potential as biological or bioterror weapons, we conclude that it is unlikely that any plant-pathogenic bacterium realistically falls into this category.

A multilocus sequence analysis of the genus Xanthomonas

A multilocus sequence analysis (MLSA) of strains representing all validly published Xanthomonas spp. (119 strains) was conducted using four genes; dnaK, fyuA, gyrB and rpoD, a total of 440 sequences. Xanthomonas spp. were divided into two groups similar to those indicated in earlier 16S rDNA comparative analyses, and they possibly represent distinct genera. The analysis clearly differentiated most species that have been established by DNA-DNA reassociation. A similarity matrix of the data indicated clear numerical differences that could form the basis for species differentiation in the future, as an alternative to DNA-DNA reassociation. Some species, X. cynarae, X. gardneri and X. hortorum, formed a single heterogeneous group that is in need of further investigation. X. gardneri appeared to be a synonym of X. cynarae. Recently proposed new species, X. alfalfae, X. citri, X. euvesicatoria, X. fuscans and X. perforans, were not clearly differentiated as species from X. axonopodis, and X. euvesicatoria and X. perforans are very probably synonyms. MLSA offers a powerful tool for further investigation of the classification of Xanthomonas. Based on the dataset produced, the method also offers a relatively simple way of identifying strains as members of known species, or of indicating their status as members of new species.

Systematic review of randomized controlled trials of the effectiveness of biofeedback for pelvic floor dysfunction

BACKGROUND

Pelvic floor dysfunction (PFD) is a type of functional constipation. The effectiveness of biofeedback as a treatment remains unclear.

METHODS

A systematic review of all randomized controlled trials evaluating the effectiveness of biofeedback in adults with PFD was carried out. All online databases from 1950 to 2007 were searched. This was supplemented by hand searching references of retrieved articles.

RESULTS

Seven trials fulfilled the inclusion criteria. Three compared biofeedback with non-biofeedback treatments and four compared different biofeedback modalities. Electromyography feedback was most widely utilized. The trials were heterogeneous with varied inclusion criteria, treatment protocols and definitions of success. Most had methodological limitations. Quality of life and psychological morbidity were assessed rarely. Meta-analysis of the studies involving any form of biofeedback compared with any other treatment suggested that biofeedback conferred a sixfold increase in the odds of treatment success (odds ratio 5.861 (95 per cent confidence interval 2.175 to 15.794); random-effects model).

CONCLUSION

Although biofeedback is the recommended treatment for PFD, high-quality evidence of effectiveness is lacking. Meta-analysis of the available evidence suggests that biofeedback is the best option, but well designed trials that take into account quality of life and psychological morbidity are needed.

Safety and side effects of immediate instillation of apaziquone following transurethral resection in patients with nonmuscle invasive bladder cancer

PURPOSE

We studied the safety, tolerability and pharmacokinetics of a single immediate post-transurethral resection intravesical instillation of apaziquone for patients with nonmuscle invasive bladder cancer.

MATERIALS AND METHODS

Patients with cTa-T1, G1-G2 urothelial cell carcinoma of the bladder underwent transurethral resection of bladder tumor(s) followed by a single intravesical instillation of apaziquone 4 mg/40 ml for 1 hour within 6 hours of transurethral bladder tumor resection. Adverse events and safety parameters were assessed on days 8 and 15 after transurethral bladder tumor resection. Blood samples were drawn before and during the instillation for pharmacokinetic analyses. The first 10 patients with pTa-T1, G1-G2 nonmuscle invasive bladder cancer were also evaluated by cystoscopy 3 months after treatment to determine mucosal healing.

RESULTS

Of 20 patients receiving apaziquone 13 (65%) reported 35 adverse events, mostly grade 1 to 2. Eight patients (40%) reported 13 adverse events related to treatment, in particular dysuria, hematuria, bladder spasm, abdominal pain, asthenia and postoperative urinary retention. Three grade 3 and 1 grade 4 event(s) occurred, but these were considered unrelated to treatment. No other significant clinical changes were observed. Apaziquone and the active metabolite EO5a were not detected with pharmacokinetic analyses at any point of time. After 3 months no evidence of impaired mucosal healing was observed.

CONCLUSIONS

A single immediate post-transurethral bladder tumor resection instillation of apaziquone was well tolerated with an expected good safety profile. Apaziquone and its metabolite EO5a were not detected systemically with pharmacokinetic analyses. These results have lead to further study of a single immediate instillation of apaziquone.

Sildenafil citrate improves erectile function: a randomised double-blind trial with open-label extension

AIMS

To evaluate once-daily 100-mg sildenafil for the treatment of erectile dysfunction (ED) in men with ED and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).

METHODS

This was a 12-week, randomised, double-blind, placebo-controlled (DBPC) trial, with an 8-week open-label (OL) extension, in men > or = 45 years of age who scored < or = 25 on the erectile function (EF) domain of the International Index of Erectile Function (IIEF) and > or = 12 on the International Prostate Symptom Score.

RESULTS

At DBPC end of treatment (EOT), the sildenafil group (n = 189, vs. placebo, n = 180) had improved EF (IIEF), improved emotional well-being [Self-Esteem And Relationship questionnaire (SEAR)], and greater treatment satisfaction (Erectile Dysfunction Inventory of Treatment Satisfaction) (p < 0.0001). At OL EOT, IIEF and SEAR scores improved slightly in the group previously randomised to sildenafil (n = 168), but much more in the group previously randomised to placebo (N = 155), such that total improvement over the 20-week trial was comparable between the groups. Erections at baseline were hard enough for penetration on approximately half of occasions and lasted long enough for successful intercourse on less than one quarter of occasions, increasing at sildenafil DBPC and OL EOT to approximately 90% (penetration) and 80% (intercourse success) vs. 61% (penetration) and 39% (intercourse success) for DBPC placebo. At sildenafil DBPC and OL EOT, > or = 90% of men were taking sildenafil 100 mg. Sildenafil was generally well tolerated.

CONCLUSIONS

In this trial of men with ED and BPH-associated LUTS, sildenafil treatment for ED was efficacious, effective and generally well tolerated.

Proposals that the International Committee on Systematics of Prokaryotes establish a public database of validly published names and that the Bacteriological Code be amended to change the prescription for citation of validly published names

It is proposed that the International Committee on Systematics of Prokaryotes formally maintain a readily accessible database of validly published names and that Rule 33b of the International Code of Nomenclature of Bacteria be revised to allow a new, abbreviated, format as the sole method by which authors indicate validation of previously published names.