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Remote ischemic conditioning (RIC) has well‐established cardioprotective effects in preclinical studies and promising results in preclinical stroke research. Effective translation from preclinical studies to clinical trials has yet to be accomplished, perhaps because of the use of multiple applications of RIC (e.g., pre‐, per‐, or post‐conditioning) in preclinical studies by both invasive and non‐invasive protocols, some of which not clinically applicable. Our systematic review conformed to PRISMA guidelines and addressed differences in clinically relevant RIC applications and outcomes between preclinical and clinical studies. We retrieved a total of 30 studies (8 human; 22 animal) that met the inclusion criteria of testing clinically relevant procedures; namely, non‐invasive and per‐ or post‐conditioning protocols. Per‐conditioning was applied in 6 animal and 3 human studies, post‐conditioning was applied in 16 animal and 5 human studies, and both conditioning methods were applied in 2 animal studies. Application of RIC varied between human and animal studies regarding initiation, duration, repetition, and number of limbs included. Study designs did not systematically apply blinding, randomization, or placebo controls. On only a few occasions did preclinical studies include animals with clinically relevant comorbidities. Clinical trials were challenged by not completing the intended number of RIC cycles or addressing this deficit in the data analysis. Consistency and transferability of methods used for positive animal studies and subsequent human studies are essential for the optimal translation of results. Consensus on preclinical and clinical RIC procedures should be reached for a full understanding of the possible beneficial effects of RIC treatment in stroke.

BACKGROUND Strongylid and ascarid parasites are omnipresent in equine stud farms, and ever-increasing levels of anthelmintic resistance are challenging the industry with finding more sustainable and yet effective parasite control programs. OBJECTIVES To evaluate egg count levels, bodyweight and equine health under defined parasite control protocols in foals and mares at two Standardbred and two Thoroughbred stud farms. STUDY DESIGN Longitudinal randomised field trial. METHODS A total of 93 foals were enrolled and split into two treatment groups, and 99 mares were enrolled and assigned to three treatment groups. All horses underwent a health examination, and episodes of colic or diarrhoea were recorded at each faecal collection date. Bodyweights were assessed using a weight tape, and mares were body condition scored. Group A foals (FA) were dewormed at 2 and 5 months of age with a fenbendazole/ivermectin/praziquantel product, while group B foals (FB) were dewormed on a monthly basis, alternating between the above-mentioned product and an oxfendazole/pyrantel embonate product. Group A mares (MA) were dewormed twice with fenbendazole/ivermectin/praziquantel, group B mares (MB) were dewormed with the same product, when egg counts exceeded 300 strongylid eggs per gram, and group C mares (MC) were dewormed every 2 months, alternating between the two products. Health data were collected monthly for 6 months (foals) and bimonthly for 13 months (mares). Data were analysed with mixed linear models and interpreted at the α = 0.05 significance level. RESULTS There were no significant bodyweight differences between foal groups, but MA mares were significantly lighter than the other two groups. Very few health incidents were recorded. Foals in group FA had significantly higher ascarid and strongylid egg counts, whereas no significant differences were observed between mare groups. MAIN LIMITATIONS Study duration limited to one season. CONCLUSIONS Anthelmintic treatment intensity was lowered from the traditional intensive regimes without measurable negative health consequences for mares and foals.

Purpose: Ischemic preconditioning (IPC) and postactivation potentiation (PAP) are warm-up strategies proposed to improve high-intensity sporting performance. However, only few studies have investigated the benefits of these strategies compared with an appropriate control (CON) or an athlete-selected (SELF) warm-up protocol. Therefore, this study examined the effects of 4 different warm-up routines on 1-km time-trial (TT) performance with competitive cyclists. Methods: In a randomized crossover study, 12 well-trained cyclists (age 32 [10] y, mass 77.7 [4.6] kg, peak power output 1141 [61] W) performed 4 different warm-up strategies—(CON) 17 minutes CON only, (SELF) a self-determined warm-up, (IPC) IPC + CON, or (PAP) CON + PAP—prior to completing a maximal-effort 1-km TT. Performance time and power, quadriceps electromyograms, muscle oxygen saturation (SmO2), and blood lactate were measured to determine differences between trials. Results: There were no significant differences (P > .05) in 1-km performance time between CON (76.9 [5.2] s), SELF (77.3 [6.0] s), IPC (77.0 [5.5] s), or PAP (77.3 [5.9] s) protocols. Furthermore, there were no significant differences in mean or peak power output between trials. Finally, electromyogram activity, SmO2, and recovery blood lactate concentration were not different between conditions. Conclusions: Adding IPC or PAP protocols to a short CON warm-up appears to provide no additional benefit to 1-km TT performance with well-trained cyclists and is therefore not recommended. Furthermore, additional IPC and PAP protocols had no effect on electromyograms and SmO2 values during the TT or peak lactate concentration during recovery.

Climate change is likely to influence livestock production by increasing the prevalence of diseases, including parasites. The traditional practice of controlling nematodes in livestock by the application of anthelmintics is, however, increasingly compromised by the development of resistance to these drugs in parasite populations. This study used a previously developed simulation model of the entire equine cyathostomin lifecycle to investigate the effect a changing climate would have on the development of anthelmintic resistance. Climate data from six General Circulation Models based on four different Representative Concentration Pathways was available for three New Zealand locations. These projections were used to estimate the time resistance will take to develop in the middle (2040–49) and by the end (2090–99) of the century in relation to current (2006–15) conditions under two treatment scenarios of either two or six yearly whole-herd anthelmintic treatments. To facilitate comparison, a scenario without any treatments was included as a baseline. In addition, the size of the infective and parasitic stage nematode population during the third simulation year were estimated. The development of resistance varied between locations, time periods and anthelmintic treatment strategies. In general, the simulations indicated a more rapid development of resistance under future climates coinciding with an increase in the numbers of infective larvae on pasture and encysted parasitic stages. This was especially obvious when climate changes resulted in a longer period suitable for development of free-living parasite stages. A longer period suitable for larval development resulted in an increase in the average size of the parasite population with a larger contribution from eggs passed by resistant worms surviving the anthelmintic treatments. It is projected that climate change will decrease the ability to control livestock parasites by means of anthelmintic treatments and non-drug related strategies will become increasingly important for sustainable parasite control., Graphical abstract Image 1, Highlights • The development of anthelmintic resistance under climate change was simulated. • Climate can become more suitable for parasite development, increasing population size. • The time resistance took to develop was linked to changes in parasite population size. • Non-drug related strategies will become increasingly important for parasite control.

Much of the biopharmaceutical industry's success over the past 30 years has relied on products derived from Chinese Hamster Ovary (CHO) cell lines. During this time, improvements in mammalian cell cultures have come from cell line development and process optimization suited for large-scale fed-batch processes. Originally developed for high cell densities and sensitive products, perfusion processes have a long history. Driven by high volumetric titers and a small footprint, perfusion-based bioprocess research has regained an interest from academia and industry. The recent pandemic has further highlighted the need for such intensified biomanufacturing options. In this review, we outline the technical history of research in this field as it applies to biologics production in CHO cells. We demonstrate a number of emerging trends in the literature and corroborate these with underlying drivers in the commercial space. From these trends, we speculate that the future of perfusion bioprocesses is bright and that the fields of media optimization, continuous processing, and cell line engineering hold the greatest potential. Aligning in its continuous setup with the demands for Industry 4.0, perfusion biomanufacturing is likely to be a hot topic in the years to come.

Objective Timely evaluation and initiation of treatment is the key for improving stroke outcomes, although minimizing the time from symptom onset to the first contact with healthcare professionals remains a challenge. We aimed to identify patient‐related factors associated with early hospital arrival. Materials and methods In this cross‐sectional survey, we included patients with stroke or transient ischemic attack admitted directly to one of two noncomprehensive stroke units or transferred to the units from comprehensive stroke centers in the Capital Region of Denmark. Patient‐reported factors associated with early hospital arrival were analyzed using multivariable logistic regression analysis adjusted for age, sex, education, living arrangement, brain location of the stroke, stroke severity, patient‐perceived symptom severity, history of prior stroke, stroke risk factors, and knowledge of stroke symptoms. Results In total, 479 patients with acute stroke were included (median age 74 (25th–75th percentile, 64–80), 40% women), of whom 46.4% arrived within 180 min of symptom onset. Factors associated with early hospital arrival were patients or bystanders choosing emergency medical service (EMS) for the first contact with a medical professional (adjusted odds ratio (OR), 3.41; 95% confidence interval, CI [1.57, 7.35]) or the patient's perceived symptom severity above the median score of 25 on a 100‐point verbal scale (adjusted OR, 2.44; 95% CI [1.57, 3.82]). Living alone reduced the likelihood of early arrival (adjusted OR, 0.53; 95% CI [0.33, 0.86]). Conclusions Only when patients perceived symptoms as severe or when EMS was selected as the first contact, early arrival for stroke treatment was ensured., Patient‐related factors associated with hospital arrival within 180 minutes

Bronchopulmonary neuroendocrine tumours are divided into typical carcinoid (TC), atypical carcinoid (AC), large cell neuroendocrine carcinoma (LCNEC), and small cell lung cancer (SCLC).To thoroughly describe a cohort of 252 patients with TC, AC and LCNEC (SCLC excluded).Collection of data from 252 patients referred to and treated at Rigshospitalet 2008-2016. Data was collected from electronic patient files and our prospective NET database. Statistics were performed in SPSS.162 (64%) had TC, 29 (12%) had AC and 61 (24%) had LCNEC. Median age at diagnosis was 69 years (range: 19-89) with no difference between genders. Thoraco-abdominal CT was performed in all patients at diagnosis. FDG-PET/CT was performed in 207 (82%) at diagnosis and was positive in 95% of the entire cohort, with no difference between tumour types. Synaptophysin was positive in 98%, chromogranin A in 92% and CD56 in 97%. Mean Ki67 index was 5% in TC, 16% in AC and 69% in LCNEC (p 0.001). Metastatic disease was found in 4% of TC, 27% of AC and 58% of LCNEC at time of initial diagnosis (p 0.001). In total 179 patients (71%) underwent surgical resection; TC: 87%, AC: 72% and LCNEC: 28% (p 0.001). Of the resected patients, 11 (6%) had recurrence. Five-year survival rate was 88% for TC, 63% for AC and 20% for LCNEC.In this comprehensive study of a cohort of 252 patients, one of the largest until date, with TC, AC and LCNEC, the gender distribution showed female predominance with 68%. FDG-PET/CT was positive in 95% of the patients independent of tumour type, which confirms that FDG-PET/CT should be a part of the preoperative work-up for TC, AC and LCNEC. Tumour type was the single most potent independent prognostic factor.

The US Food and Drug Administration in 2008 required new type 2 diabetes (T2D) medications to be subject to cardiovascular outcomes safety requirements. Accordingly, the global LEADER trial investigated cardiovascular outcomes of T2D treatment with liraglutide, a glucagon-like peptide-1 receptor agonist. LEADER (NCT01179048) was a multiregional clinical trial (MRCT) conducted from 2010 to 2016, thus completed before publication of the International Council for Harmonization (ICH) E17 guideline on MRCTs in 2017. Novo Nordisk pre-specified analysis of regional cardiovascular outcomes of LEADER participants. This paper assesses the pre-specified regional outcomes based on the ICH E17 guidelines on consistency evaluation. Regional LEADER participant numbers were broadly aligned with ICH E17 guidance and equally balanced across Europe, Asia, North America, and rest of the world. Overall primary major adverse cardiovascular events (MACE) composite outcome for the trial: hazard ratio (HR) (95% CI) 0.87 (0.78; 0.97); regional results varied, ranging from HR (95% CI) 0.62 (0.37; 1.04) (Asia) to 1.01 (0.84; 1.22) (North America). However, pre-specified Cox proportional-hazard regression analyses did not show clear evidence of interaction between regions and primary outcome (p = 0.20). Furthermore, post hoc analysis of the US population in the North American region found that adjusting for extrinsic or intrinsic factors did not account for this difference [HR (95% CI) 1.03 (0.84; 1.25)]. LEADER data evaluation demonstrated general consistency in cardiovascular safety across regions, except for US participants. Discrepancies in the North American region may relate to drug exposure or chance, but, as these were post hoc findings, the overall primary result is valid, aligned with ICH E17 guidelines.

Background A well-known complication of having hip alloplasty surgery is dislocation of the prothesis. This affects 2%-4% of the patients, and 75% of the dislocations occur within the first year after surgery. The aim of our study was to gain knowledge about the clinical considerations underlying the choice of anaesthesia for, and treatment of, patients with dislocated hips by specialists in anaesthesiology and orthopaedic surgery. Methods We used semi-structured group interviews of specialists in anaesthesiology and orthopaedic surgery. An interview guide was developed and pilot tested before the group interviews. In total, 25 specialists participated, recruited from two university hospitals in Denmark. Data saturation was reached after seven group interviews. Inductive content analysis was used in the data analysis. Results We identified four overall themes, describing essential considerations made by the specialists: "Adhering to the principle of minimal intervention", "Ensuring patient safety through optimal working conditions", "Organisational considerations" and "Pain induced gastric retention". Conclusion Our study illustrates different clinical considerations made by specialists in anaesthesiology and orthopaedic surgery in relation to the treatment of patients with dislocated hips. Our results hope to promote mutual understanding in joint clinical decision-making in relation to patients with dislocated hips as well as to inspire less-experienced anaesthesiologists and orthopaedic surgeons. Additionally, our results suggest a set of "rules of thumb" for how jointly to decide on the repositioning site of the patient during the procedure.

Human expansion can cause disturbance and intrusion of invasive species, which are detrimental to small carnivores. We investigated how European wildcats responded to disturbance from mushroom collectors, cattle and feral pigs in Sicily, Italy. We used detections from 76 cameras over 2 surveys (2015–2016 and 2018; camera days = 1985) to run occupancy and co-occurrence models and estimate overlap in activity patterns between species pairs. During 2015–2016, wildcats were detected at the same location with cattle, mushroom hunters and feral pigs at 14.4%, 26.3% and 17.1% of cameras. During 2018, wildcats were detected at the same location with cattle, mushroom hunters and feral pigs at 7.8%, 19.7% and 6.5% of cameras. Dominant species (A; cattle, mushroom hunters and feral pigs) did not affect occupancy of the subordinate species (B; wildcats) during 2015–2016. In 2018, the effect of species A on wildcat occupancy was evident for cattle-wildcat and mushroom hunters-wildcat pairs and wildcat occupancy was higher at sites where species A was not present. Probabilities of detecting wildcats at sites where species A was not present or not detected were higher than probabilities of detecting wildcats at sites where species A was detected. Overlap in activity levels was low between mushroom hunters and wildcats and higher between cattle and wildcats, but varied between surveys for feral pig-wildcat pair. Although results differed between survey periods, we suggest that wildcats generally avoided cattle, feral pigs and mushroom hunters, at both temporal and spatial scales. Anthropogenic disturbance, livestock and invasive species are emerging threats to wildcats and future conservation actions should consider our results.

Aims: To evaluate how common radiation therapy techniques perform in the setting of the new European Society for Radiotherapy and Oncology-Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) delineation recommendations for immediate breast reconstruction (IBR). Materials and methods: Seven Danish radiation therapy centres and six international European centres participated in this project. Two breast cancer cases (one left-sided and one right-sided) with a retropectoral implant were chosen for radiation therapy planning using deep-inspiration breath-hold. Target volumes were delineated according to ESTRO-ACROP delineation recommendations. The centres were asked to plan the cases using any radiation therapy technique according to the Danish Breast Cancer Group plan objectives. Results: In total, 35 treatment plans were collected. Half of the submitted plans, for both the left-sided and the right-sided case, used the field-in-field (FiF) technique (nine for each), a quarter used volumetric arc radiation therapy (VMAT; five for right-sided, four for left-sided) and the remaining quarter was a mix of inverse intensity-modulated radiation therapy (IMRT), helicoidal therapy and hybrid (combined open fields and VMAT) techniques. Mean clinical target volume doses were in the range 99-102% of the prescribed dose. The median FiF mean heart dose (MHD) for right-sided radiation therapy was 1 Gy (range 0.8-3.7) and 5.2 Gy for left-sided radiation therapy (range 2.2-6.5). For right-sided radiation therapy, the median VMAT MHD was 3.42 Gy, for IMRT was 2.3 Gy and for helicoidal therapy was 5.1 Gy. For left-sided radiation therapy, the median VMAT MHD was 6.3 Gy, for IMRT was 7.8 Gy and for helicoidal therapy was 7.3 Gy. Conclusions: Different radiation therapy techniques could be used to plan radiation therapy in the setting of IBR. FiF provided good coverage with acceptable organ at risk doses. The best dose distribution results as a trade-off between the objectives of target volume coverage and high-dose organ at risk inclusion. The radiation therapy technique affects the interplay between these objectives. (C) 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Increased demand for power in Norway as well as the possibility of power export to Central Europe initiated a national research program for finding technical solutions to the new situation. The Norwegian power producing units and systems are initially designed for optimised energy production. The new energy marked made a huge change in the way the power plants were operated, following the price fluctuation in the marked. Problems with sufficient pricing of ancillary services giving enough priority to this kind of production in order to maintain the grid capacity, was, and still is a major obstacle for building for power.

Introduction Retrospective studies have suggested that a significant proportion of patients with cardiac amyloidosis received surgical treatment for carpal tunnel syndrome (CTS) 5–10 years before diagnosis of their cardiac condition. So far, one cross-sectional study has investigated the presence of localized and systemic amyloidosis in 98 patients undergoing carpal tunnel release surgery (CTRS). Ten percent were shown to have amyloid deposits in the carpal tunnel while two had cardiac involvement caused by either AL amyloidosis or wild-type transthyretin amyloidosis (ATTR). Purpose To investigate the prevalence of cardiac amyloidosis among unselected and consecutive patients undergoing CTRS. Methods Tissue samples from the carpal tunnel of 182 CTRS patients were stained with Congo Red. Amyloid positive samples were subtyped by immunoelectron microscopy and mass spectrometry. Amyloid positive patients underwent investigations for cardiac amyloidosis including ECG-recording, echocardiography and strain imaging, cardiac magnetic resonance imaging and whole-body scintigraphy (99m-tc-DPD). Genetic investigation of the gene for TTR was performed in patients with ATTR amyloidosis or an undetermined subtype. Patients were also investigated by measurements of NT-proBNP, troponins, immunoglobulins, M-protein in serum and urine, and free light kappa and lambda chains in serum. Results In total, 16% (29/182) of the patients had amyloid positive biopsies. They were significantly older than amyloid negative patients (73 years vs 53 years, p The subtype of amyloid was shown to be (a) ATTR in 86% (n=25) of patients, (b) localized light-chain amyloidosis in 3% (n=1), and (c) fibrinogen alpha amyloidosis in 3% (n=1), while the amount of tissue did not allow subtyping in 7% (n=2). All ATTR patients had a normal genetic investigation. So far, 24 of the 29 amyloid positive patients have completed all clinical investigations and no one fulfilled diagnostic criteria of cardiac amyloidosis. Conclusion A significant number of CTRS patients, (14%), had wild-type ATTR amyloidosis confined to the carpal tunnel. None of these had cardiac involvement. These findings were different from the results in the previous prospective study and were likely to be explained by differences in the patient cohorts investigated. We investigated unselected patients in contrast to the highly selected cohort in the previous study. Based on the findings in the current study the proportion of CTRS patients with localized amyloidosis who may develop systemic disease is unknown. Therefore, it is necessary to perform long term follow-up of these patients before routine investigations for amyloidosis may be recommended. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Financial support was obtained by an unrestricted research grant from Alnylam Pharmaceuticals

Peripheral nerve blocks (PNBs) are increasingly popular in acute ankle fracture surgery but rebound pain may outweigh the benefits. The AnAnkle Trial was designed to assess the postoperative pain profile of PNB anaesthesia compared with spinal anaesthesia (SA).The AnAnkle Trial was a randomised, two-centre, blinded outcome analysis trial. Eligible adults booked for primary ankle fracture surgery were randomised to PNB or SA. The PNBs were ultrasound-guided popliteal sciatic and saphenous blocks with ropivacaine and SAs were with hyperbaric bupivacaine. Postoperatively, all subjects received paracetamol, ibuprofen, and patient-controlled i.v. morphine for pain. The primary endpoint was 27 h Pain Intensity and Opioid Consumption (PIOC) score. Secondary endpoints included longitudinal pain scores and morphine consumption separately, and questionnaires on quality of recovery.This study enrolled 150 subjects, and the PNB success rate was94%. PIOC was lower with PNB anaesthesia (median, -26.5% vs +54.3%; P0.001) and the probability of a better PIOC score with PNB than with SA was 74.8% (95% confidence interval, 67.0-82.6). Pain scores and morphine consumption analysed separately also yielded a clear benefit with PNB, despite substantial rebound pain when PNBs subsided. Quality of recovery scores were similar between groups, but 99% having PNB vs 90% having SA would choose the same anaesthesia form again (P=0.03).PNB anaesthesia was efficient and provided a superior postoperative pain profile compared with SA for acute ankle fracture surgery, despite potentially intense rebound pain after PNB.Clinicaltrialsregister.eu, EudraCT number: 2015-001108-76.

Background: It was the aim to investigate the frequency and genetic basis of dilated cardiomyopathy (DCM) among relatives of index patients with unexplained heart failure at a tertiary referral center. Methods: Clinical investigations were performed in 109 DCM index patients and 445 of their relatives. All index patients underwent genetic investigations of 76 disease-associated DCM genes. A family history of DCM occurred in 11% (n=12) while clinical investigations identified familial DCM in a total of 32% (n=35). One-fifth of all relatives (n=95) had DCM of whom 60% (n=57) had symptoms of heart failure at diagnosis, whereas 40% (n=38) were asymptomatic. Symptomatic relatives had a shorter event-free survival than asymptomatic DCM relatives ( P Results: Genetic investigations identified 43 pathogenic (n=27) or likely pathogenic (n=16) variants according to the American College of Medical Genetics and Genomics and the Association for Molecular Pathology criteria. Forty-four percent (n=48/109) of index patients carried a pathogenic/likely pathogenic variant of whom 36% (n=27/74) had sporadic DCM, whereas 60% (21/35) were familial cases. Thirteen of the pathogenic/likely pathogenic variants were also present in ≥7 affected individuals and thereby considered to be of sufficient high confidence for use in predictive genetic testing. Conclusions: A family history of DCM identified only 34% (n=12/35) of hereditary DCM, whereas systematic clinical screening identified the remaining 66% (n=23) of DCM families. This emphasized the importance of clinical investigations to identify familial DCM. The high number of pathogenic/likely pathogenic variants identified in familial DCM provides a firm basis for offering genetic investigations in affected families. This should also be considered in sporadic cases since adequate family evaluation may not always be possible and the results of the genetic investigations may carry prognostic information with an impact on individual management.

Simple Summary The most important equine intestinal worm species include the roundworms Strongylus vulgaris and Parascaris spp. as well as tapeworms such as Anoplocephala perfoliata. These parasites reside in the small and large intestine and may cause various signs of disease, such as diarrhea, unthriftiness, or colic. However, following decades of routine anti-worm treatments, it is currently unclear what relevance these infections have in the context of colic under the prevailing situation. Therefore, we examined the signs of the presence of the infection concerning the above-mentioned parasites in 620 equine clinic patients, half of these admitted after being diseased with colic and the other admitted due to non-intestinal diseases. With approximately on third of all horses being positive for antibodies directed against S. vulgaris, we detected an unexpectedly high infection rate. With every tenth horse showing respective antibodies, also tapeworm infections were encountered in a considerable proportion of the examined horses. Somewhat unexpectedly, no association between worm infection and colic was detected. However, recent—i.e., during the last seven days—anthelmintic treatment was 2.4 times more often seen in horses showing signs of colic. Overall, the considerable S. vulgaris and tapeworm infection rates mean we should stay alert in continuing worm monitoring and control. Abstract All around the world, intestinal helminths constitute one of the most prevalent life-long occurring infections and re-infections affecting all horse age groups. A range of parasite species among strongyles, ascarids, and tapeworms is known to have the potential to cause colic in horses. However, there is a lack of current scientific evidence on the actual relevance of helminth infection levels in the context of colic in horses kept during prevailing epidemiological conditions. Thus, a prospective case-control study on the occurrence of intestinal helminths in a total of 620 mainly adult equine clinic patients was conducted to investigate the association between colic and helminth infection. For each horse, a range of copromicroscopic, serological, and clinical data was obtained, in addition to a questionnaire on relevant anamnestic data, including previous anthelmintic treatment and husbandry. Using a FLOTAC-based copromicroscopic diagnosis, the highest infection rates were seen for strongyles (41.8%), followed by Anoplocephala perfoliata and Parascaris spp. (both 0.8%), with no significant difference between the two study groups. Employing a real-time PCR a 1.1% S. vulgaris DNA prevalence was found. Considerably higher seroprevalences were observed using S. vulgaris and A. perfoliata ELISAs, with 32.3% and 10.7%, respectively. It was noteworthy that no association concerning either serologic status was encountered with colic status. The shedding of strongyle eggs was associated with a 1.8-times increased risk of S. vulgaris seropositivity. Recent anthelmintic treatment was associated with the onset of colic, as animals who had received an anthelmintic during the previous week had a 2.4-times higher risk of signs of colic compared to those who had been treated at least eight weeks prior. Another noteworthy observation was that ponies were significantly less often affected by colic than warmbloods. The high S. vulgaris and considerable A. perfoliata seroprevalences encountered in this investigation should prompt veterinarians, farm managers, and horse owners to maintain consequent and effective worm control measures.

Purpose We investigated the feasibility of the Actiheart monitor to determine total daily energy expenditure and the validity of the Actiheart step test as an accurate estimate of peak oxygen uptake. Methods (Equation is included in full-text article.)O2 peak was estimated with the Actiheart step test and compared with a cardiopulmonary exercise test. Total daily energy expenditure was measured using the Actiheart monitor on days with and without classmate coadmission. Results Of 26 eligible measurement periods (15 children), 89% participated and 91% could participate safely; however, 35% fulfilled demands for valid monitoring. The percentage of children not completing the monitoring period was 10% (attrition) and adherence to classmate visits was 84%. Forty-eight percent of the measurement periods provided data, and only 27% was calibrated data. Actiheart step test significantly overestimated (Equation is included in full-text article.)O2 peak compared with the Cardio Pulmonary Exercise Test. Conclusion Measuring total daily energy expenditure using Actiheart is not feasible, nor implementable in children with cancer. Furthermore, the Actiheart step test is not a valid test to estimate (Equation is included in full-text article.)O2 peak in children with cancer.

Introduction: Postprandial hypoglycemia is a frequent and debilitating complication following Roux-en-Y gastric bypass (RYGB) without effective treatments. In a proof-of-concept study, we investigated the effects of dasiglucagon, a novel, stable glucagon analog, on postprandial hypoglycemia after RYGB. Methods: Ten RYGB-operated individuals with confirmed symptomatic postprandial hypoglycemia (plasma glucose concentration (PG) Results: Compared with placebo, treatment with both D80µg and D200µg significantly increased nadir PG (placebo: 3.0±0.2 mmol×L-1; D80µg: 3.9±0.3 mmol×L-1; D200µg: 4.5±0.2 mmol×L-1; P=0.002 and P=0.0002) and PG incremental area under the curve (iAUC70-240min) after drug administration (placebo: 752±19 mmol×L-1×min; D80µg: 917±22 mmol×L-1×min; D200µg: 992±28 mmol×L-1×min; P Conclusion: Administration of dasiglucagon effectively ameliorates postprandial hypoglycemia representing a promising new therapeutic option for management of postprandial hypoglycemia after RYGB. Disclosure C.K. Nielsen: None. C. Oehrstroem: None. U. Kielgast: None. D.L. Hansen: None. A. Lund: Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk A/S, Sanofi. T. Vilsbøll: Advisory Panel; Self; AstraZeneca, Mundipharma International, Novo Nordisk A/S, Sun Pharmaceutical Industries Ltd. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Medscape, Merck Sharp & Dohme Corp., Sanofi. F.K. Knop: Advisory Panel; Self; AstraZeneca, Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk A/S, Sanofi. Consultant; Self; Carmot Therapeutics, Inc., Eli Lilly and Company, Novo Nordisk A/S. Research Support; Self; AstraZeneca, Gubra, Novo Nordisk A/S, Sanofi, Zealand Pharma A/S. Speaker’s Bureau; Self; AstraZeneca, Lupin Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Norgine B.V., Novo Nordisk A/S.

Background Musculocontractural Ehlers–Danlos Syndrome (mcEDS) is a rare connective tissue disorder caused by biallelic loss‐of‐function variants in CHST14 (mcEDS‐CHST14) or DSE (mcEDS‐DSE), both of which result in defective dermatan sulfate biosynthesis. Forty‐one patients with mcEDS‐CHST14 and three patients with mcEDS‐DSE have been described in the literature. Methods Clinical, molecular, and glycobiological findings in three additional patients with mcEDS‐DSE were investigated. Results Three patients from two families shared craniofacial characteristics (hypertelorism, blue sclera, midfacial hypoplasia), skeletal features (pectus and spinal deformities, characteristic finger shapes, progressive talipes deformities), skin features (fine or acrogeria‐like palmar creases), and ocular refractive errors. Homozygous pathogenic variants in DSE were found: c.960T>A/p.Tyr320* in patient 1 and c.996dupT/p.Val333Cysfs*4 in patients 2 and 3. No dermatan sulfate was detected in the urine sample from patient 1, suggesting a complete depletion of DS. Conclusion McEDS‐DSE is a congenital multisystem disorder with progressive symptoms involving craniofacial, skeletal, cutaneous, and cardiovascular systems, similar to the symptoms of mcEDS‐CHST14. However, the burden of symptoms seems lower in patients with mcEDS‐DSE., Clinical, molecular, and glycobiological findings in three additional patients from two families with musculocontractural Ehlers–Danlos syndrome (mcEDS‐DSE) are described. McEDS‐DSE is a congenital multisystem disorder with progressive symptoms involving craniofacial, skeletal, cutaneous, and cardiovascular systems, similar to the symptoms of mcEDS‐CHST14. However, the burden of symptoms seems lower in patients with mcEDS‐DSE.

The emergence of inexpensive, base-perfect genome editing is revolutionising biology. Modern industrial biotechnology exploits the advances in genome editing in combination with automation, analytics and data integration to build high-throughput automated strain engineering pipelines also known as biofoundries. Biofoundries replace the slow and inconsistent artisanal processes used to build microbial cell factories with an automated design-build-test cycle, considerably reducing the time needed to deliver commercially viable strains. Testing and hence learning remains relatively shallow, but recent advances in analytical chemistry promise to increase the depth of characterization possible. Analytics combined with models of cellular physiology in automated systems biology pipelines should enable deeper learning and hence a steeper pitch of the learning cycle. This review explores the progress, advances and remaining bottlenecks of analytical tools for high throughput strain engineering.

Genetic engineering projects are rapidly growing in scale and complexity, driven by new tools to design and construct DNA. There is increasing concern that widened access to these technologies could lead to attempts to construct cells for malicious intent, illegal drug production, or to steal intellectual property. Determining the origin of a DNA sequence is difficult and time-consuming. Here deep learning is applied to predict the lab-of-origin of a DNA sequence. A convolutional neural network was trained on the Addgene plasmid dataset that contained 42,364 engineered DNA sequences from 2230 labs as of February 2016. The network correctly identifies the source lab 48% of the time and 70% it appears in the top 10 predicted labs. Often, there is not a single “smoking gun” that affiliates a DNA sequence with a lab. Rather, it is a combination of design choices that are individually common but collectively reveal the designer., The synthetic biology era has seen a rapidly growing number of engineered DNA sequences. Here, the authors develop a deep learning method to predict the lab-of-origin of a DNA sequence based on hidden design signatures.

Turnover and retention of integrated behavioral health practitioners in primary care is a significant challenge with limited empirical evidence to inform risk factors. This study used retrospective...

Integrated primary care services have grown in popularity in recent years and demonstrated significant benefits to the patient experience, patient health, and health care operations. However, broader systems-level factors for health care organizations, such as utilization, access, and cost, have been understudied. The current study reviews the results of quality improvement project conducted by the U.S. Air Force, which has practiced integrated primary care behavioral health for over 20 years. This study focuses on exploring how shifting the access point for behavioral from specialty mental health clinics to primary care, along with the use of technicians in patient care, can improve a range of health outcomes. Retrospective data analysis was conducted on an internal Air Force quality improvement project implemented at three military treatment facilities from October 2014 to September 2015. Positive preliminary support for these innovations was seen in the form of expanded patient populations, decreased time to first appointment, increased patient encounters, and decreased purchased community care compared with non-participating sites. Incorporation of behavioral health technicians further increased number of patient encounters while maintaining high levels of patient satisfaction across diverse clinical settings; in fact, patients preferred appointments with both technicians and behavioral health providers, compared with appointments with behavioral health providers only. These findings encourage further systematic review of systems-level factors in primary care behavioral health and adoption of the use of provider extenders in primary care behavioral health clinics.

Wild Turkey (Meleagris gallopavo Linnaeus, 1758) populations have grown considerably in the Midwestern U.S. alongside mesocarnivores, such as coyotes (Canis latrans Say, 1823) and bobcats (Lynx rufus (Schreber, 1777)). However, few studies have assessed habitat overlap between mesocarnivores and turkeys with a goal to understand potential impacts of mesocarnivores on turkeys. We captured and radiomarked bobcats, coyotes, and Wild Turkey hens in southern Illinois during 2011–2013 in an agricultural landscape and created single-species resource selection and overlap models. Wild Turkeys and bobcats demonstrated concentrated use in forested areas, whereas coyote use was highest in agricultural areas. We documented Wild Turkey nests (n = 107) and hen mortalities (n = 28), which were used to model the effect of bobcat, coyote, and Wild Turkey habitat use on turkey nest success and mortality. Increased coyote use was associated with higher nest success and increased turkey use was associated with higher probability of mortality. These findings suggest that top predators, such as coyotes, may be important and beneficial for ground-nesting avian species. With coyotes acting as the top predator throughout much of the Midwest, they are likely reducing densities of other important turkey nest predator species, thereby increasing nest success.

PURPOSE The aim of this study was to develop and gather validity evidence for a standardised test of competence in Focused Assessment with Sonography for Trauma (FAST) and to define the appropriate cut-off point in simulation-based learning of the FAST protocol. METHODS A 20-item simulation-based test for assessing competence in FAST was created. The test was administered to thirteen novices and twelve radiologists experienced in abdominal ultrasound diagnostics. The Contrasting Groups' method was used to establish a credible passing score. RESULTS The internal consistency was high (Cronbach's α = 0.90) and the test had good discriminatory ability (P

To achieve the flow mechanism during the closure of the guide vanes in a pump-turbine in pump mode, a three-dimensional (3-D) incompressible simulation using the shear stress transition (SST) k-ω turbulence model was performed. The dynamic mesh method was adopted to simulate the closing process of the guide vanes. Based on the validation of the steady experiments, the variation in performance characteristics (head, discharge, and torque), pressure, and velocity was presented, which shows dynamic instability at the end of the guide vanes closing process. Numerical results confirm that the dynamic instabilities at the end of the closing process originated from severe fluctuations that occurred in the guide and stay vanes. Detailed analyses of flow characteristics reveal that severe fluctuations occur due to vortices in the stay vanes, and a high-pressure circular ring in the vaneless space and a low-pressure circular ring between the guide vanes outlet and stay vanes inlet were identified. During the closing process of the guide vanes opening, the vortices appear in several passages initially, and then increasingly spread to all the passages. The position and rotating direction of the vortices vary with time. Using the Q-criterion method, the composition and evolution of vortex structures in stay vanes were identified. These structures comprise streamwise vortices, horseshoe-shaped vortices, and spanwise vortices, which lead to severe pressure fluctuations.

Importance: Truncating variants in the gene encoding filamin C (FLNCtv) are associated with arrhythmogenic and dilated cardiomyopathies with a reportedly high risk of ventricular arrhythmia.Objective: To determine the frequency of and risk factors associated with adverse events among FLNCtv carriers compared with individuals carrying TTN truncating variants (TTNtv).Design, Setting, and Participants: This cohort study recruited 167 consecutive FLNCtv carriers and a control cohort of 244 patients with TTNtv matched for left ventricular ejection fraction (LVEF) from 19 European cardiomyopathy referral units between 1990 and 2018. Data analyses were conducted between June and October, 2020.Main Outcomes and Measures: The primary end point was a composite of malignant ventricular arrhythmia (MVA) (sudden cardiac death, aborted sudden cardiac death, appropriate implantable cardioverter-defibrillator shock, and sustained ventricular tachycardia) and end-stage heart failure (heart transplant or mortality associated with end-stage heart failure). The secondary end point comprised MVA events only.Results: In total, 167 patients with FLNCtv were studied (55 probands [33%]; 89 men [53%]; mean [SD] age at baseline evaluation, 43 [18] years). For a median follow-up of 20 months (interquartile range, 7-60 months), 29 patients (17.4%) reached the primary end point (19 patients with MVA and 10 patients with end-stage heart failure). Eight (44%) arrhythmic events occurred among individuals with baseline mild to moderate left ventricular systolic dysfunction (LVSD) (LVEF = 36%-49%). Univariable risk factors associated with the primary end point included proband status, LVEF decrement per 10%, ventricular ectopy (≥500 in 24 hours) and myocardial fibrosis detected on cardiac magnetic resonance imaging. The LVEF decrement (hazard ratio [HR] per 10%, 1.83 [95% CI, 1.30-2.57]; P Conclusions and Relevance: The high frequency of MVA among patients with FLNCtv with mild to moderate LVSD suggests that higher LVEF values than those currently recommended should be considered for prophylactic implantable cardioverter-defibrillator therapy in FLNCtv carriers.

Temperature changes in the lower and middle stratosphere during 2001-2016 are evaluated using measurements from GPS Radio Occultation (RO) and Advanced Microwave Sounding Unit (AMSU) aboard the Aqua satellite. After downsampling of GPS-RO profiles according to the AMSU weighting functions, the spatially and seasonally resolved trends from the two data sets are in excellent agreement. The observations indicate that the middle stratosphere has cooled in the time period 2002-2016 at an average rate of –0.14±0.12 to –0.36±0.14 K/decade, while no significant change was found in the lower stratosphere. The meridionally and vertically resolved trends from high-resolution GPS-RO data exhibit a marked inter-hemispheric asymmetry and highlight a distinct boundary between tropospheric and stratospheric temperature change regimes matching the tropical thermal tropopause. The seasonal pattern of trend reveals significant opposite-sign structures at high and low latitudes, providing indication of seasonally varying change in stratospheric circulation.

Performance characteristics in pump mode of pump-turbines are vital for the safe and effective operation of pumped storage power plants. They are resultant of Euler head (power input) and hydraulic losses (power dissipation). In this paper, 3-D steady simulations were performed under 13mm, 19mm and 25mm guide vane openings (GVOs). Three groups of operating points under the three GVOs were chosen based on experimental validation to investigate the influence of guide vane setting on flow patterns upstream and downstream. Analysed results show that, the guide vane setting will obviously change the flow pattern downstream, which in turn influences the flow upstream. It shows a strong effect on hydraulic losses in guide and stay vanes. In addition, at the large part load conditions, the change of GVO will increase the relative flow angle at the runner outlet. As a consequence, it decreases the Euler head. However, at other operating conditions, it only has a little influence on Euler head. Flow patterns in pump mode are very dependent on the GVO and discharge.

The purpose of this study was to determine the detection rate of distant metastasis and synchronous cancer, comparing clinically used imaging strategies based on chest x-ray 1 head and neck MRI (CXR/MRI) and chest CT 1 head and neck MRI (CHCT/MRI) with 18F-FDG PET/CT upfront in the diagnostic workup of patients with oral, pharyngeal, or laryngeal cancer. Methods: This was a prospective cohort study based on paired data. Consecutive patients with histologically verified primary head and squamous cell carcinoma at Odense University Hospital from September 2013 to March 2016 were considered for the study. Included patients underwent CXR/MRI and CHCT/MRI as well as PET/CT on the same day and before biopsy. Scans were read masked by separate teams of experienced nuclear physicians or radiologists. The true detection rate of distant metastasis and synchronous cancer was assessed for CXR/MRI, CHCT/MRI, and PET/CT. Results: A total of 307 patients were included. CXR/MRI correctly detected 3 (1%) patients with distant metastasis, CHCT/MRI detected 11 (4%) patients, and PET/CT detected 18 (6%) patients. The absolute differences of 5% and 2%, respectively, were statistically significant in favor of PET/CT. Also, PET/CT correctly detected 25 (8%) synchronous cancers, which was significantly more than CXR/MRI (3 patients, 1%) and CHCT/MRI (6 patients, 2%). The true detection rate of distant metastasis or synchronous cancer with PET/CT was 13% (40 patients), which was significantly higher than 2% (6 patients) for CXR/ MRI and 6% (17 patients) for CHCT/MRI. Conclusion: A clinical imaging strategy based on PET/CT demonstrated a significantly higher detection rate of distant metastasis or synchronous cancer than strategies in current clinical imaging guidelines, of which European ones primarily recommend CXR/MRI, whereas U.S. guidelines preferably point to CHCT/MRI in patients with head and neck squamous cell carcinoma.

This paper investigates the effect of surge tank throttling on governor stability, power control, and hydraulic transients in hydropower plants. The work is intended to be practical, but includes some new research. The practical contributions include a methodology for a combined evaluation of the effects of installing surge tank throttles in hydropower plants, and a demonstration of the throttle effects through a case study. The research contributions include the evaluation of the throttle effect on power control, and a comparison of the throttle effects on power control for governor systems with speed feedback exclusively versus combined speed and power feedback. Field measurements are used to calibrate a numerical model of the case-study hydropower plant. The results from the case study show that the throttle has an insignificant positive impact on governor stability. Power control is improved when a throttle is installed; the overshoot of produced power and the time until steady-state conditions occur are reduced. The throttle has a significant effect on the hydraulic transients, and increases the water hammer and reduces the mass oscillations in the system. © 2016 IEEE. Translations and content mining are permitted for academic research only. Personal use is also permitted, but republication/redistribution requires IEEE permission.

Ecologists routinely fit complex models with multiple parameters of interest, where hundreds or more competing models are plausible. To limit the number of fitted models, ecologists often define a model selection strategy composed of a series of stages in which certain features of a model are compared while other features are held constant. Defining these multi‐stage strategies requires making a series of decisions, which may potentially impact inferences, but have not been critically evaluated. We begin by identifying key features of strategies, introducing descriptive terms when they did not already exist in the literature. Strategies differ in how they define and order model building stages. Sequential‐by‐sub‐model strategies focus on one sub‐model (parameter) at a time with modeling of subsequent sub‐models dependent on the selected sub‐model structures from the previous stages. Secondary candidate set strategies model sub‐models independently and combine the top set of models from each sub‐model for selection in a final stage. Build‐up approaches define stages across sub‐models and increase in complexity at each stage. Strategies also differ in how the top set of models is selected in each stage and whether they use null or more complex sub‐model structures for non‐target sub‐models. We tested the performance of different model selection strategies using four data sets and three model types. For each data set, we determined the "true" distribution of AIC weights by fitting all plausible models. Then, we calculated the number of models that would have been fitted and the portion of "true" AIC weight we recovered under different model selection strategies. Sequential‐by‐sub‐model strategies often performed poorly. Based on our results, we recommend using a build‐up or secondary candidate sets, which were more reliable and carrying all models within 5–10 AIC of the top model forward to subsequent stages. The structure of non‐target sub‐models was less important. Multi‐stage approaches cannot compensate for a lack of critical thought in selecting covariates and building models to represent competing a priori hypotheses. However, even when competing hypotheses for different sub‐models are limited, thousands or more models may be possible so strategies to explore candidate model space reliably and efficiently will be necessary.

Purpose To describe neonatal nurses' growth measurement practices, attitudes, knowledge, bases of practice knowledge, and barriers and facilitators for changing practice; and to identify differences in practices and knowledge by nursing organization, unit type, education, and experience. Design and methods A cross-sectional online survey of U.S. neonatal nurses was distributed through two neonatal nursing organizations. Results The survey was completed by 301 nurses. Some evidence-based practices (EBPs) were infrequently reported including recording frontal-occipital head circumference (FOC) and length using 0.1 cm increments (17.9% and 17.6%, respectively); measuring FOC, weight, and length more than once before recording (61.9%, 27.2%, and 39.6%, respectively); and for length, using a length board instead of tape measure (19.4%), with a second person assisting (25.1%), with Frankfort plane head positioning (3.3%), and measuring from crown to heels of both feet (19.1%). Most nurses perceived their measurements as accurate or highly accurate (96.7% for FOC, 99.3% for weight, and 87.1% for length). The mean percentage correct on knowledge items was 68.1%. NICU nurses scored slightly better than well-newborn nurses (mean 69.3% correct vs. 65.1% correct, p = .04). Most based measurement practices on clinical practice guidelines (86.6%) and unit policies and procedures (85.9%). Team culture (33.3%) and insufficient resources (32.6%) were the most common barriers to EBP. The support of nurse managers (70.0%) and unit educators (68.5%) were common facilitators. Conclusions and implications Knowledge gaps and practice improvement areas were identified. Results can inform interventions to improve the accuracy and reliability of neonatal growth measurement practices.

We here present results from an evaluation of the Radio Occultation Meteorology Satellite Application Facility (ROM SAF) gridded monthly mean climate data record (CDR v1.0), based on Global Positioning System (GPS) radio occultation (RO) data from the CHAMP (CHAllenging Minisatellite Payload), GRACE (Gravity Recovery and Climate Experiment), COSMIC (Constellation Observing System for Meteorology, Ionosphere, and Climate), and Metop satellite missions. Systematic differences between RO missions, as well as differences of RO data relative to ERA-Interim reanalysis data, are quantified. The methods used to generate gridded monthly mean data are described, and the correction of monthly mean RO climatologies for sampling errors, which is essential for combining data from RO missions with different sampling characteristics, is evaluated. We find good overall agreement between the ROM SAF gridded monthly mean CDR and the ERA-Interim reanalysis, particularly in the 8–30 km height interval. Here, the differences largely reflect time-varying biases in ERA-Interim, suggesting that the RO data record has a better long-term stability than ERA-Interim. Above 30–40 km altitude, the differences are larger, particularly for the pre-COSMIC era. In the 8–30 km altitude region, the observational data record exhibits a high degree of internal consistency between the RO satellite missions, allowing us to combine data into multi-mission records. For global mean bending angle, the consistency is better than 0.04 %, for refractivity it is better than 0.05 %, and for global mean dry temperature the consistency is better than 0.15 K in this height interval. At altitudes up to 40 km, these numbers increase to 0.08 %, 0.11 %, and 0.50 K, respectively. The numbers can be up to a factor of 2 larger for certain latitude bands compared to global means. Below about 8 km, the RO mission differences are larger, reducing the possibilities to generate multi-mission data records. We also find that the residual sampling errors are about one-third of the original and that they include a component most likely related to diurnal or semi-diurnal cycles.

Atmospheric climate monitoring requires observations of high quality that conform to the criteria of the Global Climate Observing System (GCOS). Radio occultation (RO) data based on Global Positioning System (GPS) signals are available since 2001 from several satellite missions with global coverage, high accuracy, and high vertical resolution in the troposphere and lower stratosphere. We assess the consistency and long-term stability of multi-satellite RO observations for use as climate data records. As a measure of long-term stability, we quantify the structural uncertainty of RO data products arising from different processing schemes. We analyze atmospheric variables from bending angle to temperature for four RO missions, CHAMP, Formosat-3/COSMIC, GRACE, and Metop, provided by five data centers. The comparisons are based on profile-to-profile differences aggregated to monthly medians. Structural uncertainty in trends is found to be lowest from 8 to 25 km of altitude globally for all inspected RO variables and missions. For temperature, it is

BackgroundRadiographic signs of osteoarthritis (OA) are frequent in knees without symptoms. The long-term impact of these findings is not completely elucidated. We wanted to evaluate whether radiographic or clinical baseline findings are associated with the risk of total knee arthroplasty (TKA) in knees without symptomatic OA but with clinical OA of the other knee during a mean follow-up period of 15 years.MethodsA follow-up analysis was performed in 100 persons with unilateral, clinical knee OA according to the ACR (American College of Rheumatology) criteria, who participated in a clinical trial between 2000 and 2002. Baseline radiographs of the contralateral, non-symptomatic knee were available in 88 participants at follow-up. Data on TKA procedures were extracted from the Danish National Patient Register at follow-up. Radiographic and clinical findings were analyzed for associations with subsequent TKA.ResultsAt follow-up, 40% had received a TKA in their non-symptomatic knee. The risk of TKA was significantly associated with baseline joint space narrowing (risk ratio (RR) 1.6 (95% confidence interval (95% CI) 1.4 to 1.9)), osteophytes (RR 1.5 (95% CI 1.3 to 1.8)) and subchondral sclerosis (RR 2.4 (95% CI 1.6 to 3.7)). Among the clinical findings, only baseline body mass index (BMI) was significantly associated with the risk of TKA (RR 1.4 (95& CI 1.1 to 1.8)).ConclusionsRadiographic OA changes and BMI at baseline were significantly associated with the long-term risk of TKA in persons without symptomatic knee OA but with symptomatic OA in the contralateral knee, implying that radiographic OA findings are important prognostic factors regardless of symptoms.

It is very important to gain a better understanding of pump series of different specific speeds when running in reverse mode. The pump is running in reverse mode to serve as turbine for mechanical rotational energy generation in the hydropower and processing plants. This review chapter employs a technical analysis as a tool to evaluate pump when running in reverse mode by assessing the technological development gathered from the literature.

Objective: To investigate whether a 18F-FDG PET/CT (PET/CT)-based diagnostic strategy adds decisive new information compared to conventional imaging in the evaluation of salivary gland tumours and the detection of cervical lymph node metastases, distant metastases, and synchronous cancer in patients with salivary gland carcinoma. Methods: The study was a blinded prospective cohort study. Data were collected consecutively through almost 3 years. All patients underwent conventional imaging—magnetic resonance imaging (MRI) and chest X-ray (CXR)—in addition to PET/CT prior to surgery. Final diagnosis was obtained by histopathology. MRI/CXR and PET/CT were interpreted separately by experienced radiologists and nuclear medicine physicians. Interpretation included evaluation of tumour site, cervical lymph node metastases, distant metastases, and synchronous cancer. Results: Ninety-one patients were included in the study. Thirty-three patients had primary salivary gland carcinoma and eight had cervical lymph node metastases. With PET/CT, the sensitivity was 92% and specificity 29% regarding tumour site. With MRI/CXR, the sensitivity and specificity were 90% and 26%, respectively. Regarding cervical lymph node metastases in patients with salivary gland carcinoma, the sensitivity with PET/CT was 100% and with MRI/CXR 50%. PET/CT diagnosed distant metastases in five patients, while MRI/CXR detected these in two patients. Finally, PET/CT diagnosed two synchronous cancers, whereas MRI/CXR did not detect any synchronous cancers. Conclusions: Compared with MRI/CXR PET/CT did not improve discrimination of benign from malignant salivary gland lesions. However, PET/CT may be advantageous in primary staging and in the detection of distant metastases and synchronous cancers.

BACKGROUND AND OBJECTIVES: Patients undergoing major elective ankle surgery often experience pain from the saphenous nerve territory persisting beyond the duration of a single-injection saphenous nerve block. We hypothesized that perineural dexamethasone as an adjuvant for the saphenous nerve block prolongs the duration of analgesia and postpones as well as reduces opioid-requiring pain.METHODS: Forty patients were included in this prospective, randomized, controlled study. All patients received a continuous sciatic catheter and were randomized to receive a single-injection saphenous nerve block with 10 mL of 0.5% bupivacaine with 1:200,000 epinephrine with addition of 1 mL of saline or 1 mL of 0.4% (ie, 4 mg) dexamethasone. The primary outcome was duration of saphenous nerve block estimated as the time until the first opioid request. Secondary outcomes were opioid consumption and pain.RESULTS: The mean (SD) duration of the saphenous nerve block until first opioid request was 29.4 (8.4) hours in the dexamethasone group and 23.2 (10.3) hours in the control group (P = 0.048). The median opioid consumption [interquartile range] during the first 24 hours was 0 mg [0-0] versus 1.5 mg [0-14.2] in the dexamethasone and control groups, respectively. Nonparametric comparison of opioid consumption from 0 to 24 hours was statistically significant. The opioid consumption was similar in the two groups in the time interval 24 to 48 postoperative hours.CONCLUSION: Perineural dexamethasone as an adjuvant for the single-injection subsartorial saphenous nerve block can prolong analgesia and reduce opioid-requiring pain after major ankle surgery.

To investigate the impact of common anesthetic techniques on postoperative opioid consumption in ankle fracture surgery.We performed a retrospective cohort study on 622 patients with isolated ankle fractures undergoing primary reconstructive surgery. Patients were identified by consecutive screening in the years 2008 to 2011. Our primary endpoint was the difference in the 24-hour postoperative opioid consumption after general anesthesia (GA) compared with different regional anesthesia modalities. Secondary endpoints were length of stay in the postanesthesia care unit, risk of postoperative nausea and vomiting, and postoperative length of hospital stay.Opioid consumption in 4 anesthesia groups (equipotent doses of IV morphine) was as follows: GA: 21.9 mg (95% confidence interval [CI]±1.2), GA+peripheral nerve block (PNB): 16.3 mg (95% CI±1.1), spinal anesthesia (SA): 17.1 mg (95% CI±0.9), and SA+PNB: 14.6 mg (95% CI±1.0). We found significant differences between "GA" and all other groups (P≤0.01). The most pronounced difference is seen when GA is compared with SA+PNB, with a 33.4% opioid reduction in the latter group.Regional anesthesia modalities reduce postoperative opioid consumption in ankle fracture surgery in comparison with GA. A benefit of PNBs is possibly due to an improved pain profile. Our study is retrospective and cannot predict the exact magnitude of this benefit.

Objective To determine whether the presence of spontaneous echocardiographic contrast (SEC) in cats with cardiomyopathy is associated with increased mortality. To establish whether specific types of cardiomyopathy are more often associated with SEC in an attempt to provide a risk-stratification scheme for cats with increased risk of thromboembolic events. Design Retrospective study 2006–2011. Setting Tertiary referral and teaching hospital. Animals Seven hundred twenty-five client-owned cats undergoing echocardiographic evaluation. Measurements and Main Results Patient characteristics, including age, breed, clinical signs, type of cardiovascular disease, presence of SEC, and survival time were recorded. Thyroxine, HCT, and blood pressure were recorded when available. Among cats diagnosed with cardiac abnormalities based on echocardiographic findings, those with SEC were at significantly increased risk of death as compared to those without SEC. Cats with dilated cardiomyopathy, unclassified cardiomyopathy, and hypertrophic cardiomyopathy were significantly more likely to have SEC compared to cats with other types of cardiac disease. Conclusions Cats with cardiomyopathy and SEC have an increased risk of death compared to cats without SEC, although other previously identified factors such as the presence of congestive heart failure and increased left atrium to aorta ratio remain important determinants of mortality. Cats with hypertrophic cardiomyopathy, unclassified cardiomyopathy, and dilated cardiomyopathy may benefit from anticoagulant therapy due to the increased risk of SEC in these subpopulations.

Objectives Congestive heart failure secondary to cardiomyopathy is a common manifestation of cardiac disease in cats, carrying a variable prognosis. The objective of this retrospective study was to evaluate the relationship between red blood cell distribution width (RDW) and survival time in feline patients with acquired heart disease with and without congestive heart failure (CHF). Methods Three hundred and forty-nine client-owned cats with echocardiograms and complete blood count, including RDW measurement, performed between March 2006 and December 2011, were included in the study. Patient characteristics, including signalment, hematocrit, RDW, echocardiographic parameters and survival, were recorded. Comparisons between RDW in cats with asymptomatic acquired heart disease and those with CHF were made. Survival was documented and compared at 30 days and 6 months. Results CHF was present in 80 cats and absent in 269 cats. Cats with CHF had an increase in mortality compared with cats without CHF at 30 days and 6 months ( P = 0.007 and P = 0.04, respectively). RDW was not significantly associated with survival in cats with or without CHF at 30 days or 6 months. A significant difference was found between median RDW values in cats with CHF vs cats without CHF (16.3% vs 15.8%; P = 0.02). The median RDW value was significantly higher in cats with unclassified cardiomyopathy compared with cats with other types of cardiomyopathy (16.3% vs 15.8%; P = 0.03). Conclusions and relevance Single RDW values did not predict mortality in cats with acquired heart disease but may be useful in determining if cats have decompensated heart disease and CHF. Human studies indicate that incremental increases in serial RDW measurements are associated with decreased survival; serial RDW measurements in cats may be an area of future study.