A comparison of endothelial cell growth on commercial coronary stents with and without laser surface texturing

Complete endothelialisation of coronary stents is an important determinant of future thrombotic complications following coronary stenting. Stent surface texture is an important factor that influences endothelial cell growth. With the emergence of second and third generation coronary stents, is limited comparative data describing endothelial cell growth in contemporary stent platforms, and limited data available on approaches used to rapidly modify the surfaces of commercial coronary stents to improve endothelialisation. In this study we have determined the in vitro proliferation of the primary human coronary artery endothelial cells on the commonly used 4 types of commercial coronary stents and found that the inner surface of BioMatrix drug-eluting stents (DES), after eliminating of the polymer and drug coating, had significantly higher endothelial cell proliferation compared to that of other bare metal stents (BMS): Multi-Link8, Integrity and Omega. The surfaces of the 3 types of BMS which are smooth, displayed similar endothelial cell proliferation, suggesting the importance of surface features in manipulating endothelial cell growth. Laser surface texturing was used to create micro/nano patterns on the stents. The laser treatment has significantly increased endothelial proliferation on the inner surfaces of all 4 types of stents, and Multi-Link8 stents displayed the highest (>100%) improvement. The laser textured BioMatrix stents had the highest absolute number of endothelial cells growth. Our results provided useful information in the endothelialisation potential for the commonly used commercial coronary stents and suggested a potential future application of laser surface bioengineering to coronary stents for better biocompatibility of the device.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

High-throughput infrared spectroscopy for quantification of peptides in drug discovery

Peptides have gained an increasing importance in drug discovery as potential therapeutics. Discovery efforts toward finding new, efficacious peptide-based therapeutics have increased the throughput of peptide development, allowing the rapid generation of unique and pure peptide samples. However, high-throughput analysis of peptides may be still challenging and can encumber a high-throughput drug discovery campaign. We report herein a fit-for-purpose method to quantify peptide concentrations using high-throughput infrared spectroscopy (HT-IR). Through the development of this method, multiple critical method parameters were optimized including solvent composition, droplet deposition size, plate drying procedures, sample concentration, and internal standard. The relative absorbance of the amide region (1600-1750 cm^-1) to the internal standard, K₃Fe(CN)₆ (2140 cm^-1), was determined to be most effective at providing lowest interference for measuring peptide concentration. The best sample deposition was achieved by dissolving samples in a 50:50 v/v allyl alcohol/water mixture. The developed method was used on 96-well plates and analyzed at a rate of 22 min per plate. Calibration curves to measure sample concentration versus response relationship displayed sufficient linearity (R² > 0.95). The repeatability and scope of detection was demonstrated with eighteen peptide samples that were measured with most values below 20% relative standard deviation. The linear dynamic range of the method was determined to be between 1 and 5 mg/mL. This developed HT-IR methodology could be a useful tool in peptide drug candidate lead identification and optimization processes.

The Manchester experience – a novel technique for supra-annular placement of the Edwards SAPIEN 3 Ultra TVH prosthesis in severe bicuspid aortic valve stenosis

Background

Bicuspid AV disease has been excluded from the seminal trials evaluating transcatheter heart valve (THV) placement in severe aortic stenosis. Although registry data has shown good results overall, case selection likely involves more challenging anatomical subsets being treated either surgically or medically in this very heterogenous condition. Conventional annular placement, as well as high annular placement in tapered anatomies remain the commonest deployment techniques. We reasoned that marked supra-annular placement with the mid-portion of the SAPIEN 3 Ultra (S3U) valve sealing skirt placed at the narrowest opening point at commissural level could be an alternative strategy allowing treatment of additional patient groups. This proposed technique takes advantage of elliptical expansion at commissural level with more circular expansion above and below this point to prevent embolisation, as well as sealing skirt positioning at the narrowest opening point to prevent paravalvular leak.

Aims

We examined the feasibility of marked supra-annular placement of the balloon-expandable S3U prosthesis with the mid-point of the sealing skirt placed at commissural level in patients with severe bicuspid aortic valve stenosis and relative contra-indications to annular placement.

Methods

We assessed patients with severe bicuspid aortic stenosis undergoing TAVI at our centre over a 9-month period and identified those with relative contra-indications to conventional annular placement. These included: (i) excessive annular size (ii) severe leaflet and raphe calcification with risk of rupture into the right ventricle (iii) excessive leaflet length with potential leaflet overhang. CT imaging was used to define the narrowest opening location at commissural level, typically 10–15mm supra-annular. The diameter at this level was used to select THV size. Calculations were made to approximate the mid skirt level to this supra-annular position. In most cases this involved supra-annular positioning with the lower THV border 5–8mm supra-annular. This was achieved in most cases by aligning the unexpanded border with the annulus.

Results

Out of 9 patients with biscupid AV, 4 had relative contra-indications for annular placement. In all 4 cases, excellent valvular expansion with only minimal paravaulvar leak was achieved with placement of the S3U prosthesis at 5–7mm above the annulus and with supra-annular sealing at commissural level. Annular dimensions of 35.5mm and 31.5mm were successfully treated with 29mm and 26mm valves due to significant tapering at commissural level in 2 patients. There were no procedural complications, incidences of AV blocks or valve embolisation.

Conclusion

As a proof of concept, we have demonstrated excellent outcomes with marked supra-annular TAVI placement in patients with severe bicuspid AV stenosis and anatomy unfavourable for conventional annular placement. This is the first description of this completely novel deployment technique.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Manchester Royal Infirmary

The effect of animal shelter sound on cat behaviour and welfare

This study assessed how sound affected fear- and maintenance-related behaviour in singly housed cats (Felis silvestris catus) in an animal shelter. Two daily 30-min observation sessions (morning and evening) were made for 98 cats from admittance for ten days or until the cat was removed. Cat behaviour and presence of sound (classified by the source) were recorded by instantaneous and onezero sampling with 15-s intervals. Each 30-min observation session was classified as 'quiet' or 'noisy' if the one-zero score for presence of sound was above or below the median of sessions at that time of day. To ensure that cats had at least two complete days of comparable observations, statistical analysis was restricted to the 70 cats (30 females, 40 males) present for two or more weekdays. Cats varied widely in the amount of fear and maintenance behaviour they performed. Males showed less fear and maintenance behaviour than females. Morning sessions consistently had much more sound than evenings, and cats showed more fear behaviour and less maintenance behaviour in the mornings. Cats showed more fear behaviour in noisy morning sessions than quiet ones, with no comparable difference in maintenance behaviour. Where sessions included a pronounced transition in sound, fear-related behaviour was more common after a transition from quiet to noisy and less common after a transition from noisy to quiet. The results show that shelter cats vary greatly in their responses and suggest that sound in shelter environments can substantially affect their behaviour. Lowering sound levels in shelters may help improve cat welfare.

Animal welfare during a period of intensification: The views of confinement and alternative pig producers

In Hungary, where intensive and non-intensive pig production co-exist, in-depth interviews were used to explore the views and priorities of pig producers regarding animal welfare and ethical animal production. Farmers using confinement systems and those with alternative, non-confinement systems shared certain core values such as attachment to animals and to traditional community values. Both groups agreed on most key elements of animal welfare (health, nutrition, etc) but had different priorities for how to achieve these within their production systems. Alternative producers considered unconfined, semi-natural environments important for animal welfare, and confinement producers with medium-sized operations (400–600 sows) generally agreed. Only the three largest producers (>1,000 sows) expressed strong confidence in confinement methods. Different producers emphasised different features for ensuring animal welfare. Producers with large-scale confinement systems depend strongly on staff and automation and require the means to find and retain good staff. Those with medium-scale confinement systems see automation and personal involvement with animals as crucial, and they need economic conditions that allow herd size to remain within their personal capacity. Those operating alternative systems see small herds and non-confinement systems as crucial for animal welfare and need markets that encourage such systems. Subsidies, regulatory systems and technological developments would need to be tailored to meet the different needs in order for producers to improve animal welfare in the different systems and according to their own values and priorities. Medium-scale confinement producers could better act on their values if economic conditions allowed them to use more natural systems.

Unstable intraguild predation causes establishment failure of a globally invasive species

Biotic resistance is often posited, but rarely known, to be the cause of invasion failure. Competition and predation are the most frequently identified processes that may prevent or limit the establishment of nonnative species. Interactions between nonnative and native species that involve intraguild predation (IGP) are very common in nature, although theory predicts most IGP systems should be unstable and lead to extinction. If this prediction is true, the frequency of invasion failures due to IGP may be underappreciated because of their fleeting nature and, thus, studies of unstable IGP systems are lacking, despite the opportunities they offer for understanding the factors affecting their unstable dynamics. We investigated a failed invasion involving an IGP relationship. In Florida, the guppy (Poecilia reticulata), a worldwide invader, fails to establish in the presence of eastern mosquitofish (Gambusia holbrooki). We tested whether and how resident mosquitofish cause guppy invasion failure using replicated mesocosm and aquarium trials. Both the predator and competitor components of the IGP relationship were strongly asymmetrical, with large impacts on guppies. We identified two effects, direct consumption of neonates and aggressive interference competition, that limited survival and recruitment. The highly unstable nature of this IGP relationship is the primary cause of the failure of the guppy to establish in Florida. Our study shows that the transient nature of an ephemeral IGP relationship can yield important insights into the underlying causes of invasion failure, including the role of strong biotic resistance.

Can eye surface temperature be used to indicate a stress response in harbour seals (Phoca vitulina)?

Infra-red thermography (IRT) is increasingly being used to estimate physiological stress responses in animals via changes in eye surface temperature. The aim of this study was to determine whether eye temperature of harbour seals (Phoca vitulina) changes in response to routine handling and the potentially painful procedure of flipper-tagging, and if responses to tagging can be mitigated by subcutaneous injection of lidocaine. Orphaned pups (n = 52) at a rehabilitation facility were assigned to one of four treatments: Lidocaine (handled twice, once for injection and once for tagging); Saline (also handled twice); Tag Only (handled once); Sham Tag (handled once). Eye temperature increased more when pups were first handled compared to pups that were not handled and increased further in pups that underwent a second handling. Eye temperature of pups that were tagged without any previous treatment (Tag Only) increased compared to pups that were sham-tagged. Eye temperature also tended to increase after pups were injected with lidocaine but not saline. These results suggest that: (i) handling causes a physiological stress response; (ii) increased eye temperature arising from the second handling suggests the first handling was likely aversive, resulting in sensitisation to further handling; (iii) the rise in eye temperature after tagging, but not sham-tagging, may reflect pain from tagging; and (iv) lidocaine, at the dosage tested, did not appear to reduce the physiological response to tagging. These results show promise for the use of eye temperature to monitor stress responses and for evaluating the potential aversiveness of routine procedures in seals.

Priority Outcomes in Critically Ill Children: A Patient and Parent Perspective

BACKGROUND

Outcomes in pediatric critical care research are typically selected by the researcher.

OBJECTIVES

(1) To identify outcomes prioritized by patients and their families following a critical illness and (2) to determine the overlap between patient-centered and researcher-selected study outcomes.

METHODS

An exploratory descriptive qualitative study nested within a longitudinal cohort study conducted in 2 pediatric intensive care units (PICUs). Participants were purposively sampled from the primary cohort to ensure adequate demographic representation. Qualitative descriptive approaches based on naturalistic observation were used to collect data and analyze results. Data were coded by using the International Classification of Functioning, Disability, and Health Children and Youth (ICF-CY) framework.

RESULTS

Twenty-one participants were interviewed a mean of 5.1 months after PICU discharge. Outcomes fell into 2 categories: patient-centered and family-centered. In the former, diagnosis, survival, and prognosis were key priorities during the acute critical illness. Once survival appears possible, functioning (physical, cognitive, and emotional), and factors that influence recovery (ie, rehabilitation, environment, and quality of life) are prioritized. Family-centered outcomes consisted of parents' psychosocial functioning and experience of care. Patient-centered outcomes were covered well by the selected study measures of functioning, but not by the clinical outcome measures.

CONCLUSION

Functioning and quality of life are key patient-centered outcomes during recovery from critical illness. These are not well captured by end points typically used in PICU studies. These results justify the importance of patient- and family-centered outcomes in PICU research and a need to determine how these outcomes can be comprehensively measured.

Improving remote lifestyle intervention studies in children: Participant and caregiver feedback of the smart heart study

OBJECTIVES

We sought to describe and analyze the quantitative and qualitative feedback obtained from participants and their caregivers of the Smart Heart study, a successful 12-month lifestyle intervention for children with overweight or obesity and congenital heart disease that provided remote lifestyle counseling, to improve future lifestyle interventions in children.

METHODS

Thirty-six participants and caregivers were polled using a standard program evaluation questionnaire at the end of the intervention. Feedback was compiled into themes, and facilitators and barriers to program success were identified.

RESULTS

There was a high level of satisfaction with the intervention and staff interactions as well as a low perceived burden of participation. There were also specific concerns, including mixed impressions regarding technology usage and a less impressive indication of actual impactful behavior change.

CONCLUSIONS

The study identified five themes, and corresponding facilitators and barriers to participant compliance, from the Smart Heart intervention feedback and offered suggestions for improving future lifestyle behavioral intervention study designs in children.

PRACTICE IMPLICATIONS

Remote smartphone counseling is effective and efficient. It is recommended that the counseling messages are specific, the counseling schedule is patient-centric, patient burden is limited, methods with immediate patient feedback are used and family is included when feasible.

Longitudinal changes of brain microstructure and function in nonconcussed female rugby players

Objective

To longitudinally assess brain microstructure and function in female varsity athletes participating in contact and noncontact sports.

Methods

Concussion-free female rugby players (n = 73) were compared to age-matched (ages 18–23) female swimmers and rowers (n = 31) during the in- and off-season. Diffusion and resting-state fMRI (rs-fMRI) measures were the primary outcomes. The Sports Concussion Assessment Tool and head impact accelerometers were used to monitor symptoms and impacts, respectively.

Results

We found cross-sectional (contact vs noncontact) and longitudinal (in- vs off-season) changes in white matter diffusion measures and rs-fMRI network connectivity in concussion-free contact athletes relative to noncontact athletes. In particular, mean, axial, and radial diffusivities were increased with decreased fractional anisotropy in multiple white matter tracts of contact athletes accompanied with default mode and visual network hyperconnectivity (p < 0.001). Longitudinal diffusion changes in the brainstem between the in- and off-season were observed for concussion-free contact athletes only, with progressive changes observed in a subset of athletes over multiple seasons. Axial diffusivity was significantly lower in the genu and splenium of the corpus callosum in those contact athletes with a history of concussion.

Conclusions

Together, these findings demonstrate longitudinal changes in the microstructure and function of the brain in otherwise healthy, asymptomatic athletes participating in contact sport. Further research to understand the long-term brain health and biological implications of these changes is required, in particular to what extent these changes reflect compensatory, reparative, or degenerative processes.

Protecting farm animal welfare during intensification: Farmer perceptions of economic and regulatory pressures

Pig (Sus scrofa) production in Hungary provides a case study in how external pressures influence animal production, animal welfare and intensification. External pressures were explored in 24 in-depth, semi-structured interviews with Hungarian pig farmers operating either confinement or alternative systems. Confinement producers reported intense economic pressure because of a power imbalance with the large meat-processing companies that buy their animals. These companies, in the view of the farmers, can source internationally and largely dictate prices. When prices paid by the companies fall below the cost of production, farmers cannot respond by reducing production because of the long time-lags between breeding and marketing; and with their large investment in confinement buildings that are difficult to modify, farmers see little option except to reduce production costs further. Alternative farmers reported being more resilient to economic pressures because they sell into niche markets, use inexpensive technologies, and typically produce a diversity of agricultural products which buffer periods of low profit in any one commodity. The current regulatory system was seen as inadequate to protect animal welfare from economic pressure because it focuses on certain inputs rather than welfare outcomes, does not cover some important determinants of animal welfare, and does not accommodate certain realities of farming. Current subsidies were also seen as an inadequate remedy, and were viewed as inequitable because they are difficult for alternative producers to access. Consumer-choice options, while used by alternative producers, are not available in mainstream markets which demand uniform 'commodity' production. The economic constraints that influence animal welfare might be better mitigated by a regulatory system developed with greater consultation with producers, a more equitable subsidy programme, and more developed consumer-choice programmes.

Once-Daily Oxycodone Prolonged-Release Tablets Are Resistant to Alcohol-Induced Dose Dumping: Results From a Randomized Trial in Healthy Volunteers

The objective of this study was to determine the effect of concomitant alcohol intake on the bioavailability of oxycodone from an oxycodone once-daily (OOD) formulation and an oxycodone twice-daily (OTD) formulation. A phase I, open-label, randomized, crossover alcohol interaction study in 20 healthy volunteers under fasting conditions was conducted. Participants received five treatments, OOD with 240 mL of 0%, 20%, or 40% alcohol; and OTD with 240 mL of 0% or 40% alcohol. Pharmacokinetic parameters did not differ between participants taking OOD with water or with 240 mL of 20% alcohol. There was a slight increase in overall oxycodone absorption from OOD with 40% alcohol but no increase in peak absorption. Oxycodone absorption from OTD showed peak and overall increases with 40% alcohol but maintained a prolonged-release profile. Although it is recommended that alcohol be avoided while taking opioids, there was no evidence of alcohol-induced dose dumping in these oxycodone formulations.

Management of cull dairy cows: Culling decisions, duration of transport, and effect on cow condition

Many cows culled from dairy farms arrive at livestock markets or abattoirs in compromised condition, but it is unknown whether cows are compromised at the time of culling or deteriorate during the marketing process. This study followed cull cows from farm to abattoir, monitored any deterioration, and tested the effect of providing such information on subsequent culling. For 11 mo, data were collected from 20 dairy farms, livestock markets, and abattoirs. Cows' body condition, lameness, and udder condition (as binary outcomes) were assessed at 4 points: when placed on the culling list, before leaving the farm, at auction, and at the abattoir. Based on the first 5 mo of data (baseline period), information materials were provided to 10 randomly selected farms (Informed treatment), and the other 10 served as a Control. Logistic mixed models were used to test differences in cows' condition at the 4 points of assessment, using the assessment before leaving the farm as a reference value and cow-within-farm as a random effect. The effects of providing information on outcome measures (proportion thin, severely lame, with udder edema, poor fitness for transport, euthanized, and died) were tested with a general linear model. As demand for milk increased during the baseline period, additional linear mixed models were fitted to test whether the same outcome measures were affected by time (baseline or treatment period) and treatment (Informed or Control) using farm as a random effect. While cows were on the culling list (before shipping) the odds of being thin or having poor fitness for transport increased. After leaving the farms, cows spent (mean ± standard deviation) 82 ± 46 h in the marketing system before being slaughtered. Shipping from farm to abattoir increased the odds of being thin, having udder edema, or showing poor fitness for transport [odds ratio (OR) 5.8, 95% confidence interval 4.2 to 8.1; OR 14.7, 10.7 to 20.2; and OR 7.3, 5.7 to 9.5, respectively]. Providing this information to farmers (Informed treatment) did not affect the outcome measures. Compared with the baseline, during the treatment period fewer cows were shipped when thin (4.9 versus 9.0%) and with poor fitness for transport (15.7 versus 25.8%), and fewer cows died (5.4 versus 11.9%) or were euthanized (13.3 versus 20.5%). Increased demand for milk appeared to lead to delayed culling, such that more compromised cows were sent to slaughter. The results of this study show a need for clear and specific guidelines to assess fitness for transport of cull dairy cows.

Fitness for transport of cull dairy cows at livestock markets

Cows are regularly removed from dairy herds and sold at livestock markets. Many cows are removed because of health problems, and their fitness for transport may vary because of seasonal variation, delayed or poor on-farm culling decisions, injuries during transport, and other factors. However, many dairy producers lack feedback about the condition of their cows during the marketing process and how cow condition influences sale price. This study evaluated the condition of cull dairy cows sold at livestock markets, tested how changing demand for milk influenced fitness for transport, and quantified how cow condition affected the price paid. For 12 mo, 2 livestock markets in British Columbia, Canada, were visited during 137 auction events when cull dairy cows were sold; 3 trained assessors observed 6,263 cull dairy cows while they were marketed in a sale ring. Observers recorded the cows' body condition score (BCS), locomotion score (LS), udder condition, quality defects (e.g., injuries, illness), and price. Logistic regression was used to test how month-to-month changes in demand for milk affected cows' fitness for transport, and a linear mixed model assessed how the animals' condition influenced the price. About 10% of the cows were thin (BCS ≤2), 7% were severely lame (locomotion score ≥4), 13% had engorged or inflamed udders, and 6% had other quality defects including abscesses, injuries, and signs of sickness (e.g., pneumonia). Cows culled during months with increased milk demand had much higher odds of poor fitness for transport (odds ratio 8.6, 95% confidence interval: 4.02-18.22). The price was most reduced if cows were thin (BCS ≤2) or visibly sick (-$0.63 ± 0.01/kg and -$0.56 ± 0.02/kg, respectively). Prices were reduced to a lesser degree by locomotion score ≥4 (-$0.35 ± 0.02/kg) and by udder condition (udder inflammation; -$0.30 ± 0.02/kg). Overall fitness for transport reduced the price by $0.51 ± 0.01/kg. In summary, about 30% of the cows sold at livestock markets had poor fitness for transport, which was partially influenced by increased milk demand and resulted in reduced market prices.

Discussion of development processes in insect-fungus association derived from the shaggy parasol fruiting on the nests of hairy wood ants

Chlorophyllum rhacodes, typically regarded as a rich grassland or open forest "mushroom" species, was found fruiting abundantly on nests of Formica lugubris, occurring in a Pinus silvestris plantation. Fruiting was absent from the rest of the woodland.Research focussed on the activities in the nests that could explain this. Within nests, there was a spatial relationship between C. rhacodes mycelium, insect cadavers, fruitbody initiation, and roots of adjacent trees.In vitro experiments found that C. rhacodes was not mycorrhizal with P. silvestris, but that it had qualities which rendered it suitable for colonization of the rhizosphere in the conditions of the nest mound and for further niche development.Implications of the unusual presence of fruit-bodies and the distribution of associated hyphae are discussed in relation to the nutritional biology (and recent taxonomical reassignment) of the fungus. This includes reference to the relevant physiology of insects and to the accepted evolution of mutualistic symbioses between fungi and the Attini and Termitidae.An argument is presented that the situation observed in vivo provides evidence of a degree of facultative association and what could be tangible support for the theory for the developmental origin of mutualistic fungus cultivation by insects. It is presented as a context for continued experimental research.

A 5-Year Review of Pavement Burns From a Desert Burn Center

Pavement burns account for significant burn-related injuries in the Southwestern United States and other hot climates with nearly continuous sunlight and daily maximum temperatures above 100°F. At peak temperatures, pavement can be hot enough to cause second-degree burns in a matter of seconds. The goal of this study was to review pavement burn injury admissions at a desert burn center compared with maximum ambient temperatures to determine which temperatures correlated to an increase in burn admissions. We obtained ambient temperature data from the National Oceanic and Atmospheric Administration. We reviewed our registry for 5 years retrospectively of all pavement burn injury admissions to our burn center. A total of 173 pavement-related burn cases were identified. We demonstrated an exponential increase in the rate of burn admissions as maximum ambient temperatures increased. More than 88% of pavement-related burn injury admissions occurred when the ambient temperature reached 95°F or higher. The risk per day was extrapolated based on the number of pavement burn injury admissions and the number of days at each of the maximum ambient temperatures recorded. The risk of pavement burns in areas of direct sunlight begins around 95°F and increases exponentially as ambient temperatures rise. This information will be used for burn outreach prevention and public health awareness programs. The benefit of this study relates to the entire community since high ambient temperatures put everyone at risk for hot pavement burns.

Remote Lifestyle Counseling Influences Cardiovascular Health Outcomes in Youth with Overweight or Obesity and Congenital Heart Disease

BACKGROUND

Children with overweight/obesity and congenital heart disease (CHD) are at increased cardiovascular risk. A lifestyle intervention may help reduce these risks. We sought to determine the feasibility of a smartphone-based lifestyle intervention to improve cardiovascular health outcomes in children with overweight/obesity and CHD.

METHODS

We examined the effect of bi-weekly nutrition and fitness counseling delivered via smartphone over 12 months. Thirty-four youth, previously diagnosed with CHD and with overweight or obesity, participated in the intervention. They were divided into two groups depending on whether the heart disease required surgical correction (operated, n = 19) or not (non-operated, n = 15). Anthropometry, body composition cardiorespiratory exercise capacity, and cardio-metabolic risk factors were assessed at baseline, 6 months, and 12 months.

RESULTS

Statistically significant decreases in waist circumference (WC), body mass index z-score, WC z-score, and waist to height ratio z-score were observed at 6 and 12 months in the operated group. A significant linear increase in lean body mass was observed in both groups. The study also had a high retention rate and a low attrition rate.

CONCLUSION

The observed changes in anthropometry were positive with significant improvement to some cardiovascular and metabolic risk indicators. However, this was only observed in the operated group suggesting that other factors, such as perception of condition and self-efficacy, may influence lifestyle behaviors. The results from this pilot study clearly demonstrate the feasibility to perform a larger controlled study on remote lifestyle intervention in children with congenital heart defects and overweight or obesity.

Performance Monitoring in Children Following Traumatic Brain Injury Compared to Typically Developing Children

Children with traumatic brain injury are reported to have deficits in performance monitoring, but the mechanisms underlying these deficits are not well understood. Four performance monitoring hypotheses were explored by comparing how 28 children with traumatic brain injury and 28 typically developing controls (matched by age and sex) performed on the stop-signal task. Control children slowed significantly more following incorrect than correct stop-signal trials, fitting the error monitoring hypothesis. In contrast, the traumatic brain injury group showed no performance monitoring difference with trial types, but significant group differences did not emerge, suggesting that children with traumatic brain injury may not perform the same way as controls.

Brain biomarkers and pre-injury cognition are associated with long-term cognitive outcome in children with traumatic brain injury

Background

Children with traumatic brain injury (TBI) are frequently at risk of long-term impairments of attention and executive functioning but these problems are difficult to predict. Although deficits have been reported to vary with injury severity, age at injury and sex, prognostication of outcome remains imperfect at a patient-specific level. The objective of this proof of principle study was to evaluate a variety of patient variables, along with six brain-specific and inflammatory serum protein biomarkers, as predictors of long-term cognitive outcome following paediatric TBI.

Method

Outcome was assessed in 23 patients via parent-rated questionnaires related to attention deficit hyperactivity disorder (ADHD) and executive functioning, using the Conners 3rd Edition Rating Scales (Conners-3) and Behaviour Rating Inventory of Executive Function (BRIEF) at a mean time since injury of 3.1 years. Partial least squares (PLS) analyses were performed to identify factors measured at the time of injury that were most closely associated with outcome on (1) the Conners-3 and (2) the Behavioural Regulation Index (BRI) and (3) Metacognition Index (MI) of the BRIEF.

Results

Higher levels of neuron specific enolase (NSE) and lower levels of soluble neuron cell adhesion molecule (sNCAM) were associated with higher scores on the inattention, hyperactivity/impulsivity and executive functioning scales of the Conners-3, as well as working memory and initiate scales of the MI from the BRIEF. Higher levels of NSE only were associated with higher scores on the inhibit scale of the BRI.

Conclusions

NSE and sNCAM show promise as reliable, early predictors of long-term attention-related and executive functioning problems following paediatric TBI.

INVITED REVIEW: Farm size and animal welfare

Critics of agricultural intensification have argued that the transition from smaller to larger farms has compromised animal welfare. To critically examine evidence relevant to this claim, we reviewed more than 150 publications that examined the relationship between farm size and at least one animal welfare indicator. Although much of this literature focuses on dairy cattle, we also reference other farmed species where appropriate. We found little evidence of any simple relationship, negative or positive, between farm size and animal welfare. Instead, the evidence suggests that larger farms provide some opportunities to improve animal welfare but may also create welfare risks. For example, larger farms permit more specialized and professional management of animal health but can make it more difficult to accommodate outdoor access that some view as integral to animal welfare. Future research should attempt to specify the underlying casual mechanisms by which statistical associations between farm size and indicators of welfare are believed to occur. We also suggest that policy and advocacy efforts aimed at reversing increases in farm size would be better directed toward improving welfare on farms of all sizes.

Continuous flow hydrogenations using novel catalytic static mixers inside a tubular reactor

Continuous flow reactor for the hydrogenation of organic substrates using novel catalytic static mixers.

Feasibility of hybrid off pump artery bypass grafting and transaortic transcatheter aortic valve implantation: A case series

INTRODUCTION

Patients with complex coronary artery disease and severe aortic stenosis unsuitable for conventional cardiac surgery pose a significant treatment challenge. This is especially difficult for patients where percutaneous revascularization is technically very challenging and/or would not offer as complete revascularisation compared to surgical revascularisation. In addition, patients who are unsuitable for transfemoral transcatheter aortic valve implantation (TAVI) pose an additional technical challenge, particularly with dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). As a potential solution we describe the first case series of hybrid off-pump coronary artery bypass grafting (CABG) combined with transaortic TAVI.

METHODS AND RESULTS

Over a ten-month-period, four patients underwent hybrid off-pump CABG combined with transaortic TAVI. A full sternotomy allowed off-pump arterial and vein graft anastomosis to significantly stenosed coronaries. The first three patients had severe aorto-iliac disease precluding femoral access; the fourth patient was deemed unsuitable for PCI. Transaortic TAVI using Edwards Sapien 3 valves were performed without complication in all four patients.

CONCLUSION

The hybrid off-pump CABG and transaortic TAVI procedure allows for more complete coronary revascularization, negates the need for DAPT, and minimizes treatment delay of a TAVI procedure, particularly in patients unsuitable for transfemoral access. We propose this as an important treatment option for the heart team to consider. © 2016 Wiley Periodicals, Inc.

Public Attitudes to Housing Systems for Pregnant Pigs

Understanding concerns about the welfare of farm animals is important for the development of socially sustainable production practices. This study used an online survey to test how views on group versus stall housing for pregnant sows varied when Canadian and US participants were provided information about these systems, including access to scientific papers, YouTube videos, Google images, and a frequently-asked-questions page (S1 Appendix). Initial responses and changes in responses after accessing the information were analyzed from Likert scores of 242 participants and from their written comments. Participants were less willing to accept the use of gestation stalls after viewing information on sow housing. For example, initially 30.4% of respondents indicated that they supported the use of gestation stalls; this declined to 17.8% after participants were provided additional information. Qualitative analysis of comments showed that supporters of gestation stalls expressed concern about the spread of disease and aggression between animals in less confined systems, whereas supporters of group housing placed more emphasis on the sow’s ability to interact socially and perform natural behaviors. These results point to public opposition to the use of gestation stalls, and indicate that the more that the public learns about gestation stalls the less willing they will be to accept their use.

Access site practice and procedural outcomes in relation to clinical presentation in 439,947 patients undergoing percutaneous coronary intervention in the United kingdom

OBJECTIVES

This study sought to determine the relationships among access site practice, clinical presentation, and procedural outcomes in a large patient population.

BACKGROUND

Transradial access (TRA) has been associated with improved patient outcomes in selected populations in randomized trials. It is unclear whether these outcomes are achievable in clinical practice.

METHODS

Using the BCIS (British Cardiovascular Intervention Society) database, we investigated outcomes for percutaneous coronary intervention procedures undertaken between 2007 and 2012 according to access site practice. Patients were categorized as stable, non-ST-segment elevation acute coronary syndrome (NSTEACS) and ST-elevation acute coronary syndrome (STEACS). The impact of access site on 30-day mortality, major adverse cardiac events, bleeding, and arterial access site complications was studied.

RESULTS

Data from 210,260 TRA and 229,687 transfemoral access procedures were analyzed. Following multivariate analysis, TRA was independently associated with a reduction in bleeding in all presenting syndromes (stable odds ratio [OR]: 0.24, p < 0.001; NSTEACS OR: 0.35, p < 0.001; STEACS OR: 0.47, p < 0.001) as well as access site complications (stable OR: 0.21, p < 0.001; NSTEACS OR: 0.19; STEACS OR: 0.16, p < 0.001). TRA was associated with reduced major adverse cardiac events only in patients with unstable syndromes (stable OR: 1.08, p = 0.25; NSTEACS OR: 0.72, p < 0.001; STEACS OR: 0.70, p < 0.001). TRA was associated with improved outcomes compared with a transfemoral access (TFA) with a vascular closure device in a propensity matched cohort.

CONCLUSIONS

In this large study, TRA is associated with reduced percutaneous coronary intervention-related complications in all patient groups and may reduce major adverse cardiac events and mortality in ACS patients. TRA is superior to transfemoral access with closure devices. Use of TRA may lead to important patient benefits in routine practice. TRA should be considered the preferred access site for percutaneous coronary intervention.

Percutaneous coronary intervention in the UK: recommendations for good practice 2015

Over the last 35 years, there has been dramatic progress in the technology and applicability of percutaneous techniques to treat obstructive coronary heart disease. Percutaneous coronary intervention (PCI) has a considerable evidence base and it is firmly established as the most common procedure used in the invasive treatment of patients with coronary heart disease in the UK. This set of guidelines aims to address specifically issues relating to PCI and not the growing subspecialty of structural heart disease intervention. It is not intended to provide a review of the entire evidence base for coronary intervention. The evidence base relating to PCI is extensively reviewed in international guidelines and the British Cardiovascular Intervention society endorses these guidelines and their updates. The guidelines presented here focus on issues pertinent to practice within the UK and set out a recommended template to ensure optimal delivery of patient care.

Thrombus capture by withdrawal of an open filter device: a useful treatment for large non-occlusive coronary thrombus

AIMS

The aim of this study was to assess the safety and feasibility of manual removal of a non-occlusive coronary thrombus using an open filter device. Between April 2006 and December 2011, 1,102 patients were treated percutaneously for acute coronary syndrome at our institution. Of these, nine (1%) had a large "cannon-ball" non-occlusive intracoronary thrombus, which did not improve with standard thrombectomy aspiration catheters. In these patients, we describe a novel technique of thrombus removal using the ev3 Spider™ filter device. Four patients had LAD thrombus, three had RCA thrombus, one LCX thrombus and one SVG thrombus. The primary endpoint of substantial or complete thrombus removal, prevention of no-reflow/slow flow phenomenon and achievement of TIMI 3 flow post stenting was achieved in all cases. Coronary dissection occurred in one case where the lesion was heavily calcified. There were no other complications related to the device. This is the first case series describing the use of the ev3 Spider™ filter device for the removal of a large intracoronary thrombus refractory to conventional treatment. This was associated with a high procedural success rate and may reduce the risk of no-reflow in these cases.

Early and Late Electrophysiological Effects of Distractor Frequency in Picture Naming: Reconciling Input and Output Accounts

The "distractor-frequency effect" refers to the finding that high-frequency (HF) distractor words slow picture naming less than low-frequency distractors in the picture-word interference paradigm. Rival input and output accounts of this effect have been proposed. The former attributes the effect to attentional selection mechanisms operating during distractor recognition, whereas the latter attributes it to monitoring/decision mechanisms operating on distractor and target responses in an articulatory buffer. Using high-density (128-channel) EEG, we tested hypotheses from these rival accounts. In addition to conducting stimulus- and response-locked whole-brain corrected analyses, we investigated the correct-related negativity, an ERP observed on correct trials at fronto-central electrodes proposed to reflect the involvement of domain general monitoring. The whole-brain ERP analysis revealed a significant effect of distractor frequency at inferior right frontal and temporal sites between 100 and 300-msec post-stimulus onset, during which lexical access is thought to occur. Response-locked, region of interest (ROI) analyses of fronto-central electrodes revealed a correct-related negativity starting 121 msec before and peaking 125 msec after vocal onset on the grand averages. Slope analysis of this component revealed a significant difference between HF and low-frequency distractor words, with the former associated with a steeper slope on the time window spanning from 100 msec before to 100 msec after vocal onset. The finding of ERP effects in time windows and components corresponding to both lexical processing and monitoring suggests the distractor frequency effect is most likely associated with more than one physiological mechanism.

Incidence and mechanisms of longitudinal stent deformation associated with Biomatrix, Resolute, Element, and Xience stents: Angiographic and case-by-case review of 1,800 PCIs

BACKGROUND

There is conflicting evidence regarding the incidence of longitudinal stent deformation (LSD) in contemporary practice.

METHODS AND RESULTS

To assess the incidence and mechanism of LSD across commonly used DES platforms, we performed a case-by-case review of 1,800 PCI cases involving 450 consecutive procedures using Biomatrix Flex, Resolute Integrity, Promus Element, and Xience V stents, respectively, between January 2009 and December 2011. LSD was detected in a higher proportion with Promus Element [15 (3.1%)] compared with other platforms (Xience V [4 (0.9%)], Biomatrix [3 (0.7%)], Resolute [3 (0.7%)]; P = 0.002). LSD was characterized as guide catheter/guide extension induced, or as impact from secondary devices such as postdilatation balloons or IVUS catheters. The incidence of guide catheter/guide extension LSD was similar across platforms; (Promus Element [5 (1.1%)], Xience V [4 (0.9%)], Biomatrix [3 (0.7%)], Resolute [3 (0.7%)]; P = 0.85). Secondary device LSD occurred exclusively with Promus Element (9/450 cases [2%] (P < 0.0001). Re-entering the deformed stent was more difficult in cases of secondary device LSD (6/9 compared with 0/12 treated cases; P < 0.001). Univariate predictors of LSD were previous CABG, culprit vessel, ostial involvement, and lesion tortuosity. Multivariate predictors of LSD were the Promus Element stent (OR 5.53 CI[1.54-19.85]), Guideliner use (OR 22.09 CI[4.73-103]), postdilation balloons (OR 5.47 CI[1.31-22.81]) and number of stents deployed (OR 2.06 CI[1.45-2.9].

CONCLUSION

LSD is more common than previously reported. LSD by a guide catheter/guide extension occurred equally with all platforms, however, LSD associated with secondary devices only occurred with the Element stent. These findings have important implications regarding current and future stent designs.

Five population-based interventions for smoking cessation: a MOST trial

Little is known about the relative, additive, and interactive effects of different population-based treatments for smoking cessation. The goal of this study was to evaluate the main and interactive effects of five different smoking interventions. Using the multiphase optimization strategy (MOST), 1,034 smokers who entered a Web site for smokers (smokefree.gov) were randomly assigned to the "on" and "off" conditions of five smoking cessation interventions: the National Cancer Institute's (NCI) Web site (www.smokefree.gov vs a "lite" Web site), telephone quitline counseling (vs none), a smoking cessation brochure (vs a lite brochure), motivational e-mail messages (vs none), and mini-lozenge nicotine replacement therapy (NRT vs none). Analyses showed that the NCI Web site and NRT both increased abstinence; however, the former increased abstinence significantly only when it was not used with the e-mail messaging intervention (messaging decreased Web site use). The other interventions showed little evidence of effectiveness. There was evidence that mailed nicotine mini-lozenges and the NCI Web site (www.smokefree.gov) provide benefit as population-based smoking interventions.

Welfare of non-traditional pets

The keeping of non-traditional or 'exotic' pets has been growing in popularity worldwide. In addition to the typical welfare challenges of keeping more traditional pet species like dogs and cats, ensuring the welfare of non-traditional pets is complicated by factors such as lack of knowledge, difficulties meeting requirements in the home and where and how animals are obtained. This paper uses examples of different species to highlight three major welfare concerns: ensuring that pets under our care i) function well biologically, ii) are free from negative psychological states and able to experience normal pleasures, and iii) lead reasonably natural lives. The keeping of non-traditional pets also raises ethical concerns about whether the animal poses any danger to others (e.g. transmission of zoonotic diseases) and whether the animal might cause environmental damage (e.g. invading non-native habitats when released). The authors used these considerations to create a checklist, which identifies and organises the various concerns that may arise over keeping non-traditional species as pets. An inability to address these concerns raises questions about how to mitigate them or even whether or not certain species should be kept as pets at all. Thus, the authors propose five categories, which range from relatively unproblematic pet species to species whose keeping poses unacceptable risks to the animals, to humans, or to the environment. This approach to the evaluation and categorisation of species could provide a constructive basis for advocacy and regulatory actions.

The globalisation of farm animal welfare

Animal welfare has achieved significant global prominence for perhaps three reasons. First, several centuries of scientific research, especially in anatomy, evolutionary biology and animal behaviour, have led to a gradual narrowing of the gap that people perceive between humans and other species; this altered perception has prompted grass-roots attention to animals and their welfare, initially in Western countries but now more globally asthe influence of science has expanded. Second, scientific research on animal welfare has provided insights and methods for improving the handling, housing and management of animals; this 'animal welfare science' is increasingly seen as relevant to improving animal husbandry worldwide. Third, the development and use of explicit animal welfare standards has helped to integrate animal welfare as a component of national and international public policy, commerce and trade. To date, social debate about animal welfare has been dominated bythe industrialised nations. However, as the issue becomes increasingly global, it will be important for the non-industrialised countries to develop locally appropriate approaches to improving animal welfare, for example, by facilitating the provision of shelter, food, water and health care, and by improving basic handling, transportation and slaughter.