Being an adolescent with epilepsy during the transition from pediatric to adult hospital care: A qualitative descriptive study

BACKGROUND

The transition from pediatric to adult care is challenging for adolescent patients despite numerous recommendations in recent decades. However, the perspective of the patients is sparsely investigated.

AIM

To explore the experiences and needs of adolescents with epilepsy (AWE) during the transition from pediatric to adult hospital care.

METHODS

We conducted 15 semi-structured interviews with AWEs aged 13-20 years and 10 h of field observations of consultations. Interviews were audio-recorded, transcribed, anonymized, and entered into NVivo (version 12, QSR International) with the transcribed field notes. Data were analyzed using systematic text condensation.

RESULTS

Three themes were identified: (1) Navigating epilepsy in everyday life; (2) The difficult balance between concealment and openness about epilepsy; and (3) Being seen as an individual and not an illness. AWEs' needs in transition are closely associated with their experiences and perceptions of illness, treatment, consultations, and seizures. Notably, AWEs reveal a significant concern about being overlooked beyond their medical condition in appointments.

CONCLUSIONS

This study highlights the vulnerability and challenges of AWEs transitioning to adult care. Overall, AWEs seek understanding, acceptance, and autonomy in managing their epilepsy and transitioning to adult care. Their experiences underscore the importance of holistic support and communication in healthcare settings. A concerted effort from healthcare professionals (HCP) is necessary to foster the recognition of AWEs as individuals with distinct personalities, needs, and capabilities.

Treatment and Rehabilitation for Esophageal Cancer-Striving to Meet Obstacles and Long-term Impacts: A Qualitative Descriptive Study

BACKGROUND

Following esophagogastric cancer treatment, patients with esophageal cancer and their relatives struggle with adjusting to a new everyday life as they experience various challenges after treatment requiring rehabilitation. Health professionals must address long-term impacts on patients' health, everyday life, family functioning, and support needs.

OBJECTIVE

This qualitative descriptive study aimed to explore patients', relatives', and health professionals' experience with long-term impacts and rehabilitation after treatment for esophageal cancer.

METHODS

A qualitative approach based on a phenomenological-hermeneutical methodology was used. Two methods were selected in the study: focus group interviews with health professionals and individual interviews with patients and relatives. Inductive thematic analysis with inspiration from Braun and Clarke was used for data analysis.

RESULTS

Three main themes emerged from the data analysis: (1) forced into limitations in everyday life, (2) learning and navigating a new everyday life, and (3) rehabilitation accepting new normality.

CONCLUSION

Patients and relatives experience persistent long-term impacts after treatment for esophageal cancer, making rehabilitation strenuous and demanding. Relatives take considerable responsibility for the patients' rehabilitation but feel invisible and unsupported by health professionals. Health professionals acknowledge the severity of long-term impacts but fail to prepare patients and relatives for the impacts and do not see the relatives' need for support.

IMPLICATIONS FOR PRACTICE

The study emphasizes the need for a proactive approach in the healthcare system, addressing patients' and relatives' physical and psychological vulnerability. Cancer nurses need to prepare and involve patients and relatives in treatment, long-term impacts, and rehabilitation.

Decision making in the oesophageal cancer trajectory a source of tension and edginess to patients and relatives: a qualitative study

PURPOSE

The curative oesophageal cancer continuum-diagnosis, treatment and survivorship represents different phases with its own challenges for the involved parties. The process of treatment decisions and interactions between patients with oesophageal cancer (EC), relatives and health professionals is vital yet not well described. The purpose of the study was to explore patients' and relatives' experiences with the process of decision-making through the EC illness and treatment trajectory.

METHODS

Longitudinal explorative design was employed based on ethnographic fieldwork in the form of participant observations inspired by the American anthropologist James Spradley.

RESULTS

Sixteen patients and 18 relatives were recruited for participant observations. In total, 184 hours of participant observations were conducted. The study showed that decision-making was filled with tension and edginess. Four themes were identified: 1) The encounter with the medical authority, 2) The need to see the big picture in the treatment trajectory, 3) A predetermined treatment decision, and 4) Meeting numerous different health professionals.

CONCLUSION

The EC trajectory and decision-making were filled with anxiety. Patients and relatives lacked an overview of the treatment pathway, leading to their role in decision-making often being governed by the medical authority. Timing information and continuity are vital factors in decision-making.

Caught between competing emotions and tensions - a focus group study exploring experiences of family caregivers of out-of-hospital cardiac arrest survivors

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Being a family member caring for an out-of-hospital cardiac arrest (OHCA) survivor may impact family caregivers’ lives due to the sudden onset of the illness and possible secondary cognitive, emotional and physical challenges. However, experiences of caring for an OHCA survivor are sparsely described.

Purpose

This purpose of this study was to explore the subjective experiences of family caregivers of OHCA survivors as a means of understanding the potential burden they face.

Methods

Using an explorative qualitative approach, six focus group interviews were conducted with a sample of 25 family caregivers of OHCA survivors and analysed using a phenomenological hermeneutic approach inspired by the philosophy of Ricoeur. OHCA survivors and their family caregivers were attenting at a residential rehabilitation course, where the caregivers were interviewed as part of the course.

Results

Three themes emerged: i) Feeling unexpectedly alone and invisible; the family caregivers felt an emotional burden that could not be shared – leading to caregiving being a lonely and anxious experience. The family caregiver felt alone with the responsibility of the shared life, ii) Fear of loss; the fear of losing a loved one was a constant companion contributing to the burden of caregiving, and iii) Adjusting to a new everyday life; the family caregivers had difficulties adjusting to living their lives on the basis of the survivors’ needs. This often resulted in an existential crisis trying to adapt (Figure 1).

Conclusion

The findings of this study illuminate and emphasise the burden experienced by family caregivers and how they can be caught between competing emotions and tensions. The possible caregiver burden following OHCA should be acknowledged.

Systematic screening is needed to identify those at risk of high caregiver burden. Further, collaboration with family care givers should be an essential part of post-cardiac arrest care, and interventions to reduce the burden should be tested and implemented as part of the clinical care of OHCA survivors and their families.

The use of advanced platelet-rich fibrin after surgical removal of mandibular third molars: a systematic review and meta-analysis

The objective of this systematic review was to test the hypothesis of no difference in recovery following surgical removal of mandibular third molars with the application of advanced platelet-rich fibrin (A-PRF) in the extraction socket compared with alternative biomaterials or natural wound healing. A search of MEDLINE (PubMed), Embase, Cochrane Library, and Scopus was conducted. Human randomized controlled trials published in English up until December 31, 2020 were included. Outcome measures were pain, facial swelling, trismus, soft tissue healing, alveolar osteitis, and quality of life; these were evaluated by descriptive statistics and meta-analysis including 95% confidence intervals (CI). Four studies with a low or moderate risk of bias fulfilled the inclusion criteria. A-PRF resulted in significantly lower pain scores when compared with leucocyte platelet-rich fibrin or natural wound healing after 2 days (-16.8, 95% CI -18.9 to -14.7), 3 days (-12.1, 95% CI -13.4 to -10.7), and 7 days (-1.9, 95% CI -2.9 to -0.9). A-PRF seems to have a negligible effect on facial swelling and trismus and some beneficial effect on soft tissue healing. Alveolar osteitis and quality of life were not assessed. The included studies were characterized by considerable heterogeneity and confounding variables. Thus, the level of evidence appears to be inadequate for clinical recommendations according to the focused question.

Undertaking responsibility and a new role as a relative: a qualitative focus group interview study

BACKGROUND

Being a relative of a patient with oesophageal cancer can evoke strong emotions and uncertainty about the future. As a consequence of the treatment course for oesophageal cancer and an increase in outpatient treatment, relatives are becoming increasingly responsible for patients' physical and emotional care. There is a lack of research exploring relatives' experiences with illness, treatment and decision-making.

AIMS AND OBJECTIVES

To explore relatives' experiences with illness, treatment of the patient and decision-making in the context of oesophageal cancer.

DESIGN

A qualitative explorative design was chosen.

METHODS

We conducted two focus group interviews with 11 relatives. The analysis was based on Ricoeur's theory of interpretation.

RESULTS

Throughout illness and treatment, relatives faced the fear of loss, leading to distress and anxiety. Relatives were simultaneously taking responsibility and asserting a new role during treatment as they regarded treatment as a joint affair. Regarding decision-making, relatives positioned themselves on the sidelines, awaiting the authority of the patients and healthcare professionals to give them space for participation.

CONCLUSION

Relatives of patients with oesophageal cancer undergoing treatment are suppressing their anxiety and doubt about the future. As they are undertaking responsibility during treatment, they are claiming control in new areas, which leads to changing roles within the family. However, they do not feel empowered in decision-making because they recognise patients' decision-making authority. This study highlights the complexity of balancing patients' authority with acknowledgement of relatives' role as active collaborators.

A radical change: A qualitative study of patients' experiences of eating and daily living through the first year after oesophageal resection

PURPOSE

The purpose of this study is to explore the lived experiences of patients in terms of eating and consequences in everyday life in the first year after oesophageal cancer surgery.

METHODS

Thirteen patients participated in qualitative interviews one year after surgery for oesophageal cancer. Descriptions capturing the meaning of the lived experiences of patients were then derived from subsequent analysis and interpretation of the interviews. A phenomenological hermeneutical approach comprised the epistemological stance, and theoretical perspectives were drawn from Schutz' theory of everyday life.

RESULTS

Patient descriptions of their experiences with food, eating and everyday life in the first year after oesophageal cancer surgery fell into four themes: Adjusting to a different anatomy - food and eating as a dominant and difficult activity; changed body - food and eating as an underlying shadow; feeling different - social consequences of changed eating; a nutritional jungle - guidance and support in an uncertain time.

CONCLUSION

The physical and social consequences of oesophageal cancer resection upend everyday structures, requiring patients to adopt a new, conscious and reflexive approach to food and eating as a social activity. Continuous support from healthcare professionals and patient-to-patient interaction can help redefine everyday life.

Patients' Experiences With Illness, Treatment, and Decision-Making for Esophageal Cancer: A Qualitative Study in a Danish Hospital Setting

Patients with curable esophageal cancer or cancer in the esophageal junction face several challenges during the course of their treatment because of the burden of uncertainty in their prognoses and complexity and side effects of the treatment. The aim of this study is to explore patient experiences with illness, treatment, and decision-making in the context of esophageal cancer. A qualitative approach using phenomenological–hermeneutical methodology was used. Data consisted of participant observations and interviews. We analyzed the data based on Ricoeur’s theory of interpretation. The results show that patients with esophageal cancer are putting their ordinary lives on hold and experiencing the meal as a battleground during treatment. Patients strive to maintain autonomy, gain control, and take ownership. The results emphasize the need for a systematic approach to establish an ongoing dialogue with patients throughout the course of treatment.

The role of home visits by a nurse to improve palliation in patients treated with self-expandable metallic stents due to incurable esophageal cancer

Self-expandable metallic stent (SEMS) is a preferred option to relieve dysphagia and to palliate patients with incurable esophageal or gastro-esophageal junction (GEJ) cancer. Health Related Quality of Life (QoL) represents a clinically relevant outcome measure in research focused on palliation of patients with advanced GI cancer. In this context, home visits by a nurse carry the potential to offer important advantages. Eighty patients with incurable esophageal or GEJ cancer were randomized to either standard follow up or to an intervention containing regular home visits by a nurse. The primary outcome variable QoL was assessed by EORTC QLQ-C30 and OES-18 before insertion of SEMS, and at 2, 7 and 12 weeks thereafter. Secondary outcomes were; need for re-interventions, number of patients receiving palliative oncological therapy and overall survival. Sixty-six males and 13 females, with a median age of 71, were included. Self-reported overall QoL was significantly higher in the intervention group (P = 0.03). The organ specific module OES-18 revealed a significant reduction in dysphagia by the intervention (P = 0.03) as well as fewer eating disabilities (P = 0.04). No differences were observed in secondary outcomes except for overall survival, where the median survival was increased from 114 to 183 days by the active intervention (P = 0.02). Home visits by a nurse seem to play an important palliative role after placement of SEMS in patients with incurable esophageal or GEJ cancer by improving QoL and may carry the potential to increase overall survival.

Being a relative on the sideline to the patient with oesophageal cancer: a qualitative study across the treatment course

BACKGROUND

Being a relative of patients with oesophageal cancer or cancer in the oesophageal junction is stressful, as the healthcare system often overlooks concerns about the future as well as the roles and needs of relatives. There is a lack of research addressing relatives' experiences, roles and needs for participation in decisions.

AIMS AND OBJECTIVES

To explore relatives' experiences before the start of treatment and their subsequent roles and needs for participation in treatment decisions.

DESIGN

A qualitative approach based on a phenomenological - hermeneutical methodology was used.

METHODS

Data consisted of participant observations and semi-structured interviews with 19 relatives of patients with oesophageal cancer. We analysed data with inspiration from Ricœur's theory of interpretation.

RESULTS

The relatives were fellow sufferers, experiencing uncertainties and fear for the future with the patients, but they were simultaneously a challenged anchor during a difficult time, actively involved in handling the diagnosis and the everyday life. The relatives were positioned on the sideline both by the professionals and by themselves; they took a passive and subordinate part in decisions.

CONCLUSION

Relatives are central to cancer care and treatment. Adequate and timely information is imperative for relatives as well for patients in order to facilitate shared decision-making. We advocate for a new approach to relatives in order to prepare the relatives for their roles and support their individual needs but also to acknowledge relatives' knowledge about everyday life from the relatives' perspective.

Lactase persistence, milk intake, hip fracture and bone mineral density: a study of 97 811 Danish individuals and a meta-analysis

BACKGROUND

Whether a causal relationship exists between milk intake and reduced risk of fractures is unclear.

OBJECTIVES

We tested the hypothesis that genetically determined milk intake reduces the risk of fractures and increases bone mineral density (BMD).

METHODS

We investigated the association between milk intake, LCT-13910 C/T (rs4988235), which is associated with lactase persistence (TT/TC) in Northern Europeans, and hip fractures in three Danish prospective studies (N = 97 811, age ≥20 years). We added meta-analyses of LCT-13910 and fractures and BMD from five published Northern European population studies.

RESULTS

In the Danish studies, the adjusted hazard ratio (HR) for hip fracture per one glass per week higher milk intake was 1.00 (95% CI: 0.99-1.01). The per T-allele milk intake was 0.58 (0.49-0.68) glasses per week, but HR was 1.01 (0.94-1.09) for hip fracture. In meta-analyses of Danish studies with published Northern European population studies, the random effects odds ratio for any fracture was 0.86 (0.61-1.21; I² = 73%) for TT vs. CC and 0.90 (0.68-1.21; I² = 63%) for TC vs. CC. The standardized mean difference in femoral neck BMD was 0.10 (0.02-0.18; I² = 0%) g cm^-2 for TT vs. CC and 0.06 (-0.04 to 0.17; I² = 17%) g cm^-2 for TC vs. CC. There were no differences in lumbar spine or total hip BMD comparing TT or TC with CC.

CONCLUSION

Genetically lifelong lactase persistence with high milk intake was not associated with hip fracture in Danish population-based cohorts. A meta-analysis combining Danish studies with published Northern European population studies also showed that lactase persistence was not associated with fracture risk. Genetic lactase persistence was associated with a higher femoral neck BMD, but not lumbar spine or total hip BMD.

Effect of substituting soybean meal and canola cake with dried distillers grains with solubles at 2 dietary crude protein levels on feed intake, milk production, and milk quality in dairy cows

Dried distillers grain with solubles (DDGS) is an alternative source of feed protein for dairy cows. Previous studies found that DDGS, based on grains other than corn, can substitute for soybean meal and canola cake as a dietary protein source without reducing milk production or quality. As societal concerns exist, and in many areas strict regulation, regarding nitrogen excretion from dairy cows, the dairy industry has focused on reducing dietary protein level and nitrogen excretion. In the present study, we investigated the use of DDGS as a protein source, at a marginally low dietary crude protein (CP) levels, in a grass-clover and corn silage-based ration. The experiment involved 24 Holstein cows and 2 protein sources (DDGS or soybean-canola mixture) fed at 2 levels of CP (14 or 16%) in a 4 × 4 Latin square design. The aim of this study was to evaluate the effect of both protein source and protein level on feed intake, milk yield, and milk quality. The results indicated that feed intake, milk yield, and protein in milk increased when the protein level in the ration was 16% CP compared with 14%. We found no effect of substituting the soybean-canola mixture with DDGS. Moreover, no sensory problems were observed when comparing fresh milk with stored milk, and milk taste was unaffected by DDGS. Milk from cows fed DDGS had a slightly higher content of linoleic acid and conjugated linoleic acid (CLA 9-11), and lower content of C11 to C17 fatty acids than cows fed diets with the soybean-canola mixture. Cows fed the diets with 16% CP produced milk with higher oleic acids and lower palmitic acid content than cows fed 14% CP diets. To conclude, DDGS can substitute for a soybean-canola mixture without affecting feed intake, milk yield and quality, or sensory quality. Under the conditions of this experiment, feeding 16% CP compared with 14% CP in the ration can increase feed intake and milk production.

Effect of substituting soybean meal and canola cake with grain-based dried distillers grains with solubles as a protein source on feed intake, milk production, and milk quality in dairy cows

The growth of the bioethanol industry is leading to an increase in the production of coproducts such as dried distillers grains with solubles (DDGS). Both corn-based DDGS and grain-based DDGS (gDDGS; defined as originating from grain sources such as barley, wheat, triticale, or a mix, excluding corn) appear to be relevant sources of feed and protein for dairy cows. To date, most of the studies investigating DDGS have been performed with corn-based DDGS. The objectives of this study were to determine the effects of the proportion of gDDGS in the diet on feed intake, milk production, and milk quality. The present experiment involved 48 Holstein cows in a replicated 3 × 3 Latin square design with 3 grass-based dietary treatments consisting of 4, 13.5, and 23% gDDGS on a dry matter (DM) basis (L, M, and H, respectively) as a replacement for a concentrate mix. The concentrate mix consisted of soybean meal, canola cake, and beet pulp. Dry matter intake and energy-corrected milk yield were not affected by the proportion of gDDGS in the diet. Daily milk yield decreased with the H diet compared with the L and M diets. The percentage of fat in milk was higher when cows were fed the H diet compared with the L and M diets, whereas milk fat yield was not affected by dietary treatment. The M diet had a higher percentage of protein in milk compared with the L and H diets. Milk protein yield was similar for the L and M diets; however, it decreased for the H diet. Milk taste was not affected by the proportion of gDDGS in the diet or when milk was stored for 7 d. Linoleic acid and conjugated linoleic acid cis-9,trans-11 in milk increased with increasing proportion of gDDGS. To conclude, gDDGS can replace soybean meal and canola cake as a protein source in the diet of dairy cows. Up to 13.5% of the diet may consist of gDDGS without negatively affecting milk production, milk quality, or milk taste. When gDDGS represents 23% of dietary DM, milk production is reduced by 1.6 kg/d, whereas energy-corrected milk production is numerically reduced by 1 kg.

Effect of dietary nitrate level on enteric methane production, hydrogen emission, rumen fermentation, and nutrient digestibility in dairy cows

Nitrate may lower methane production in ruminants by competing with methanogenesis for available hydrogen in the rumen. This study evaluated the effect of 4 levels of dietary nitrate addition on enteric methane production, hydrogen emission, feed intake, rumen fermentation, nutrient digestibility, microbial protein synthesis, and blood methemoglobin. In a 4×4 Latin square design 4 lactating Danish Holstein dairy cows fitted with rumen, duodenal, and ileal cannulas were assigned to 4 calcium ammonium nitrate addition levels: control, low, medium, and high [0, 5.3, 13.6, and 21.1g of nitrate/kg of dry matter (DM), respectively]. Diets were made isonitrogenous by replacing urea. Cows were fed ad libitum and, after a 6-d period of gradual introduction of nitrate, adapted to the corn-silage-based total mixed ration (forage:concentrate ratio 50:50 on DM basis) for 16d before sampling. Digesta content from duodenum, ileum, and feces, and rumen liquid were collected, after which methane production and hydrogen emissions were measured in respiration chambers. Methane production [L/kg of dry matter intake (DMI)] linearly decreased with increasing nitrate concentrations compared with the control, corresponding to a reduction of 6, 13, and 23% for the low, medium, and high diets, respectively. Methane production was lowered with apparent efficiencies (measured methane reduction relative to potential methane reduction) of 82.3, 71.9, and 79.4% for the low, medium, and high diets, respectively. Addition of nitrate increased hydrogen emissions (L/kg of DMI) quadratically by a factor of 2.5, 3.4, and 3.0 (as L/kg of DMI) for the low, medium, and high diets, respectively, compared with the control. Blood methemoglobin levels and nitrate concentrations in milk and urine increased with increasing nitrate intake, but did not constitute a threat for animal health and human food safety. Microbial crude protein synthesis and efficiency were unaffected. Total volatile fatty acid concentration and molar proportions of acetate, butyrate, and propionate were unaffected, whereas molar proportions of formate increased. Milk yield, milk composition, DMI and digestibility of DM, organic matter, crude protein, and neutral detergent fiber in rumen, small intestine, hindgut, and total tract were unaffected by addition of nitrate. In conclusion, nitrate lowered methane production linearly with minor effects on rumen fermentation and no effects on nutrient digestibility.

Novel aspects of health promoting compounds in meat

Meat is an integral part of the human diet. Besides essential amino acids and nutritive factors of high quality and availability, meat provides often overlooked components of importance for human health. These are amino acids and bioactive compounds that may be very important in i) preventing muscle wasting diseases, such as in sarcopenia, ii) reducing food and caloric intake to prevent metabolic syndrome, iii) blood pressure homeostasis via ACE-inhibitory components from connective tissue, and iv) maintaining functional gut environment through meat-derived nucleotides and nucleosides. In addition, meat could be an important source of phytanic acid, conjugated linoleic acids and antioxidants. Further, it becomes increasingly apparent that design of in vitro meat will be possible, and that this development may lead to improved health benefits from commercially viable and sustainable meat products.

Methane production and digestion of different physical forms of rapeseed as fat supplements in dairy cows

The purpose of this experiment was to study the effect of the physical form of rapeseed fat on methane (CH4) mitigation properties, feed digestion, and rumen fermentation. Four lactating ruminal-, duodenal-, and ileal-cannulated Danish Holstein dairy cows (143 d in milk, milk yield of 34.3 kg) were submitted to a 4×4 Latin square design with 4 rations: 1 control with rapeseed meal (low-fat, CON) and 3 fat-supplemented rations with either rapeseed cake (RSC), whole cracked rapeseed (WCR), or rapeseed oil (RSO). Dietary fat concentrations were 3.5 in CON, 5.5 in RSC, 6.2 in WCR, and 6.5% in RSO. The amount of fat-free rapeseed was kept constant for all rations. The forage consisted of corn silage and grass silage and the forage to concentrate ratio was 50:50 on a dry matter basis. Diurnal samples of duodenal and ileal digesta and feces were compiled. The methane production was measured for 4 d in open-circuit respiration chambers. Additional fat reduced the CH4 production per kilogram of dry matter intake and as a proportion of the gross energy intake by 11 and 14%, respectively. Neither the total tract nor the rumen digestibility of organic matter (OM) or neutral detergent fiber were significantly affected by the treatment. Relating the CH4 production to the total-tract digested OM showed a tendency to decrease CH4 per kilogram of digested OM for fat-supplemented rations versus CON. The acetate to propionate ratio was not affected for RSC and WCR but was increased for RSO compared with CON. The rumen ammonia concentration was not affected by the ration. The milk and energy-corrected milk yields were unaffected by the fat supplementation. In conclusion, rapeseed is an appropriate fat source to reduce the enteric CH4 production without affecting neutral detergent fiber digestion or milk production. The physical form of fat did not influence the CH4-reducing effect of rapeseed fat. However, differences in the volatile fatty acid pattern indicate that different mechanisms may be involved.

Milk fatty acid composition and production performance of Danish Holstein and Danish Jersey cows fed different amounts of linseed and rapeseed

Fat supplements are used in diets for dairy cows to increase energy intake and milk production and the fatty acid composition of the feed affects milk fatty acid composition. A total of 74 Danish Holstein and 41 Danish Jersey cows were divided into 4 groups and the cows within each group were fed a mixed ration supplemented with 0, 3.5, 6.8, or 10.2% of dry matter of a linseed:rapeseed (1:3) mixture during lactation wk 6 to 30. Milk yield, fat, and lactose contents were not affected by treatments for Danish Holsteins, whereas these parameters increased when increased amounts of oilseeds were fed to Danish Jerseys. For both breeds, milk protein content decreased when increased amounts of oilseeds were fed. The milk fatty acid composition showed higher concentrations of saturated fatty acids and lower concentrations of unsaturated fatty acids in milk fat from Danish Jerseys compared with Danish Holsteins. Increased amounts of oilseeds in feed increased milk fat concentration of all C18 fatty acids except C18:2 n-6, whereas the content of C6 to C14, C11 to C17, and in particular, C16, decreased. This effect was more pronounced for Danish Holsteins than for Danish Jerseys. The apparent recovery of C18:2 n-6 and C18:3 n-3 decreased when increased amounts of oilseeds were fed; however, this was most likely due to increased amounts of fatty acid from feed used for other energy demands than milk production. It was concluded that up to 6.8% of oilseed supplementation can be fed without production problems and, in many cases, with positive production responses, including an improved milk fatty acid profile.

Milk quality as affected by feeding regimens in a country with climatic variation

To investigate the influence of climatic conditions and season on milk composition, bulk tank milk was sampled on 5 occasions during a period of 15 mo from 20 Swedish dairy farms. These farms included 5 organic and 5 conventional farms in central Sweden and 7 traditional conventional farms and 3 conventional farms growing maize for silage in southern Sweden. Feed data and milk yield were recorded and milk was analyzed for content of fatty acids, carotenoids, and tocopherol. Differences between milk from the 2 regions and between summer and winter seasons were shown. Milk from central Sweden differed from milk from southern Sweden in that it had a higher content of carotenoids, tocopherol, short-chain fatty acids (C4-C14), C18:0, and C18:3 n-3 and a lower content of C16. Summer milk samples had a lower fat content and contained higher amounts of C18:1 cis-9 and conjugated linoleic acid cis-9,trans-11, and lower amounts of C4 to C16 compared with winter milk. Differences between farm types from central Sweden were lower content of conjugated linoleic acid cis-9,trans-11 and higher content of C18:3 n-3 in organic milk compared with conventional milk. In southern Sweden the use of maize silage caused lower milk content of carotenoids and C18:3 n-3 when compared with traditional feeding. Differences in milk composition could be related to climatic differences because legumes are more dominating in the leys of central Sweden and maize growing is limited to southern Sweden.

Modified cytokeratins expressed on the surface of carcinoma cells undergo endocytosis upon binding of human monoclonal antibody and its recombinant Fab fragment

Previously, we have reported on successful imaging of colon, rectal, and pancreatic carcinomas in patients by using a radiolabeled all-human monoclonal antibody, COU-1, directed against modified cytokeratin. To further develop this antibody for use as an immunoconjugate, COU-1 was cloned by phage display selection and the human Fab fragment was expressed in bacteria. Analysis by confocal laser scanning microscopy demonstrated that COU-1 bound in a uniform punctate pattern to the surface of viable carcinoma cells stained at 4 degrees C, and binding increased significantly when cells were cultured on fibronectin, laminin, or collagen IV. In the case of fibronectin, COU-1 staining was particularly enhanced at intercellular junctions. When carcinoma cells were cultured with COU-1 at 37 degrees C for 6 hr, the antibody was found in large perinuclear vesicles and the punctate surface staining was significantly reduced. Similar results were obtained using intact IgM COU-1 and the recombinant Fab fragment. Immunohistological studies indicated that COU-1, in contrast to murine monoclonal antibodies against normal cytokeratin 8 and 18, could differentiate between malignant and normal colon epithelia, and between colon cancer metastasis in the liver and surrounding normal hepatocytes. Within biopsies of malignant tissue, COU-1 exhibited membrane-associated staining of proliferating cells, while resting cells had a filamentous pattern. Thus, modified cytokeratin at the surface of carcinoma cells may represent a new target for immunoconjugates and may explain the promising results of the phase I/II clinical study.

The day-to-day variation in insulin sensitivity in non-insulin-dependent diabetes mellitus patients assessed by the hyperinsulinemic-euglycemic clamp method

The objective was to study the day-to-day variation in insulin sensitivity in non-insulin-dependent diabetes mellitus (NIDDM) and to analyze within- and between-person variances in the glucose infusion rate during steady state (M value). Ten NIDDM patients attending the outpatient clinic at Aarhus Amtssygehus were studied three times under standardized conditions. Each time, a 120-minute hyperinsulinemic-euglycemic clamp was performed. Similar M values were found on the 3 study days, with difference between M values on the 3 days of (mean +/- SD) 0.3 +/- 1.8 mg glucose/kg lean body mass (LBM)/min. The total coefficient of variation (CV) for M values was 57% after the first clamp, 55% after the second, and 53% after the third. Ninety percent of the total day-to-day variation in M values could be ascribed to between-person variation and 10% to within-person variation. Within-person components of variance included all sources of variation other than between-person variation. The within-person CV for M values was 11.9% +/- 7.2% after two clamp studies and 12.1% +/- 7.3% after three (P < .55). In conclusion, under standardized conditions, a valid estimate of insulin sensitivity assessed by the hyperinsulinemic-euglycemic clamp in NIDDM patients is obtained after a single measurement. Because of large between-person variation, paired data should be used when comparing insulin sensitivity in NIDDM patients.