Journal articles: '559.0/142 20' – Grafiati (2024)

Abstract:

ABSTRACT Ochratoxin A (OTA) is one of the most important mycotoxins owing to its widespread occurrence and toxicity, including nephrotoxicity and potential carcinogenicity to humans. OTA has been detected in a wide range of agricultural commodities, including cereal grains and their processed products. In particular, oat-based products show a higher incidence and level of contamination. Extrusion cooking is widely used in the manufacturing of breakfast cereals and snacks and may reduce mycotoxins to varying degrees. Hence, the effects of extrusion cooking on the stability of OTA in spiked (100 μg/kg) oat flake was investigated by using a laboratory-scale twin-screw extruder with a central composite design. Factors examined were moisture content (20, 25, and 30% dry weight basis), temperature (140, 160, and 180°C), screw speed (150, 200, and 250 rpm), and die size (1.5, 2, and 3 mm). Both nonextruded and extruded samples were analyzed for reductions of OTA by high-performance liquid chromatography, coupled with fluorescence detection. The percentage of reductions in OTA in the contaminated oat flakes upon extrusion processing were in the range of 0 to 28%. OTA was partially stable during extrusion, with only screw speed and die size having significant effect on reduction (P < 0.005). The highest reduction of 28% was achieved at 180°C, 20% moisture, 250 rpm screw speed, and a 3-mm die with 193 kJ/kg specific mechanical energy. According to the central composite design analyses, up to 28% of OTA can be reduced by a combination of 162°C, 30% moisture, and 221 rpm, with a 3-mm die.

Abstract:

The effectiveness of low-fat milk, alone and with an additional 20 mmol/l NaCl, at restoring fluid balance after exercise-induced hypohydration was compared to a sports drink and water. After losing 1·8 (sd 0·1) % of their body mass during intermittent exercise in a warm environment, eleven subjects consumed a drink volume equivalent to 150 % of their sweat loss. Urine samples were collected before and for 5 h after exercise to assess fluid balance. Urine excretion over the recovery period did not change during the milk trials whereas there was a marked increase in output between 1 and 2 h after drinking water and the sports drink. Cumulative urine output was less after the milk drinks were consumed (611 (sd 207) and 550 (sd 141) ml for milk and milk with added sodium, respectively, compared to 1184 (sd 321) and 1205 (sd 142) ml for the water and sports drink; P < 0·001). Subjects remained in net positive fluid balance or euhydrated throughout the recovery period after drinking the milk drinks but returned to net negative fluid balance 1 h after drinking the other drinks. The results of the present study suggest that milk can be an effective post-exercise rehydration drink and can be considered for use after exercise by everyone except those individuals who have lactose intolerance.

Abstract:

Abstract Background: Ninety percent of hypercalcemia cases are related to either primary hyperparathyroidism or malignancy (1). This case presents one of the atypical etiologies of hypercalcemia. Clinical Case: A 53-year-old man with past medical history of nephrectomy was admitted for acute respiratory distress syndrome secondary to SARS-CoV-2. Hospital stay was complicated by septic shock and acute kidney injury requiring hemodialysis. Three months post hospital admission, the patient developed non-parathyroid (PTH) mediated hypercalcemia. Lab work results showed elevated serum calcium of 12.7 mg/dl (8.6–10.6), ionized calcium 6.8 mg/dl (4.2–5.4), albumin 2.6 g/dl (3.4–5.4), serum creatinine of 3.5 mg/dl (0.5–1.5), eGFR of 18.4 ml/min, and a PTH of 4 pg/ml (12–88). Liver profile - total bilirubin of 10.5 mg/dl (0–1.2), direct bilirubin of 5.9 mg/dl (0–0.2), GGTP 2055 U/L (6–60), alkaline phosphatase of 936 u/L (40–125), bone fractionated alkaline phosphatase 216 u/L (0–55), 25-OH Vitamin D of 11 ng/nl (20–80), 1,25 OH vitamin D of &lt;5 pg/ml (19–79), TSH of 3.56 mciu/mL (0.35–4.0), CPK of 20 u/L (21–232) and a normal SPEP and immune-electrophoresisTreatment for hypercalcemia was initiated with calcitonin and oral steroids (prednisone 40mg/day for 4 days, 20mg/day for 1 day, and 10mg/day for 2 days), resulting in normalization of serum calcium. Patient received tube feedings that contained 2192 mcg retinol activity equivalents of vitamin A daily, which is associated with vitamin A intoxication in the presence of renal insufficiency. Vitamin A returned 0.78 mg/L (0.3–1.2). Serum Parathyroid hormone-related peptide (PTHrP) was elevated at 12.4 pmol/L (0.0–2.0). There was no obvious malignancy on various imaging studies. A magnetic resonance cholangiopancreatography (MRCP) showed biliary stricturing suggestive of primary sclerosing cholangitis (PSC), however, liver biopsy was not consistent with PSC. Serum IgG4 level was found to be elevated to 142 mg/dl (range: 1–123) which raised suspicion for autoimmune cholangiopathy. Discussion: Patient presented with non-PTH mediated hypercalcemia with low serum 1,25 OHD levels and elevated serum PTHrP level. Although most cases of elevated PTHrP associated with hypercalcemia are due to solid tumors, increased PTHrP levels have been seen in hypercalcemic patients with hematological malignancies and rare benign causes such as pneumonia (5). Association of elevated hypercalcemia with elevated IgG4 levels and PTHrP levels has not been previously reported. MRCP findings and abnormal morphology detailed in liver biopsy are suggestive of IgG4-related disease (IgG4RD) (3). The responsiveness in hypercalcemia to prednisone also supports this diagnosis. IgG4RD is associated with multi-organ autoimmune involvement. This case report highlights another complication of IgG4RD (i.e. hypercalcemia) associated with elevated PTHrP levels.

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Abstract Current recommendations for patients with CML (Baccarani M, et al. Blood2006;108:1809–20) advocate regular treatment response monitoring, including evaluation of: cytogenetic response (CyR) at least every 6 months until complete CyR is achieved, then every 12 months; molecular response (MolR) every 3 months; mutational analysis in cases of failure/suboptimal response. Yet, few data exist on monitoring in current clinical practice. A survey of CML physicians in the US/Europe suggests practices in some CML management areas are not in line with recommendations (Kantarjian H, et al. Cancer2007;109:1365–75). UNIC is a cross-sectional study, with retrospective chart review of currently treated CML or Ph+ALL patients in Austria, Belgium, France, Italy, Netherlands, Spain, Sweden and UK. Patients were recruited September 2006-March 2007. The study aimed to estimate the proportion of patients ever treated with imatinib and those who experienced imatinib resistance and/or intolerance (primary objectives). Here, we focus on data collected on patterns of disease monitoring (a secondary objective) in CML/Ph+ALL patients. A patient was defined as imatinib resistant if reported as such by the physician in the medical chart. Case Report Forms (CRFs) were completed for 1716 patients. CRFs were analyzable for 1551 CML and 48 Ph+ALL patients. Of the CML patients, 98% were in chronic phase; 2% were in advanced phases. Of the 1493 (96%) CML and 46 (96%) Ph+ALL patients who received imatinib, 241 (16%) CML and 6 (13%) Ph+ALL patients were reported as resistant. Patterns of cytogenetic, molecular and mutational testing are shown in the tables. In the last 12 months, 31% of CML patients had not had a cytogenetic analysis and 10% had not had a PCR analysis to assess MolR. Of imatinib-resistant patients, 57% CML and 50% Ph+ALL patients had not been assessed for mutations. Examination CML Ph+ALL Number of cytogenetic analyses per patient in the last 12 months, n (%) N=1427 N=42 0 447 (31.3) 13 (31.0) 1 559 (39.2) 15 (35.7) 2 271 (19.0) 2 (4.8) ≥3 150 (10.5) 12 (28.6) ≥1 fluorescent in situ hybridization since diagnosis, n (%) N=1497 N=45 No 852 (56.9) 18 (40.0) Yes 645 (43.1) 27 (60.0) ≥1 PCR in the last 12 months, n (%) N=1504 N=48 No 149 (9.9) 2 (4.2) Yes 1355 (90.1) 46 (95.8) Patients with 4 PCRs in the last 12 months, n (%) N=1422 N=40 200 (14.1) 4 (10.0) Number of mutational analyses since diagnosis in imatinib-resistant patients, n (%) Imatinib-resistant patients CML (N=209) Ph+ALL (N=6) 0 120 (57.4) 3 (50.0) 1 75 (35.8) 3 (50.0) 2 12 (5.7) 0 ≥3 2 (1.0) 0 This large European observational study suggests different methods of disease monitoring are used less often in real life than according to recommendations. Further research into the consequences of suboptimal monitoring of patients’ disease status is warranted.

Abstract:

Teaching Computer Science in higher education is imperative, even though today’s students have been born into a world where technology is an essential part of everyday life. To efficiently master modern, business, technical and scientific knowledge and to proficiently produce quality results in a work environment it is crucial to have high level IT knowledge. In business, Excel is the lingua franca and so knowing how to aptly use spreadsheets is a must for our students. The primary objective of the authors was to examine the perceived and actual knowledge of spreadsheet applications of students entering higher education. Accordingly, a questionnaire and a practical assignment have been developed. In the questionnaire, students were asked to provide information concerning their previous IT studies and rate their knowledge of word processing, spreadsheets and database management. During the practical, students were asked to solve an Excel exercise taken from a high school Computer Science final exam at standard level. Out of the 666 registered students on our electronic education system (Neptun) at the beginning of the year, 557 took part in this survey, and following data cleansing and processing, 513 were considered in the results. Looking at the results of the practical, the most significant proportion of students, 142 of them have performed between 0-10%. A total of 260 students have achieved less than 20% performance and 434 people, which is nearly 85% of students have accomplished less than 40%. Compared to the results from the self-evaluation questionnaire it is very poignant that the actual scores differ quite significantly (in both directions) from the perceived knowledge of the students. JEL Classification: Q20

Abstract:

Abstract Inhibition of growth in man and laboratory animals by glucocorticoid treatment is well recognized, yet we have previously shown that glucocorticoids may paradoxically enhance GH secretion and increase serum insulin-like growth factor (IGF) levels. IGFs circulate bound to high-affinity binding proteins (IGFBPs) which modulate their actions, and circulating GH may be associated with two binding proteins (GHBPs) of which the high-affinity GHBP has been characterized and is structurally identical to the extracellular domain of the GH receptor. We have investigated the time-course of changes in GH, IGFs and their binding proteins induced by glucocorticoid treatment in normal male volunteers (n=12, age range 22–31 years) sampled at 0800 h daily before and during treatment with dexamethasone (2 mg twice daily) for 5 days. In addition, subjects were sampled at 30-min intervals over 7-h periods (0730–1430 h) during the day prior to dexamethasone (day 0), on day 1 following the first dose of dexamethasone and on day 5 following the last dose of dexamethasone. Mean serum IGF-I rose over the initial 72 h and remained elevated at 96 h (297 ± 11·5 compared with basal levels of 215·5 ± 9·3 μg/l, P<0·001) whereas IGF-II levels did not change (472·6 ± 20·5 vs 450·3 ± 21·7 μg/l, P=0·97). There was a concomitant rise in serum IGFBP-3 from basal levels of 3·69 ± 0·23 mg/l to a peak at 5 days of 4·16 ± 0·21 (P=0·003 vs day 1). Mean fasting IGFBP-1 levels fell significantly within 24 h, remaining low throughout the 5-day period whilst fasting insulin and C-peptide levels increased. IGFBP-2 rose within 24 h from basal levels of 315·5 ± 27·9 to 407·8 ± 27·3 μg/l at 24 h (P=0·01), then fell steadily to reach a nadir at 5 days of 240·4 ± 18·9 μg/l (P=0·02 vs basal levels). Peak GH secretion on day 1 (14·5 ± 3·7 μg/l) occurred between 4 and 5 h after dexamethasone administration. On day 5, the time of peak GH secretion was similar but the peak was attenuated (7·9 ± 1·2 μg/l, P<0·01 vs day 1). No morning rise in GH secretion had been observed prior to dexamethasone (day 0). GHBP fell steadily during the 5-day treatment period from basal levels of 29·3 ± 1·9% to day 5 levels of 24·4 1·6%, P=0·001. The fall in GHBP as a result of dexamethasone treatment is in accordance with the reported inverse relationship between 24-h GH secretion and GHBP in health and disease states in man. This study has demonstrated clear temporal relationships between alterations in circulating levels of GH, IGF-I and IGFBP-1, -2 and -3 during dexamethasone treatment which support possible mechanisms whereby glucocorticoids induce a catabolic state through their endocrine and local tissue effects. Journal of Endocrinology (1994) 142, 547–554

Abstract:

Background:Tapering and withdrawal of biological DMARDs (bDMARDs) is often attempted in Juvenile Idiopathic Arthritis (JIA) patients but data about response to re-treatment after an unsuccessful tapering are scarce.Objectives:Our aim is to assess response to re-treatment after a disease flare during tapering or withdrawal of bDMARDs and to describe re-treatment strategies.Methods:A retrospective, descriptive study was conducted in a cohort of JIA patients followed up in a referral hospital and who had received bDMARDs between 2000 and 2019. All JIA patients with at least one flare during tapering or withdrawal were included. Response to re-treatment was defined as achieving Wallace criteria for remission for 6 months.Results:A total of 142 flares during tapering or withdrawal were identified and included. In 3/142 (2.1%) patients bDMARDS were not re-started after a flare, 1 due to patient refusal, 2 due to unplanned pregnancy. Main characteristics according to tapering strategies are reported in Table 1.Table 1.Main characteristics according to tapering strategies. Apso, Psoriatic Arthritis; ERA, Enthesitis related Arthritis; OligE, Oligoarticular Extended; OligP, oligoarticular persistent; Poly RF+, polyarticular rheumatoid factor positive; PolyRF-, polyarticular rheumatoid factor negative; sJIA, Systemic JIA; Und, Undifferenciated.TaperingWithdrawalCases, n (%)80 (57.5)59 (42.4)Female, n (%)57 (71.3)36 (61)Age at diagnosis,years, median (IQR)5 (2-11)4 (2-11)Age at start of tapering or withdrawal, years, median (IQR)17 (11-25)16 (8-29)Categories, n (%)OligP19 (23.8)12 (20.3)OligE15 (18.8)13 (22)sJIA10 (12.5)11 (18.6)ERA12 (15)8 (13.6)Apso7 (8.8)6 (10.2)Poly RF+9 (11.3)4 (6.8)Poly RF-7 (8.8)3 (5.1)Und1 (1.3)2 (3.4)Uveitis, n (%)24 (30)16 (27.1)Laboratory values, n (%)- RF15 (18.8)5 (8.5)- ANA45 (56.3)33 (55.9)cDMARDs at start of tapering, n (%)40 (50)20 (33.9)bDMARD target, n (%)- TNF inhibitors63 (78.8)45 (76.3)- IL6-blockers14 (17.5)5 (8.5)- IL1-blockers2 (2.5)7 (11.9)- Rituximab1 (1.3)2 (3.4)Line of bDMARD, n (%)- First50 (62.5)45 (76.3)- Second18 (22.5)10 (16.9)- Third5 (6.3)2 (3.4)- Forth6 (7.5)2 (3.4)- Fifth1 (1.3)0 (0)Time in bDMARD treatment, months median (IQR)28.4 (13.3-52.5)28.2 (13.9-44.6)Remission prior tapering or withdrawal,months median (IQR)8 (6-12)8 (6-12)Fifty-nine out of 80 (73.8%) tapering cases were on remission at 6 months (6m) and 42/80 (52.5%) at 12 months (12m). Regarding dosage schedule adjustments, interval widening was the most frequent in 70/80 (87.5%) followed by combined strategy in 7/80 (8.8%) and lower dosage in 3/80 (3.8%). Median remaining dosage administrated was 54.9% IQR(50-75). Median time to flare was 14.9 months IQR (5.6-24.7). Median time to re-start of bDMARDs was 0 months min-max(0-13).After withdrawal of bDMARDs 23/59 (39%)cases at 6m and 14/59 (23.7%) cases at 12m were on remission. Median time to flare was 4.7 months IQR (2.8-11.4). Median time to re-start of bDMARDs was 1 month min-max (1-6).Most frequent re-treatment strategies were re-start of standard dosage [tapering 42/80 (52.5%), withdrawal 34/59 (57.6%)], re-start of previous effective dosage [tapering 28/80 (35%), withdrawal 11/59 (18.6%)], change of bDMARD [tapering 6/80 (7.5%), withdrawal 6/59 (10.2), re-start of bDMARD and cDMARD [tapering 4/80 (5%), withdrawal 6/59 (10.2)] and re-start of cDMARD [tapering 0/80 (0), withdrawal 1/59 (1.7%)].Overall response to re-treatment was 75/80 (93.8%) and 53/58 (91.4%) among tapering and withdrawal, respectively. In 12/139 (8.6%) patients bDMARD was changed, achieving remission in 11/12 (91.7%) cases. No factors were associated with response to re-treatment and there were no differences between re-treatment strategies and re-achieving remission (p=0.596).Conclusion:Response to re-treatment was high (92.7%), no risk factors were identified. Most frequent retreatment strategy was re-start of standard bDMARD dosage in 76/139 (54.7%) followed up by restart of previous effective bDMARD dosage in 39/139 (28.1%).Disclosure of Interests:None declared

Abstract:

Cysteine is considered to promote male pronuclear (MPN) formation in porcine through oocyte glutathione (GSH) synthesis (Yoshida et al. 1993 Biol. Reprod. 49, 89–94). The GSH has an important role in providing cells with a redox state and in acting to protect cells from toxic effects of oxidative damage (Meister et al. 1976 AM Rev. Biochem. 45, 559–604). However, such previous investigations were carried out under high O2 tension (20% O2) incubation conditions. Here we simply study IVM-IVF-IVC competence of porcine oocytes matured in IVM media supplemented with cysteine of different concentrations under low oxygen tension (5% O2). Cumulus–oocyte complexes (COCs) from prepubertal gilts were collected, matured, and fertilized in vitro according to Kikuchi et al. (2000 Biol. Reprod. 66, 1033–1041). COCs were cultured in IVM medium supplemented with 0 (Group 1; control), 0.05 (Group 2), 0.1 (Group 3), 0.2 (Group 4), and 0.6 mm (Group 5) cysteine under low oxygen tension. Nuclear maturation of oocytes, fertilization status, and number of cells in resultant embryos were assessed with orcein staining; also, the GSH content of IVM oocytes was measured by the method described by Ozawa et al. (2002 Reproduction 124, 683–689). Maturation rates of Groups 1–5 were 68.2 � 3.2, 70.6 � 7.7, 69.7 � 15.9, 75.9 � 7.7, and 68.8 � 8.0%, respectively, indicating no difference in maturation competence among the groups (P > 0.05 by ANOVA). The rates of sperm penetration, MPN formation (95.9 � 2.4, 100 � 0, 92.8 � 4.7, 94.0 � 4.1, and 92.4 � 2.7%, respectively), monospermy, and even blastocyst rates after 6 days of IVC were not different among the groups (P > 0.05 by ANOVA). Moreover, the cell numbers of blastomeres in blastocysts (38.68 � 3.5, 40.1 � 3.1, 37.5 � 3.0, 36.2 � 3.3, and 43.8 � 4.0, respectively) were uniformly the same among the groups (P > 0.05 by ANOVA). However, GSH content of IVM oocytes increased significantly (P < 0.05 by ANOVA) as the concentration of cysteine increased (12.2 � 0.6, 14 � 0.8, 15.1 � 0.5, 16.4 � 0.4, and 16.4 � 0.5 pmol/oocyte, respectively). The GSH level of oocytes in Group 1 (control) seems to be higher than that reported by Aberydeera et al. (1998 Biol. Reprod. 58, 213–218), who matured porcine oocytes under high O2 tension. This may reflect the effect of low O2 tension and explain the same developmental rate to the blastocyst stage as that of oocytes matured in the media supplemented with cysteine in this study. In conclusion, an addition of 0.05–0.6 mm cysteine during IVM, under 5% O2 tension, of porcine oocytes significantly increased intracellular GSH synthesis according to its concentration. However, it had no promoting effects on nuclear maturation, fertilization, male pronucleus formation, and subsequent embryonic development to the blastocyst stage. Thus, O2 tension during IVM of oocytes is suggested to be important for the in vitro production of porcine blastocysts.

Abstract:

Equine embryos appear to require a high glucose concentration for development to the blastocyst stage. The complete cell-culture medium, DMEM/F-12 (DM), which contains 17 mM glucose, has been widely used for equine embryo culture; however, in other species, high glucose during the early stages of embryo development is detrimental. To avoid this, we initiated a 2-step system using a low-glucose human embryo culture medium (Global) from Days 0 to 5 [Day 0 = day of intracytoplasmic sperm injection (ICSI)], with glucose (20 mM) added to the medium in the second step (Days 5 to 10; Choi et al. 2015 Reproduction 150, 31–41). We noted a high pregnancy loss rate (20%) in our clinical ICSI program (Hinrichs et al. 2014 J. Equine Vet. Sci. 34, 176), which used this 2-step Global system. Limited data are available on pregnancy with DM-produced embryos, but in one study, the loss rate was 1/13 (7.7%; Choi et al. 2011 Reproduction 142, 529–538). It is possible that use of DM in the second step of culture would better support normal blastocyst development than does Global with added glucose. However, DM is typically used at 5% CO2, and Global at 6% CO2, so use of both media would necessitate 2 sets of incubators. In the present study, we explored the use of DM in the second step of a two-step equine embryo culture system, under different CO2 environments. Oocytes were collected from research mares via follicle aspiration and were held overnight before being matured in vitro for 30 h. All media included 10% fetal bovine serum. On Days 0 to 5 after ICSI, all embryos were cultured in Global under 6% CO2 in mixed gas (5% O2 and remainder N2) at 38.2°C. In Experiment 1, on Day 5, embryos were transferred to DM prepared according to our standard method, with 14.3 mM NaHCO3 and 5 mM NaOH, and were cultured in mixed gas at either 5% CO2 or 6% CO2. Five replicates were performed. In Experiment 2, DM was prepared by our standard method, or with 24.2 mM bicarbonate and no NaOH. When pH was measured using a pH meter after media were equilibrated overnight, this higher bicarbonate provided the same pH at 6% CO2 (pH 7.3), as was achieved with the standard DM preparation at 5% CO2. Six replicates were performed. In both experiments, blastocyst development was assessed on Days 7 to 10, and blastocyst rates were compared between treatments by Fisher’s exact test. In Experiment 1, blastocyst rates were 43%, 13/30 and 27%, 8/30 for the standard DM preparation in 5% and 6% CO2, respectively (P > 0.05). In Experiment 2, the blastocyst rates were 34%, 14/44 for the standard DM preparation at 5% CO2 and 43%, 19/44 for the high-bicarbonate DM at 6% CO2 (P > 0.05). We conclude that a 2-step Global-DM system can support equine blastocyst production under a consistent CO2 environment (6%) if DM bicarbonate levels are adjusted to balance the increased CO2. This work was supported by the Clinical Equine ICSI Program, Texas A&M University, and by the Link Equine Research Endowment Fund, Texas A&M University.

Abstract:

<p><strong>Introducción</strong></p><p>El reemplazo total de rodilla en secuela de trauma, secundaria a fracturas periarticulares de fémur distal o tibia proximal, implica un tratamiento complejo pero es una opción válida para el manejo de estos pacientes. El ojetivo de este trabajo es evaluar en forma retrospectiva los resultados obtenidos en RTR en pacientes con secuela de fracturas peri articulares de la rodilla.</p><p><strong>Material y Métodos</strong></p><p><strong></strong>En un estudio retrospectivo, multicéntrico donde se evaluaron 29 pacientes, con artrosis secundaria a fracturas a los que se les realizó RTR entre 2008-2015. 19 mujeres y 10 varones. Edad promedio 59 años. 23 fracturas en tibia proximal y 6 en fémur distal: 6 extraarticulares y 23 intraarticulares. Tratamiento inicial: ortopédico en 8 pacientes; reducción abierta y fijación interna (RAFI) en 21. Promedio de cirugías hasta la artroplastia 2,14 (1 a 7). Se empleó el Knee Society Score (KSS) y radiografías para la evaluación pre y postquirúrgica. Rango de movimiento (ROM) prequirúrgico: flexión 60° (45°-90°), extensión 15° (0°-30°). KSS dolor 30 (10-45) y para KSS funcional 25 (20-45). KSS total 30 (20-60)</p><p><strong>Resultados</strong></p><p><strong></strong>El seguimiento promedio 45 meses (6-104). Se restauró el eje mecánico en todos los casos. ROM en el último control: flexión 112° (60°-140°); extensión 5° (0°-30°). KSS dolor 40 (30-50) y KSS funcional 35 (30-50). KSS total 81 (50-95) Resultados buenos (KSS ≥80 puntos) 22 pacientes (75,8%), regulares 6 (20,6%) y pobres 1 caso (3,44 %).. 13% de complicaciones mayores.</p><p><strong>Discusión</strong></p><p><strong></strong>Si bien el RTR para el tratamiento de secuelas de fracturas periarticulares de la rodilla, presenta mayor porcentaje de complicaciones, siendo los resultados inferiores a los publicados en RTR en artrosis no traumaticade rodilla, el RTR es una opcion valida para el rescate postraumatico, obteniendo una mejoria significativa tanto en el KSS como en el rango de movimiento. El mismo implica un manejo de partes blandas minucioso, y una mayor complejidad técnica.</p>

Abstract:

Abstract Abstract 715 The optimal first line immunosuppression (IS) for eradicating factor (F)VIII inhibitors in acquired haemophilia A (AHA) is controversial. Steroids and cyclophosphamide are commonly used and there has been recent interest in the role of rituximab. Prospective randomised controlled trials (RCTs) would be challenging and in their absence registries may provide useful data to guide clinical practice. EACH2 collected data on 281 analysable patients who received first line IS. Complete remission (CR) was defined as inhibitor undetectable, FVIII>70IU/dL and IS stopped. Stable CR was defined as CR without relapse. A higher proportion of patients achieved CR with steroids and a cytotoxic (predominantly cyclophosphamide) (77%) than those treated with steroids alone (58%) (P<0.005) or a rituximab based regimen (61%) (P<0.02). The 12 patients treated with rituximab alone had the lowest proportion achieving CR (42%). Median time to normal FVIII and undetectable inhibitor was similar in the steroid alone and steroid and cytotoxic groups (about 5 weeks) but slower in those treated with a rituximab based regimens (about 9 weeks), although this was in part due to the slow response of patients treated with rituximab alone. Relapse was most common after initial treatment with steroids alone (19%). In this group relapse was diagnosed a median (range) 134 (13-695) days after stopping IS. In contrast, only 1 patient (4%) who achieved a CR with a rituximab based regimen relapsed. Stable CR after first line treatment was highest after steroids plus a cytotoxic (67%) and rituximab plus another IS (64%). Stable CR was lower in the steroids alone (48%) and rituximab alone groups (42%). Patients who achieved CR after first line IS had higher FVIII and lower inhibitor titres compared with those who did not, median (IQR) for FVIII 2 (1-7) compared to 1 (1-4)IU/dL (P<0.005) and inhibitor titre 13 (4-45) compared to 31 (7-75)BU/mL P<0.03. To minimise bias, propensity score matched analysis based on age, weight, gender, FVIII level, inhibitor titre and underlying aetiology was performed to compare oral prednisone plus oral cyclophosphamide with oral prednisone alone (n=70 in each arm). This showed an odds ratio (95% CI) of achieving a stable CR of 3.25 (1.51-6.99) (P<0.003) in favour of combined treatment despite the prednisone alone group being treated with a higher mean dose of prednisone/kg (P<0.005). There were insufficient patients to perform a propensity score matched analysis with the rituximab group. There was no statistically significant difference in survival between the groups and similarly a proportion of patients were alive and in CR at final follow up (FU), median (IQR) FU was 246 (66-665) days. In conclusion, stable CR after first line IS was more likely following combination therapy with oral prednisone and cyclophosphamide than oral prednisone alone. Although a lower proportion of patients achieved CR with rituximab based regimens than steroids plus cytotoxics the lower relapse rate resulted in a comparable proportion achieving stable CR. Stable CR after rituximab alone was low, although there were only 12 patients. These are the best data available to date relating to the response to first line IS in AHA and will be useful for informing treatment guidelines and designing future RCTs. Table. Outcome of first line immunosuppression (IS) for AHA. Regimen Age Years FVIII at diagnosis (IU/dL) Inhibitor titre at diagnosis (BU/mL) CR after 1st line IS N (%) Days from start of IS Relapse (%) Stable CR after 1st line IS % Alive and in CR at final FU % Inhibitor -ve FVIII >70 IU/dL IS stopped Steroids alone n=142 75 (63–81) 3 (1–6) 13 (5–43) 83 (58) 34 (17–76) 32 (15–51) 108 (55–208) 19 48 60 13–104 0–28 0.1–1020 5–321 3–551 11–1169 Steroids and cytotoxics n=88 76 (63–80) 1 (1–4) 22 (8–67) 68 (77) 32 (12–77) 40 (18–81) 74 (52–151) 14 67 60 16–101 0–34 0.4–2800 0–386 2–386 1–386 All rituximab regimen n=51 74 (5–78) 2 (0–7) 16 (6–62) 31 (61) 65 (29–144) 64 (28–206) 43 (22–96) 4 59 67 14–104 0–20 0.1–2176 10–436 10–569 17–257 Rituximab plus another IS n=39 75 (57–78) 2 (0–7) 16 (9–62) 26 (67) 47 (28–96) 38 (28–141) 55 (26–96) 4 64 61 14–104 0–20 0.1–2176 10–436 10–569 17–257 Rituximab alone n=12 69 (65–77) 1 (0–8) 16 (3–71) 5 (42) 53, 145, 209, 334* 145, 209, 252, 334* 21, 21, 21, 21, 22* 0 42 70 50–85 0–15 1–460 Data are median, interquartile range (IQR) and range, * actual days due to low number of patients. Disclosures: Collins: NovoNordisk: Consultancy, Honoraria, The EACH2 registry was funded by Novonordisk; Baxter Healthcare: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. Off Label Use: The use of Rituximab for the treatment of acquired haemophilia. Baudo:NovoNordisk: Consultancy, Honoraria, NovoNordisk fund the EACH2 registry, Speakers Bureau; Bayer Healthcare: Honoraria, Speakers Bureau. Knoebl:NovoNordisk: Consultancy, Membership on an entity's Board of Directors or advisory committees, NovoNordisk fund the EACH2 registry, Research Funding; Baxter Healthcare: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Levesque:NovoNordisk: NovoNordisk fund the EACH2 registry. Nemes: NovoNordisk: Novonordisk fund the EACH2 registry. Pellegrini:Novonordisk: Consultancy, Honoraria, Speakers Bureau, The EACH2 registry is funded by Novonordisk. Tengborn:NovoNordisk: NovoNordisk fund the EACH2 registry. Huth-Kuehne:NovoNordisk: Consultancy, Membership on an entity's Board of Directors or advisory committees, NovoNordisk fund the EACH2 registry; Baxter Healthcare: Consultancy, Membership on an entity's Board of Directors or advisory committees.

Abstract:

Abstract Abstract 2434 Background: Recurrent cytogenetic abnormalities detected by FISH have prognostic significance in CLL patients (pts) [Dohner NEJM 2000]. While pts in unfavourable cytogenetic risk groups (deletion 17p, deletion 11q) consistently show poor overall (OS) and treatment-free survival (TFS), those in intermediate and favourable risk groups (trisomy 12, deletion 13q, normal FISH) are clinically heterogeneous. There remains a need to further refine these FISH prognostic categories to better risk stratify pts. Recently, IGH translocations [t (IGH)] have been increasingly reported in the literature and are suggested to portend a poor prognosis [Cavazzini BJH 2008]. We sought to determine the frequency of t (IGH) in CLL pts at our institution and determine their clinical significance in relation to other common FISH abnormalities, specifically the intermediate-favourable risk groups. Methods: We reviewed all CLL pts referred for FISH analysis from 2006 onwards to Vancouver General Hospital (VGH), an academic quaternary-care referral centre and home of the Leukemia/BMT Program of BC. Since 2006, a commercially available FISH panel (Cytocell Ltd.) consisting of ATM, D13S19–25, TP53 DNA locus specific probes, chromosome 12 centromere probe, and an IGH breakapart probe was used for all CLL specimens. All patients were tested for t (11;14) and excluded if positive. Clinical and laboratory data was collected from an institutional CLL database. The primary endpoint was TFS, defined as time from diagnosis to primary therapy. Results: 142 CLL pts had FISH performed at VGH between 2006–2009. Median age at diagnosis was 58 yrs (range, 35–85). The prevalence of FISH abnormalities was: 13 deletion 17p (9%), 20 deletion 11q (14%), 41 trisomy 12 (29%), 78 deletion 13q (55%), 37 t (IGH)(26%) and 28 IGH deletion (20%). At median follow-up of 6.9 yrs, 77 pts required CLL treatment (54%); 15 died (11%). Median time from diagnosis to FISH testing was 4.2 yrs (range, 0–22) and median time from diagnosis to therapy was 2.1 yrs (range, 0–17). 49 pts had FISH testing after initiation of therapy. Median TFS for the 142 pts was 5.3 yrs (range, 3.8–6.9); median OS 18.6 yrs. Analysis of the 37 pts with t (IGH) showed they were associated with intermediate-favourable risk cytogenetic abnormalities including trisomy 12 (n=6) and deletion 13q (n=19). The only pts with concomitant deletion 17p (n=1) or deletion 11q (n=5) had FISH testing done after initiation of therapy. When the impact of t (IGH) was assessed irrespective of other cytogenetic abnormalities, pts with t (IGH) did as well as those without; median TFS 4.9 vs. 5.9 yrs (P=0.92) and median OS 18.7 vs. 14.6 yrs (P=0.57) respectively. Next, pts were categorized by the Dohner hierarchy and grouped as follows: unfavourable (deletion 17 or deletion 11q, n= 32), intermediate (trisomy 12 or normal FISH, n=66), or favourable (deletion 13q, n=44). Median TFS for each group was 2.8 yrs, 7.2 yrs, and 7.5 yrs respectively (Figure 1A, P=0.001 across all groups). No significant TFS difference was found in pts with t (IGH) in unfavourable and intermediate risk cytogenetic groups (P=0.43 and P=0.45 respectively). In contrast, a significant difference in median TFS was seen in deletion 13q pts with coexistent t (IGH)(n=14) compared to those without (n=30), 4.7 yrs vs. 8.0 yrs respectively (P=0.027), and a trend towards worse median OS, 14.6 yrs vs. not reached (P=0.31). Pts with deletion 13q alone retained their good prognosis, while those with t (IGH) fell between intermediate and unfavourable risk groups (Figure 1B, P<0.001 across all groups). When only pts with FISH testing prior to therapy were examined, there remained a significant difference between those with deletion 13q and t (IGH)(n=10) vs. deletion 13q alone (n=24)(median TFS 4.7 yrs vs. not reached, P=0.039). Conclusion: In this cohort, the presence of t (IGH) negatively impacted pts with deletion 13q, further stratifying this group into 2 separate prognostic entities. Importantly, the outcome of CLL pts with deletion 13q and coexistent t (IGH) was similar to those with intermediate-unfavourable cytogenetics. This may explain the clinical heterogeneity seen in pts with deletion 13q and lends further support to include this marker in routine FISH analysis. Further analyses of IGH abnormalities in this favourable risk cytogenetic group in a larger population are in progress to validate these results. Disclosures: Toze: Hoffmann-La Roche: Honoraria, Research Funding; Genzyme: Honoraria, Research Funding; GlaxoSmithKline: Honoraria.

Abstract:

Objectives:To analyze the risk of admission for COVID19 infection and outcome of patients treated with bDMARD or tsDMARD from our biologic therapy center, to compare with all patients admitted for COVID-19 infection in our hospital.Methods:Records of the patients from our center admitted for COVID-19 infection between March 8 and May 8, 2020 were analyzed retrospectively. Age, gender, and outcome of all patients admitted for COVID19 infection to our hospital on the same dates were collected. Chi-square, Student’s t and Man-Whitney U tests were used for comparisons when appropriate.Results:1,668 patients with inflammatory diseases treated with bDMARD or tsDMARD were included. Median age 53.0 years (range 17-91), 52.4% women. Diagnoses and DMARD distribution are shown in tables 1 and 2. 19/1668 (1.1%; 6.8 patient-years) were admitted for severe COVID19 infection. Mortality ratio: 4/19 (21.1%). Median age of the admitted patients was higher: 61.0y (SD 14.2) vs 53.0y (SD 15.0); p <0.009. Median age of deceased patients was also higher 69.5y (SD 20.3) vs 53.0y (SD 15.0); p: NS. Female gender had a worse prognosis trend: 52.4% of all group, 68.4% of those hospitalized, 75.0% of those who died. Females had a higher median age than men: 55.0y (SD 14.9) vs. 50.0y (SD 14.9); p <0.001.When comparing patients treated with DMARD admitted for COVID19 infection with all patients hospitalized for the same reason (4,601patients), no differences were found neither in age (61.0y [SD 14.2] vs 58.3y [SD 18.1]; NS) nor gender (female: 68.4% vs 54.7%; NS). However, DMARD group seemed to have higher mortality: 4/19 (21.1%) vs 551/4601 (12.0%); p: NS, at a younger age: 69.5y (SD 20.3) vs 82.4 (SD 11.4); p: NS.Rheumatoid arthritis patients were admitted more frequently: (9/392 (2.3%) vs 10/1276 (0.8%); p <0.025. And were older: median 62y (SD 13.5) vs 50.0y (SD 14.4); p <0.001.Patients treated with anti-TNF suffered less admissions: 6/1055 (0.6%) vs 13/613 (2.1%); p<0.001 and were younger: median 51.0y (SD 15.0) vs 55.0y (SD 14.7); p <0.001. Anti-TNF were less used in patients with rheumatoid arthritis 188/392 (48.0%) vs 867/1276 (67.9%); p<0.001.DiseaseN (%)AdmitteddeathsRheumatoid arthritisSpondylarthritisPsoriatic arthritisJIACTDVasculitisIBDPsoriasisOthers392 (23.5%)277 (16.6%)124 (7.4%)30 (1.8%)31 (1.9%)20 (1.2%)582 (34.9%)202 (12.1%)10 (0.6%)9/392 (2.3%)2/277 (0.7%)1/124 (0.8%)0/30 (0.0%)1/31 (3.2%)0/20 (0.0%)4/578 (0.7%)2/202 (1.0%)0/10 (0.0%)110010100TOTAL1,668 (100%)19/1668 (1.1%)4/19 (21.1%)JIA: Juvenile Idiopathic Arthritis; CTD: Connective Tissue Disease; IBD: Inflammatory Bowel DiseaseTreatmentN (%)AdmitteddeathsAnti-TNFAnti-CD20Anti-IL6CTLA4-IgAnti-IL17Anti-IL12/23Anti-integrinJAK inhibitorPDE4 inhibitorAnti-IL231055 (63.2%)79 (4.7%)96 (5.8%)44 (2.6%)92 (5.5%)143 (8.6%)79 (4.7%)34 (2.0%)32 (1.9%)14 (0.8%)6/1055 (0.6%)3/79 (3.8%)3/96 (3.1%)3/44 (6.8%)2/92 (2,2%)1/143 (0.7%)0/79 (0.0%)1/34 (2.9%)0/32 (0.0%)0/14 (0.0%)2101000000TOTAL1,668 (100%)19/1668 (1.1%)4/19 (21.1%)Conclusion:It seems reasonable that patients with inflammatory diseases treated with bDMARD or tsDMARD continue their treatment during the COVID19 epidemic. The different rates of hospitalization based on the diagnosis or DMARD may be due to comorbidity, confounding by indication and other bias. The study is not powerful enough to study these confounders.Disclosure of Interests:Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Luis Alberto Menchén Viso Grant/research support from: Abbvie, Janssen, MSD, Takeda, Consultant of: Abbvie, Janssen, Takeda, MSD, Medtronic, Tillotts, Pfizer, Dr. Falk Pharma, Speakers bureau: Abbvie, Janssen, Takeda, MSD, General Electric, Tillotts, Pfizer, Ferring, General Electric, Fresenius, Ofelia Baniandrés Rodríguez: None declared, Ana Herranz Alonso: None declared, Carmen Lobo Rodríguez: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Indalecio Monteagudo Sáez: None declared, Ignacio Marín Jiménez: None declared, Amparo López: None declared, Ana López: None declared, Arantza Ais Larisgoitia: None declared, Esther Chamorro de Vega: None declared, Paloma Morales de los Ríos: None declared, Maria Jesus Lizcano: None declared, Jose Maria Alvaro Gracia: None declared, Sonia García de San José: None declared

Abstract:

Samples of Oxytricha falax were collected from Tigris River by 55µ. mesh net. Culturing of O. falax were cultivated in specific conditions (DO 3-5mg/l.; W.Temp. 24±1ºC; pH: 6.8-7.5).The effect of various furfural concentration 0, 20, 40, 80,100 and 124 ppm and toluene concentration 0, 15, 30, 34.2, 34.5 and 35 ppm after two periods of treatment (24 and 48 hr.) on the physiological parameters of O. falax ciliate were observed. This study showed that the lethal concentration of furfural was 124ppm and 80ppm after 24hr. and 48hr. from treatment which killed all the individual community respectively. Furthermore the treatment of O. falax individuals with different concentrations of toluene indicated that 34.5 ppm of it caused disappearance of the individuals' population after 48hr., while the 35ppm concentration from toluene caused dead of all individuals after 24 hr. from their treatment.

Abstract:

Abstract The acquired bone marrow failure (BMF) syndromes include aplastic anemia (AA), paroxysmal nocturnal hemoglobinuria (PNH), and myelodysplastic syndromes (MDS). In this study, to clarify what the frequencies of borderline PNH patients with lower proportions of glycosylphosphatidylinositol (GPI)-deficient erythrocytes and no apparent clinical symptoms of PNH, such as visible hemoglobinuria, are and the significance of serum haptoglobin (Hpl) in patients with BMF, we investigated flow cytometry of erythrocytes and granulocytes with expression of CD59 and quantified serum Hpl in 142 Japanese patients with BMF, including 54 AA, 36 PNH, and 52 MDS patients. The diagnosis and grading of the severity of AA were based on the criteria of the International Agranulocytosis and Aplastic Anemia Study Group and that of Frickhoten et al, respectively. A patient with over 1% of CD59− erythrocytes was judged to have PNH erythrocytes. The diagnosis and phenotypes of MDS were determined according to the French-American-British criteria. The concentrations of serum Hpl were measured by the nephelometric procedure, developed by Van Lente et al, with some modifications. The proportions of CD59− erythrocytes and CD59− granulocytes from 32 healthy individuals were 0.047 ± 0.052% (range, 0–0.17%) and 0.056 ± 0.065% (range. 0–0.22%), respectively. The frequencies of AA and MDS patients with over these maximum values were 25.9% and 7.7%, respectively, in erythrocytes and 31.5% and 23.1%, respectively, in granulocytes. Thirteen (36.1%) of 36 PNH patients had lower proportions (range, 1–10%) of CD59− erythrocytes and no apparent clinical symptoms. Subsequently, the concentrations of serum Hpl in AA, MDS, and PNH patients were 127.6 ± 130.4 mg/dl (range, 7–551 mg/dl), 73.2 ± 74.3 mg/dl (range, 3–430 mg/dl), and 13.2 ± 24.6 mg/dl (range, 2–130 mg/dl), respectively. There were significant differences in the values between AA and MDS, MDS and PNH, and AA and PNH patients (p&lt;0.01 in all comparisons). The values of serum Hpl in 436 Japanese healthy individuals were 152.4 ± 72.7 mg/dl (range, 42.6–309 mg/dl). The frequencies of AA, MDS, and PNH patients with below 40 mg/dl of serum Hpl were 27.8%, 38.5%, and 94.4%, respectively. The white blood cell counts, absolute neutrophil counts, and platelet counts in the group with low concentrations of serum Hpl in AA patients (n=15) or the concentrations of hemoglobin in that in MDS patients (n=20) significantly decreased compared with those in the group with normal concentrations of that in AA patients (n=39) or in MDS patients (n=32), respectively (p&lt;0.005, p&lt;0.01, and p&lt;0.02; or p&lt;0.05, respectively). In conclusion, our findings suggest that diagnostic criteria for PNH should be reconsidered according to proportions of GPI-negative erythrocytes, and that concentration of serum Hpl can be used as a hallmark sharply knowing existence of over 1% of GPI-negative erythrocytes in PNH.

Abstract:

An experiment was conducted in a greenhouse - research station B - College of Agricultural Engineering Sciences, University of Baghdad, during the fall season of 2018 with the aim of propagating and initially studying the field performance of 18 and 20 potential potato lines derived from Rivera and Arizona cv. after in vitro exposure of nodal segments to different dosages of gamma rays (0, 10, 20, and 30 Gray) and EMS (0, 10, 20, and 30 mM). Each control cultivar and their derived lines were independently cultured in plastic bags according to the RCBD, with three replications. The results showed that the highest plant height and number of leaves were obtained from Arizona derived lines which gave 60.11 cm and 25.30 leaves.plant-1 in lines 207 and 222, respectively when compared with their control that gave 38.11 cm and 13.67 leaves.plant-1, respectively. Minitubers diameter, weight, and plant yield were in its highest values in Arizona derived lines 551, 551, and 459 which gave 35.73 mm.minituber-1, 33.13 g. minituber-1, and 133.8 g.plant-1, respectively compared to their control that gave 25.35 mm.minituber, 16.8 g.minituber, and 78.57 g.plant-1, respectively. The resulted lines were analyzed at the molecular level utilizing the inter simple sequence repeats (ISSR) markers and revealed that lines 69, 10, 68, 102, and 7 were the much distanced from its derived Rivera cultivar and gave 40.7%, 37.1%, 36.8%, 33.3%, and 30.0%, respectively while lines 551, 261, 474, and 254 were the much genetically distanced from their derived cultivar Arizona with genetic distances of 24.1%, 22.6%, 18.8%, and 17.6%, respectively.

Abstract:

AbstractObjectiveTo determine the impact of BMI on post-operative outcomes and resource utilization following elective total hip arthroplasty (THA).DesignA retrospective cohort analysis on all primary elective THA patients between 1996 and 2004. Primary outcomes investigated using regression analyses included length of stay (LOS) and costs (US dollars).SettingMayo Clinic Rochester, a tertiary care centre.SubjectsPatients were stratified by pre-operative BMI as normal (18·5–24·9 kg/m2), overweight (25·0–29·9 kg/m2), obese (30·0–34·9 kg/m2) and morbidly obese (≥35·0 kg/m2). Of 5642 patients, 1362 (24·1 %) patients had a normal BMI, 2146 (38·0 %) were overweight, 1342 (23·8 %) were obese and 792 (14·0 %) were morbidly obese.ResultsAdjusted LOS was similar among normal (4·99 d), overweight (5·00 d), obese (5·02 d) and morbidly obese (5·17 d) patients (P= 0·20). Adjusted overall episode costs were no different (P= 0·23) between the groups of normal ($17 211), overweight ($17 462), obese ($17 195) and morbidly obese ($17 655) patients. Overall operative and anaesthesia costs were higher in the morbidly obese group ($5688) than in normal ($5553), overweight ($5549) and obese ($5593) patients (P= 0·03). Operating room costs were higher in morbidly obese patients ($3418) than in normal ($3276), overweight ($3291) and obese ($3340) patients (P< 0·001). Post-operative costs were no different (P= 0·30). Blood bank costs differed (P= 0·002) and were lower in the morbidly obese group ($180) compared with the other patient groups (P< 0·05). Other differences in costs were not significant. Morbidly obese patients were more likely to be transferred to a nursing home (24·1 %) than normal (18·4 %), overweight (17·9 %) or obese (16·0 %) patients (P= 0·001 each). There were no differences in the composite endpoint of 30 d mortality, re-admissions, re-operations or intensive care unit utilization.ConclusionsBMI in patients undergoing primary elective THA did not impact LOS or overall institutional acute care costs, despite higher operative costs in morbidly obese patients. Obesity does not increase resource utilization for elective THA.

Abstract:

Soil water dynamic is considered an important process for water resource and plantation management in Horqin Sand Land, northern China. In this study, soil water content simulated by the SWMS-2D model was used to systematically analyse soil water dynamics and explore the relationship between soil water and rainfall among micro-landforms (i.e., top, upslope, midslope, toeslope, and bottomland) and 0–200 cm soil depths during the growing season of 2013 and 2015. The results showed that soil water dynamics in 0–20 cm depths were closely linked to rainfall patterns, whereas soil water content in 20–80 cm depths illustrated a slight decline in addition to fluctuations caused by rainfall. At the top position, the soil water content in different ranges of depths (20–40 and 80–200 cm) was near the wilting point, and hence some branches, and even entire plants exhibited diebacks. At the upslope or midslope positions, the soil water content in 20–80 or 80–200 cm depths was higher than at the top position. Soil water content was higher at the toeslope and bottomland positions than at other micro-landforms, and deep caliche layers had a positive feedback effect on shrub establishment. Soil water recharge by rainfall was closely related to rainfall intensity and micro-landforms. Only rainfalls &gt; 20 mm significantly increased water content in &gt; 40 cm soil depths, but deeper water recharge occurred at the toeslope position. A linear equation was fitted to the relationship between soil water and antecedent rainfall, and the slopes and R² of the equations were different among micro-landforms and soil depths. The linear equations generally fitted well in 0–20 and 20–40 cm depths at the top, upslope, midslope, and toeslope positions (R² value of about 0.60), with soil water in 0–20 cm depths showing greater responses to rainfall (average slope of 0.189). In 20–40 cm depths, the response was larger at the toeslope position, with a slope of 0.137. In 40–80 cm depths, a good linear fit with a slope of 0.041 was only recorded at the toeslope position. This study provides a soil water basis for ecological restoration in similar regions.

Abstract:

Abstract Introduction: The distinction between essentialthrombocythemia(ET) and early, prefibrotic primary myelofibrosis (prePMF) by strictly applying the criteria of the WHO classification results in a newly defined subgroup of myeloproliferative neoplasm (MPN) in which the frequency and severity of clinical features are currently poorly characterized. Since prePMF was usually summarized under the subgroup of ET in previous classifications, little is known about the frequency of prePMFamong MPN. The importance of accurate diagnosis, however, is underlined by various publications that could demonstrate a significant impact on management and outcome of these patients. Aims: The aim of this study was to describe the clinical characteristics and symptoms at diagnosis of prePMF as a distinct entity and to evaluate the course of the disease in regard to survival, transformation into overt myelofibrosis and acute leukemia. Methods: All patients with representative bone marrow biopsies at presentation and complete clinical data at time of diagnosis and follow up were included in this study. All patients included were recruited from the MPN cohort of the Medical University of Vienna. Results: In total, 807 MPN patients diagnosed according to the WHO 2008 criteria were analyzed. The relative frequency of prePMF in our cohort was 17.6% (n=142) as opposed to 27.4% (221) in ET (Fig. 1). The median age for prePMF patients was 63.4 years (range 26.9-88.1) and 55.1% were female. The majority showed an elevated platelet count (median 770 G/l, range 78-2869), hemoglobin levels were on the lower end of the normal range in both genders (median 13.9, range 8.1-18.4 and 13.2, range 7.9-16.2 in men and women respectively). Leukocyte counts in the upper range of normal were common (median 9.87, range 4.0-46.0). The lactate dehydrogenase levels (LDH) were markedly elevated (median 303, range 153-729 with an institutional cut-off of 250 U/L). Therewasalso a considerate proportion of patients with splenomegaly (39.8%). Further, 22.6% of patients reported constitutional symptoms such as night sweats and weight loss. Fiber grade of 1 of a three-graded score in the bone marrow biopsy was reported in 26.2% of cases. 27.0% of patients presented withleftshiftingwith a few peripheral blasts. JAK2 positivity was found in 57.1%, CALR in 32.7 and MPL in 3.3% of cases. Only 5.9% were triple negative. 5-, 10- and 20-year survival rates were 87.6%, 67.0% and 28.8% respectively (38.2% of patients followed to death). Cumulative rate of progression into overt fibrosis was 34.2% after 10 and 58.8% after 20 years (Fig. 2). Discussion: Our data highlight important features of prePMF. Firstly, compared to ET, it has a later onset. More importantly, thrombocytosis is not a feature limited to ET, but is also frequently seen in prePMF and is therefore not suitable to accurately characterize MPN at time of diagnosis. However, leukocytosis and elevated LDH levels are features uncommon for ET as is fiber grade > 0 that is almost never seen in the WHO-defined ET, but relatively common in prePMF. Splenomegaly and presence of a few blasts are generally signs of beginningextramedullaryhematopoiesis are therefore more commonly associated with early stages primary myelofibrosis. Lastly, overall survival and fibrosis-free survival is substantially impaired in prePMF in comparison to data previously published for ET and similar to polycythemiavera. In conclusion, prePMF is a distinct entity, that while sharing some features of ET, most notably thrombocytosis, shows several striking features that should be regarded when investigating newly diagnosed MPN patients. Figure Figure. Figure Figure. Disclosures Gisslinger: Baxalta: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; AOP Orphan: Consultancy, Honoraria.

Abstract:

Abstract Introduction: We prospectively collected data from lower-risk patients (pts) with MDS in an ongoing US registry in order to assess the association between chelation and clinical outcomes. In addition, we evaluated the association between chelation and overall survival (OS). Here we report outcomes at 5 years. Methods: The registry enrolled 600 pts from 107 US centers. Pts were ≥18 years old with lower-risk MDS (WHO, FAB, and/or IPSS criteria) and transfusional iron overload (serum ferritin ≥1000 µg/L and/or ≥20 packed red blood cell units and/or ≥6 units every 12 weeks). Pts were analyzed by iron chelation status; ie, had never been chelated or had ever used iron chelation, and a subgroup of the latter group—pts with ≥6 mo of chelation. Pts were evaluated every 6 mo for 5 years or until death with respect to characteristics, survival, disease status, comorbidities, cause of death, and MDS therapy. Results: 600 pts (median age, 76 years [range, 21-99], 346 [57.8%] male, 519 [86.6%] Caucasian) were evaluated. IPSS status was similar across chelation groups. Chelated pts (n=271) had a greater median number of lifetime units transfused at the time of enrollment vs nonchelated pts (n=328): 38.5 vs 20.0. At baseline, cardiac and vascular comorbidities (CVC) were significantly higher in nonchelated vs chelated pts (52.4% vs 34.3% [P<0.0001], 59.8% vs 48.0% [P=0.0039], respectively). Endocrine comorbidities (EC) were numerically higher in nonchelated vs ≥6 mo chelated pts (44.2% vs 35.6%). As of May 1, 2014, 61 pts continue in the registry; 538 discontinued (400 died, 66 lost to follow-up, 46 completed study, and 26 discontinued for other reasons). Of the 271 chelated pts, 187 (69.0%) were chelated with deferasirox, 40 (14.8%) with deferasirox and deferoxamine, 32 (11.8%) with deferoxamine, and 1 (0.4%) with an unknown chelator; in 11 (4.1%), the chelator name was not provided. Cumulative duration of chelation was 18.9 mo in pts who had ever used iron chelation and 27.0 mo in pts with ≥6 mo of iron chelation. OS from diagnosis of MDS and time to acute myeloid leukemia (AML) were significantly greater in the chelated vs nonchelated pts (P<0.0001 for both). In pts with CVC, median OS was also significantly greater in chelated vs nonchelated pts (67.66 vs 43.40 mo; P<0.0001). In pts with EC, median OS was also greater in chelated pts (74.98 vs 44.63 mo; P<0.0001) (Table). Patients with ≥6 mo of chelation had numerically fewer deaths in the registry, numerically greater OS, time to death, and time to AML transformation vs pts who had any chelation (Table). Conclusions: Limitations of these analyses include variation in time from diagnosis, duration of chelation, impact of pt clinical status on decision to chelate, and optional conduct of clinical assessments. Nonetheless, the results after 5 years of follow-up of lower-risk pts with MDS suggest iron chelation therapy is associated with improved OS and longer time to AML transformation. Causation has not been established. Abstract 1350. TABLE. Characteristics of Patients Nonchelated, Chelated, and Chelated ≥6 Months Nonchelated n=328 Chelated n=271 Chelated ≥6 Months n=202 Time to death, median (min/max) mo 47.8 (43.4, 53.1) 88.0 (78.4, 103.0) *P<0.0001 100.0 (83.4, 118.2) *P<0.0001 Deaths (n), % 239 (72.9) 161 (59.4) *P=0.0005 115 (56.9) *P=0.0002 Median OS (mo): No CVCMedian OS (mo): With CVC 34.0 (n=42) 43.4 (n=286) 69.3 (n=72) 67.7 (n=199) *P<0.0001 79.3 (n=60) 72.6 (n=142) *P<0.0001 Median OS (mo): No ECMedian OS (mo): With EC 38.5 (n=162) 44.6 (n=166) 67.1 (n=149) 75.0 (n=122) *P<0.0001 69.6 (n=114) 81.8 (n=88) *P<0.0001 Time to AML transformation from diagnosis, median (min, max) mo 46.4 (6.9, 82.5) 72.1 (16.4, 176.6) *P<0.0001 78.8 (16.4, 176.6) *P<0.0001 AML transformation, n (%) 34 (10.4) 17 (6.3) 14 (6.9) Cause of death, n (%) MDS/AML 103 (31.4) 73 (26.9) 53 (26.2) Cardiac 36 (11.0) 21 (7.7) 15 (7.4) Infection 27 (8.2) 14 (5.2) 14 (6.9) Other 16 (4.9) 16 (5.9) 10 (5.0) Unknown 29 (8.8) 18 (6.6) 12 (5.9) Malignancy 14 (4.3) 2 (0.7) 0 (0.0) Respiratory 7 (2.1) 7 (2.6) 4 (2.0) Multiorgan failure 3 (0.9) 3 (1.1) 3 (1.5) CVA 1 (0.3) 5 (1.8) 3 (1.5) GvHD/transplant 3 (0.9) 2 (0.7) 1 (0.5) CVC, cardiovascular comorbidity; EC, endocrine comorbidity; CVA, cerebrovascular accident; GvHD, graft-vs-host disease *Versus nonchelated. Disclosures Paley: Novartis Pharma: Employment. Esposito:Novartis Pharma: Employment. McNamara:Novartis Pharmaceuticals Corporation: Employment. Garcia-Manero:Novartis Pharma: Research Funding.

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AbstractIn a feeding experiment β-hydroxybutyrate (BHB), glucose, albumin, total protein, globulin and urea concentrations in the plasma of twin-bearing ewes were analysed. Mature Suffolk cross ewes were given either formic acid (FA)-treated grass silage or grasslmolassed sugar-beet pulp (MSBP) silage in late pregnancy. The experiment commenced on day 91 of pregnancy and the dietary treatments were FA-treated silage (Tl), FA-treated silage + soya-bean meal (SBM) (T2), MSBP silage (T3), MSBP silage + SBM (T4), FA-treated silage + MSBP (T5), FA-treated silage + MSBP + SBM (T6) or FA-treated silage + 150 g crude protein (CP) per kg concentrate (T7). SBM was given only in the last 22 days of pregnancy aiming for a total CP intake of 220 g per ewe per day. Blood samples were collected by jugular venipuncture from each ewe 3 h following consumption of the morning dietary allowance on days 121, 128, 135 and 142 of pregnancy. Daily metabolizable energy (ME) intakes of 6·8, 11·4, 9·6, 12·8, 10·5, 13·7 and 14·7 (s.e. 0·58) MJ per ewe were recorded for Tl to T7 respectively over the last 3 weeks of pregnancy. Respective CP intakes of 72, 213, 110, 225, 109, 215 and 175 (s.e. 5·64) g per ewe were recorded for Tl to T7 respectively over the last 3 weeks of pregnancy. BHB concentrations (mmol/l) on day 121 of pregnancy of 1·18, 1·25, 0·52, 0·52, 0·56, 0·39 and 0·45 (s.e. 0·17), on day 128 of pregnancy of 1·17, 0·94, 0·52, 0·51, 0·72, 0·62 and 0·39 (s.e. 0·20), on day 135 of pregnancy of 1·53, 0·68, 0·68, 0·66, 0·71, 0·62 and 0·46 (s.e. 0·20) and on day 142 of pregnancy of 1·43, 0·60, 0·62, 0·56, 0·62, 0·56 and 0·63 (s.e. 0·20) were recorded for Tl to T7 respectively. There was a quadratic relationship between plasma BHB concentration and ME intake on days 121 (R2 = 0·538, P < 0·001), 128 (R2 = 0·324, P < 0·001), 135 (R2 = 0·429, P < 0·001)) and 142 (R2 = 0·344, P < 0·002) of pregnancy. There was a positive relationship between plasma glucose concentration and ME intake on day 222 (R2 = 0·208, P < 0·002), 228 (R2 = 0·203, P < 0·05), and 135 (R2 = 0·160, P < 0·02) of pregnancy. Albumin concentrations (gll) on day 128 of pregnancy of 21·8, 21·7, 23·6, 22·9, 22·5, 22·9 and 24·3 (s.e. 0-75), on day 135 of 20·9, 23·6, 24·2, 24·1, 22·4, 24·1 and 23·8 (s.e. 0·75), and on day 142 of 16·9, 22·6, 20·7, 22·2, 20·4, 22·7 and 21·1 (s.e. 1·05) were recorded for Tl to T7 respectively. Plasma albumin concentrations were significantly affected by SBM supplementation (P < 0·05). Despite the lower than generally recommended energy concentrations in T2 to T7, the concentrations of plasma BHB were within the normal range for healthy sheep.

Abstract:

Abstract Leydig cells isolated from goat testis were sonicated and pure nuclear preparations obtained for 125I-3,5,3′-triiodothyronine (T3)-binding assay. Under optimum assay conditions of pH 7·2 at 37 °C and 90 min of incubation, binding of 125I-T3 to Leydig cell nuclei reached saturation at 1·2 nmol/l concentration. A Scatchard analysis of T3 binding exhibited a Kd of 0·535 × 10−9 mol/l and a maximum binding capacity of 1·25 pmol/mg DNA. Competitive inhibition studies showed T3 binding to be analogue specific. The physiological relevance of T3 binding to goat Leydig cell was examined by adding increasing concentrations of T3 to the Leydig cell incubation (1×10 cells/incubation). T3 (10, 25 and 50 ng/ml or 4, 10 and 20 ng/incubation) resulted a dose dependent increase in androgen release and in all cases stimulation of androgen release was statistically significant (P<0·01) compared with control. Stimulation of Leydig cell androgen release by T3 was significantly inhibited by actinomycin-D (P<0·01) and cycloheximide (P<0·01). T3 had additive stimulatory effects on LH-augmented androgen release from Leydig cells. T3 (50 ng/ml or 20 ng/incubation) effected a more than twofold increase in Leydig cell protein synthesis compared with control and both actinomycin-D and cycloheximide (50 μg/ml) inhibited it completely. The data indicated that the stimulatory effect of T3 on androgen release is mediated via T3-induced protein(s). Sub-cellular fractions obtained from T3-treated Leydig cells showed an increase in protein synthesis in mitochondrial and soluble supernatant fractions (100 k sup) and it was only 100 k sup which stimulated androgen release from Leydig cells in separate incubations. Treatment of 100 k sup with trypsin or heat abolished its stimulatory effect. Incubation of Leydig cells with T3 for different times showed an increase in protein synthesis prior to the stimulation of androgen release. The results therefore indicated that T3 binding to Leydig cells induced the generation of a proteinaceous factor(s) which in turn stimulated androgen release. Journal of Endocrinology (1994) 143, 549–556

Abstract:

This note presents the effect of lime, cement, fly ash and ground granulated blast furnace slag (GGBS) on free swell index (FSI), liquid limit (LL), plasticity index (PI), compaction characteristics, hydraulic conductivity (k) and strength characteristics of an expansive soil. The effect of the above chemicals on California bearing ratio (CBR) is also presented. Lime content was 0, 1, 2, 4 and 6% and the amounts of other additives were 0, 5, 10, 15 and 20% by dry weight of the soil. FSI, LL and PI decreased significantly with increasing additive contents. Compaction characteristics also improved with increasing additive contents. Strength characteristics showed improvement at higher additive contents especially at higher curing periods. CBR (determined in soaked condition) also increased significantly with increasing additive contents.

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Eight unlinked isozyme loci were used as genetic markers to characterize fecundity genes contributing to inbreeding depression in two selfed progeny arrays of Mimulus guttatus. Five fecundity traits were measured. Six of eight marked chromosomal segments were significantly associated with the expression of these traits. The number of genes detected for five traits in two progeny arrays varied, with an average of 2.8 genes per trait. Individual segments explained 1.44–9.29%, and together accounted for 3.85–11.32%, of phenotypic variation. Of 20 significant associations, 10 could be interpreted as exhibiting partial dominance, 7 overdominance, 3 partial recessivity, and 0 underdominance. Significant pairwise epistasis was rare. The results of this study suggest that inbreeding depression is caused by many deleterious genes of relatively small, partially dominant effects.Key words: linkage, isozymes, QTLs, inbreeding depression, Mimulus guttatus.

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Abstract:Background:SUSTAIN-2 (NCT02497287) was an open-label, phase III trial evaluating the safety of esketamine (ESK) nasal spray plus a newly initiated oral antidepressant (AD) for up to 1 year in adults with treatment-resistant depression (TRD). ESK is a schedule III drug that acts via glutamate receptor modulation. ESK is rapidly cleared from the plasma, and with intermittent dosing there is no accumulation. Thus, no withdrawal syndrome is expected. The current analysis assessed potential withdrawal symptoms in patients who discontinued ESK after long-term, intermittent use. In the absence of a glutamatergic-specific withdrawal scale, the Physicians Withdrawal Checklist1 (PWC-20) was used. The PWC-20 was designed to assess new or worsening benzodiazepine-like discontinuation symptoms after stopping non-SSRI anxiolytics.Methods:ESK nasal spray was administered two times per week during a 4-week induction phase (IND). Responders entered the optimization/maintenance phase (O/M) where ESK nasal spray was dosed either weekly or every two weeks for up to 48 weeks. Patients entered a 4-week follow up period (F/U) after discontinuation from either phase, during which continuation of the AD was recommended. PWC-20 assessments were conducted at the last ESK dosing (endpoint of IND or O/M) and at weeks 1, 2 and 4 of F/U. Symptoms were rated using a 0-3-point scale (Not present = 0, Mild = 1, Moderate = 2, Severe = 3). To account for worsening of underlying depression, subset calculations were performed for depressive symptoms (PWC-DS: loss of appetite; anxiety or nervousness; irritability; dysphoric mood or depression; insomnia; fatigue, lethargy or lack of energy; restlessness or agitation; headaches; muscle aches or stiffness; weakness; difficulty concentrating or remembering; depersonalization-derealization) and withdrawal symptoms (PWC-WS: nausea and/or vomiting; diarrhea; poor coordination; diaphoresis; tremor or tremulousness; dizziness or light-headedness; increased acuity of sound, smell, or touch; paresthesias).Results:Data on 357 patients entering F/U were included in the analysis (91 completed treatment during the IND phase and 141 were treated during O/M). The mean (SD) PWC-20 total scores (range 0-60) at treatment endpoint, Week 1, 2 and 4 were 7.2 (6.8), 7.5(7.0), 7.4 (7.1) and 7.2 (6.9), respectively. At these same assessment times, mean PWC-WS scores (range 0-24) were 0.9 (1.7), 1.0 (1.7), 1.0 (1.8), and 0.9 (1.8). Mean PWC-DS scores (range 0-36) were 6.3 (5.6), 6.5 (5.7), 6.5 (5.8), and 6.3 (5.7), respectively. Complete analysis of data from the entire SUSTAIN-2 dataset will be presented.Conclusions:No indication of drug-specific withdrawal symptoms was seen after stopping up to 1-year of intermittent treatment with ESK nasal spray for TRD.Funding Acknowledgements:Janssen Research and Development

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Ebb-and-flow systems can be used to apply systemic pesticides to greenhouse crops without worker exposure or runoff. However, there is little information on the efficacy of pesticides applied with ebb-and-flow systems. We are using silverleaf whitefly (Bemisia argentifolii) control on poinsettia (Euphorbia pulcherrima) with imidacloprid as a model system to study pesticide efficacy in ebb-and-flow systems. The objective of this study was to determine the effect of the amount of insecticide taken up by the pot on the efficacy of whitefly control. Different amounts of imidacloprid uptake were obtained by not watering the plants for 0, 1, 2, or 4 days before the imidacloprid application. The imidacloprid (132 g·L–1) was applied once when the roots of the cuttings had reached the side of the pots. These treatments were compared to an untreated control on ebb-and-flow and a standard drench application (100 mL) to hand-watered plants. Pots in the different subirrigation treatments absorbed 12 to 175 mL of imidacloprid solution. Four days after the application, leaf tissue of the hand-watered plants contained 8 to 20 times more imidacloprid than the subirrigated plants. Efficacy was determined from the percentage of surviving mature whiteflies after 2 days on the plants and by counting the number of immatures after 2 weeks. Surprisingly, imidacloprid efficacy was better in the subirrigated imidacloprid treatments than in the hand-watered treatment. Whitefly control in all subirrigated imidacloprid treatments was excellent, irrespective of the amount of imidacloprid solution taken up by the pots.

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AbstractThis experiment investigated the effect of feeding grass silage alone or supplemented with additional energy and/or protein on the partitioning of nutrients between fat and lean deposition in cattle grown from approximately 140 to 550 kg. The distribution of total body fat between the main fat depots was also assessed. Ninety-two Hereford ✕ Friesian steers (140±18•8 kg initial live weight) were allocated to one of four dietary treatments; grass silage offered either alone (diet S) or supplemented with fish meal (diet FM; 150 g/kg silage dry matter (DM) intake but offered at equal estimated metabolizable energy (ME) intake to silage) or forage-concentrate diets of silage and a barley/soya (80: 20) concentrate at ratios of 70: 30 or 30: 70 on a DM basis (diets 30C and 70C, respectively). Eight animals were slaughtered at the start of the trial to determine initial carcass composition. Of the remaining 21 animals per diet, three were slaughtered at each of seven live weights ranging between 250 and 550 kg, at 50-kg intervals. Animals were given food individually and diets were offered ad libitum (except for FM) along with 100 g/day of a commercial vitamin/mineral pre-mix. At slaughter, half carcasses were minced for the determination of fat and protein content and visceral fat depots, perirenal, mesenteric and omental were removed and weighed. The relationships between chemical composition and empty body weight (EBW) at slaughter were assessed using allometric equations (loge y = loge a + b loge EBW). The composition of the silage was 271•9 g/kg toluene DM with a total nitrogen and estimated ME of 26•5 g/kg DM and 11•8 MJ/kg DM, respectively. DM intakes increased (P < 0•001) with increasing level of concentrate and this generated the expected differences in both energy and protein intake. Live-weight gains increased by proportionately about 0•1, 0•18 and 0•34 on the FM, 30C and 70C treatments, respectively, compared with the S alone. Carcass protein deposition (kg) was relatively linear across the slaughter weights 250 to 550 kg, except for the 70C treatment where the slope (shape or curvature parameter, b) was lower compared with S (P = 0•007). Carcass fat (kg) was similar between S and FM. However, at 350 kg EBW and above, the carcasses of animals given concentrate contained more fat (P < 0•01) compared with those on silage. Carcass fat deposition (kg) showed significant curvature between 200 and 500 EBW (kg) and this was most pronounced for the concentrate treatments with the slopes of the 30C and 70C (P = 0•072, P = 0•003 respectively) differing from the silage. Similar responses were observed for the visceral fat depots. Feeding concentrates resulted in a lower proportion of the total fat being deposited as carcass fat (and hence more as non-carcass fat), proportions averaging 0•65 and 0•61 for S and 70C, respectively; P = 0•066). The proportion of mesenteric fat decreased substantially with increasing total fat (P < 0•001). The relative contribution of intramuscular fat (g/kg total fat) in the longissimus dorsi muscle increased with total fat (P = 0•007) and this was particularly apparent for the S, FM and 30C and less so for 70C. It is concluded that good quality grass silage will support high levels of performance without the need for additional concentrate supplementation. The latter may contribute towards increased fat deposition within the animal.

Abstract:

Patients with primary central nervous system lymphoma (PCNSL) not fulfilling inclusion criteria for clinical trials represent an underreported population. Thirty-four consecutive PCNSL patients seen at our center between 2005 and 2019 with exclusion criteria for therapeutic trials were analyzed (non-study patients) and compared with patients from the G-PCNSL-SG-1 (German PCNSL Study Group 1) study (study patients), the largest prospective multicenter trial on PCNSL, comprising 551 patients. Median follow up was 68 months (range 1–141) in non-study patients and 51 months (1–105) in study patients. Twenty-seven/34 (79.4%) non-study patients received high dose methotrexate (HDMTX), while seven/34 (20.6%) with a glomerular filtration rate (GFR) < 50 mL/min did not. Median overall survival (OS) was six months (95% confidence interval [CI] 0–21 months) in those 34 non-study patients. The 27 non-study patients treated with HDMTX were compared with 526/551 G-PCNSL-SG-1 study patients who had received HDMTX as well. Median OS was 20 months (95% CI 0–45)/21 months (95% CI 18–25) in 27 non-study/526 study patients (p = 0.766). Favorable prognostic factors in non-study patients were young age, application of HDMTX and early response on magnet resonance imaging (MRI). If HDMTX-based chemotherapy can be applied, long-term disease control is possible even in patients not qualifying for clinical trials. Initial response on early MRI might be useful for decision on treatment continuation.

Abstract:

Background Childhood stunting remains the most challenging consequence of undernutrition because it is associated with suboptimal brain development and the subsequent increased risk of metabolic diseases and decreased earnings in adult life. The Sambas District in Indonesia has a high prevalence of stunting (28.4%), followed by underweight (25.5.%) and wasting (14.4%) among children, as well chronic energy deficiency (27%) and anemia (62%) among pregnant women. The present study sought to determine significant factors in childhood stunting with a focus on maternal and child nutrition and prenatal and postnatal determinants. Methods This prospective, repeat, cross-sectional study investigated factors associated with stunting among 559 infants age 0–11 months in Sambas District, Indonesia. Anthropometric measurements were performed by trained enumerators. Data from a 2016 survey of pregnant women and a 2017 survey on mothers and their children were used for postnatal data collection to quantify the prevalence of stunting at age 0–11 months. Using 20 potential predictors of stunting categorized by household characteristics, maternal characteristics, antenatal care services, and child characteristics, logistic regression analysis was conducted to assess the adjusted association between stunting and these factors. Results Of 559 children analyzed, 20.8% were stunted. In the model with low birth weight (LBW) as predictor for stunting, the odds of stunting increased significantly among children who weighed <2.500 g at birth; children who had diarrhea in the past 2 weeks and children who had incomplete basic immunization coverage as infants age 9–11 months. In model without LBW, the odds of stunting increased significantly among children who had preterm at birth, short maternal stature and children who had incomplete basic immunization coverage for 9–11 months infants. Conclusions Postnatal factors—preterm birth, low birth weight, diarrhea and complete basic immunization coverage—were associated with infant stunting in Sambas District, Indonesia. The prenatal factors such as short maternal stature were significant in the multivariate model. Policy makers, especially in the government, should recommend measures focused on those prenatal and postnatal factors to prevent stunting in children and to avoid the sequelae of childhood stunting in adult life.

Abstract:

554 Background: Panitumumab (Pmab) is a fully human monoclonal antibody specific to the epidermal growth factor receptor. It has been associated with very few infusion reactions, but has been pointed out more severe skin toxicity, compared to cetuximab which is a chimeric antibody.To evaluate the safety of Pmab for patients (pts) with metastatic colorectal cancer (mCRC) in daily clinical practice in Japan, retrospectively. Methods: Two hundred pts with mCRC treated by Pmab contained chemotherapy were retrospectively registered from 20 centers in Japan (HGCSG1002 study). Adverse events were evaluated using Common Terminology Criteria for Adverse Events(CTCAE) Version 4.0. Results: Of 195 pts were able to evaluate for adverse events. Patients’ characteristics were as follows; male/female 112/83, median age 64 (range 40-82), ECOG performance status (0/1/2-) 103/71/21. Treatment line (1st/2nd/more than 3rd): 17/26/152. Grade 3 or higher adverse events related to Pmab were hypomagnesemia (11.5%), rash acneiform (14.3%), paronychia (4.6%). Adverse events accounted for 7.3% of pts discontinuation, but there were no treatment-related deaths. Grade 3 or higher hypomagenesaemia and rash acneiform were observed more often in more than 3rd line treatment, compared to 1st or 2nd line treatment (1st or 2nd/3rd-, 1/ 17, p=0.128, 2/26, p= 0.05). Conclusions: Severe hypomagnesemia was observed more often in daily practice in Japan, compared with previous reports. Grade 3 or higher hypomagnesemia and rash acneiform were observed more often in more than 3rd line setting, compared with 1st or 2nd line settings.

Abstract:

Abstract Introduction Febrile neutropenia (FN) is a serious adverse effect of myelosuppressive chemotherapy, which often results in hospitalization and chemotherapy dose modification. FN risk depends on patient characteristics and chemotherapy regimen risk. Understanding the FN risk associated with individual chemotherapy regimens can help guide the use of prophylactic granulocyte colony-stimulating factor (G-CSF) and patient monitoring. To this end, the NCCN has classified regimens into high (≥20%), intermediate (10%-20%), or low (<10%) FN risk based primarily on clinical trial data. However, even for the same regimen, the FN risk is often higher in clinical practice than in clinical trials. In this study, we assessed the FN risk associated with several regimens for which FN risk has not been determined or has shown substantial variability outside of a clinical trial setting, using data from Kaiser Permanente Southern California (KPSC), a large, community-based practice. Methods Included were patients diagnosed with incident non-Hodgkin's lymphoma (NHL), breast cancer (BC), or multiple myeloma (MM) between 2008 and 2013 at KPSC who initiated the following chemotherapy regimens: bendamustine ± rituximab for NHL; docetaxel, carboplatin, and trastuzumab (TCH) or docetaxel and cyclophosphamide (TC) for BC; or Q4W lenalidomide 25 mg/dexamethasone for MM. Bendamustine ± rituximab, TCH, and lenalidomide are not classified by NCCN; TC is classified as intermediate FN risk but has shown considerable variability of FN incidence when used in clinical practice. Data on cancer diagnosis, chemotherapy use, G-CSF use, neutrophil count, and infections were obtained from KPSC's electronic medical records to estimate the incidence proportions of FN and grade 3 and 4 neutropenia. FN was defined as (1) hospitalization with absolute neutrophil count (ANC) <1000/µL or (2) hospitalization with primary or secondary diagnosis codes of neutropenia (ICD-9 288.0x) and fever (ICD-9 780.6), diagnosis code for bacterial/fungal infection, or antibiotic use. Grade 3 neutropenia was defined as ANC ≥500/µL to <1000/µL; grade 4 neutropenia as ANC <500/µL. Patients who received prophylactic G-CSF within 5 days of chemotherapy initiation were excluded from analysis. Results Overall, 40 (12%) NHL patients; 149 (24%) and 340 (28%) BC patients who received TCH and TC, respectively; and 0 (0%) MM patients were excluded due to prophylactic G-CSF. Over the first 6 cycles of bendamustine (median 338.4 mg/m2) ± rituximab for NHL patients (n = 307), 7.2% experienced FN, 4.2% grade 3 neutropenia, and 17.6% grade 4 neutropenia. Over the first 6 cycles of TCH for BC patients (n = 462), 24.2% experienced FN, 10.6% grade 3 neutropenia, and 44.6% grade 4 neutropenia. Over the first 6 cycles of TC for BC patients (n = 859), 20.5% experienced FN, 9.5% grade 3 neutropenia, and 37.5% grade 4 neutropenia. Over the first 4 cycles of lenalidomide/dexamethasone for MM patients (n = 186), 3.8% experienced FN, 5.9% grade 3 neutropenia, and 18.3% grade 4 neutropenia (Table 1). Conclusions Using NCCN criteria, bendamustine ± rituximab for NHL and lenalidomide/dexamethasone for MM would be classified as low-FN-risk regimens (<10%). By contrast, BC regimens TCH and TC would be classified as high-FN-risk regimens (>20%) based on our data. These results could help inform prophylactic G-CSF use for the selected regimens in clinical practice. Table 1. Number and Incidence Proportion of Neutropenic Outcomes Overall and by Cycle Cancer: Regimen Cycle Patients n FN Events n (%) Grade 3 Neutropenia Events n (%) Grade 4 Neutropenia Events n (%) NHL: Bendamustine ± rituximab Overall 307 22 (7.2) 13 (4.2) 54 (17.6) 1 307 12 (3.9) 5 (1.6) 28 (9.1) 2 225 3 (1.3) 4 (1.8) 21 (9.3) 3 173 2 (1.2) 4 (2.3) 15 (8.7) 4 130 2 (1.5) 4 (3.1) 10 (7.7) 5 92 4 (4.4) 4 (4.4) 8 (8.7) 6 69 2 (2.9) 2 (2.9) 0 (0) BC: TCH Overall 462 112 (24.2) 49 (10.6) 206 (44.6) 1 462 70 (15.2) 39 (8.4) 138 (29.9) 2 326 13 (4.0) 15 (4.6) 42 (12.9) 3 282 17 (6.0) 9 (3.2) 39 (13.8) 4 247 6 (2.4) 8 (3.2) 31 (12.6) 5 199 4 (2.0) 6 (3.0) 25 (12.6) 6 169 8 (4.7) 3 (1.8) 12 (7.1) BC: TC Overall 859 176 (20.5) 82 (9.5) 322 (37.5) 1 859 126 (14.7) 51 (5.9) 266 (30.9) 2 649 21 (3.2) 42 (6.5) 82 (12.6) 3 571 19 (3.3) 23 (4.0) 62 (10.9) 4 511 14 (2.7) 22 (4.3) 45 (8.8) 5 94 1 (1.1) 3 (3.2) 9 (9.6) 6 84 2 (2.4) 1 (1.2) 2 (2.4) MM: Lenalidomide / dexamethasone Overall 186 7 (3.8) 11 (5.9) 34 (18.3) 1 186 2 (1.1) 8 (4.3) 17 (9.1) 2 101 3 (3.0) 5 (5.0) 14 (13.9) 3 63 2 (3.2) 2 (3.2) 8 (12.7) 4 37 0 (0) 0 (0) 4 (10.8) Disclosures Family: Amgen Inc.: Research Funding. Klippel:Amgen Inc.: Employment, Equity Ownership. Li:Amgen Inc.: Employment, Equity Ownership. Page:Amgen Inc.: Employment, Equity Ownership.

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Este estudo teve o objetivo de determinar os teores de macronutrientes (N, P, K, Ca, Mg e S) nos diferentes órgãos do híbrido de pimentão Elisa, sob fertirrigação e ambiente protegido, por meio de coletas de plantas durante o ciclo. Ao final do experimento, obtiveram-se os teores dos macronutrientes no fruto, folha, caule, raiz e na planta como um todo, em cada etapa de crescimento. A fertilização no ciclo estudado, 140 dias, foi feita via irrigação localizada (gotejamento). O experimento foi desenvolvido nas dependências do Departamento de Recursos Naturais - Ciência do Solo, FCA-UNESP, Câmpus de Botucatu - SP, e constou de oito tratamentos (épocas de coleta de planta: 0; 20; 40; 60; 80; 100; 120 e 140 dias após o transplante das mudas) e quatro repetições, sendo cada repetição formada por quatro plantas. Os resultados mostram que os teores de macronutrientes encontrados na planta de pimentão seguem, na média, a seguinte ordem decrescente: K (39,9 g kg-1) > N (28,3 g kg-1) > Ca (12,8 g kg-1) > Mg (5,9 g kg-1) > S (4,1 g kg-1) > P (3,7 g kg-1).

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Introduction: Radiology training is an important component of emergency medicine (EM) education, but its delivery has been variable. Program directors have reported a lack of radiology skills in incoming interns. A needs assessment is a crucial first step toward improving radiology education among EM residencies. Our objective was to explore the current state of radiology education in EM residency programs. Methods: This was a cross-sectional survey study of all Accreditation Council for Graduate Medical Education-accredited EM programs in the United States. Program leadership completed an online survey consisting of multiple choice, Likert scale, and free-response items. We calculated and reported descriptive statistics. Results: Of eligible EM programs, 142/252 (56%) completed the survey including 105 postgraduate year (PGY) 1-3 and 36 PGY 1-4 programs. One respondent opted out of answering demographic questions. 23/141 (16%) were from the Western region, 29/141 (21%) were from the North Central region, 14/141 (10%) were from the South-Central region, 28/141 (20%) were from the Southeast region, and 47/141 (33%) were from the Northeast region. A total of 88/142 (62%) of responding programs did not have formal radiology instruction. Of the education that is provided, 127/142 (89%) provide it via didactics/lectures and 115/142 (81%) rely on instruction during clinical shifts. Only 51/142 (36%) provide asynchronous opportunities, and 23/142 (16%) have a dedicated radiology rotation. The majority of respondents reported spending 0-2 hours per month on radiology instruction (108/142; 76%); 95/141 (67%) reported that EM faculty “often” or “always” provide radiology instruction; 134/142 (95%), felt that it was “extremely” or “very important” for ED providers to be able to independently interpret radiograph results; and 129/142 (90.84%) either “sometimes” or “always” rely on their independent radiograph interpretations to make clinical decisions. The radiology studies identified as most important to be able to independently interpret were radiographs obtained for lines/tubes, chest radiographs, and radiographs obtained for musculoskeletal-related complaints. Conclusion: A minority of EM residency programs have formal instruction in radiology despite the majority of responding program leadership believing that these are important skills. The most important curricular areas were identified. These results may inform the development of formal radiology curricula in EM graduate medical education.

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ObjectiveTo investigate regional variation in the registration of births (still+live) as live born for birth weight <500 g and the impact on the city/county ranking of neonatal mortality rate (NMR) in Taiwan.DesignPopulation-based cross-sectional ecological study.Setting20 cities/counties in Taiwan.ParticipantsRegistered births for birth weight <500 g and neonatal deaths in 2015–2016.Main outcome measuresCity/county percentage of births <500 g registered as live born and ranking of city/county NMR (deaths per 1000 live births) including and excluding live births <500 g.ResultsThe percentage of births <500 g registered as live born ranged from 0% in Keelung City (0/26) and Penghu County (0/4) to 20% in Taipei City (112/558), 24% in Hsinchu County (5/21) and 28% in Hualien County (9/32). The change in city/county ranking of NMR from including to excluding live births <500 g was most prominent in Taipei City (from the 15th to the 1st) followed by Kaohsiung City (from the 18th to the 14th).ConclusionsThe city/county NMR in Taiwan is influenced by variation in the registration of live born for births with uncertain viability. We recommend presenting city/county NMR using both criteria (with or without minimum threshold of gestation period or birth weight) for better interpretation of the findings of comparisons of city/county NMR.

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BACKGROUND The incidence and number of circulating tumor cells (CTCs) in the peripheral blood of colorectal cancer patients are lower than in other cancer types, which may point to a particular biology of colorectal cancer affecting CTC detection. METHODS We detected CTCs in the peripheral and mesenteric blood of colorectal cancer patients by use of 2 independent technologies on the basis of different biological properties of colon cancer cells. Seventy-five patients diagnosed with localized (M0, n = 60) and metastatic (M1, n = 15) colorectal cancer were included. Peripheral and mesenteric blood samples were collected before tumor resection. We performed CTC enumeration with an EpCAM-independent enrichment method followed by the Epispot assay that detected only viable CK19-releasing CTCs. In parallel, we used the FDA-cleared EpCAM-dependent CellSearch® as the reference method. RESULTS The enumeration of CK19-releasing cells by the CK19-Epispot assay revealed viable CTCs in 27 of 41 (65.9%) and 41 of 74 (55.4%) (P = 0.04) patients in mesenteric and peripheral blood, respectively, whereas CellSearch detected CTCs in 19 of 34 (55.9%) and 20 of 69 (29.0%) (P = 0.0046) patients. In mesenteric blood, medians of 4 (range 0–247) and 2.7 CTCs (range 0–286) were found with Epispot and CellSearch (P = 0.2), respectively, whereas in peripheral blood, Epispot and CellSearch detected a median of 1.2 (range 0–92) and 0 CTCs (range 0–147) (P = 0.002). CONCLUSIONS A considerable portion of viable CTCs detectable by the Epispot assay are trapped in the liver as the first filter organ in CRC patients.

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O objetivo deste trabalho foi verificar a viabilidade da utilização da ultra-sonografia para estimar a espessura de gordura na carcaça (EGSC) no momento do abate. Foram confinados 24 machos inteiros Brangus e 24 Nelore com dietas contendo 20, 40, 60 ou 80% de concentrado. A área de olho de lombo (AOLU) e a espessura de gordura (EGSU) entre a 12ª e a 13ª costelas e a espessura de gordura sobre o músculo Biceps femoris (EGPU), foram obtidas com equipamento de ultra-som PieMedical Scanner 200 Vet com transdutor linear de 178 mm e guia acústica, a cada intervalo de aproximadamente 28 dias. Após 142 dias de confinamento, os animais foram abatidos e 24 h após foi obtida a EGSC. As correlações entre EGSU e EGSC foram de 0,19, 0,64, 0,74, 0,78, 0,82, 080 e 0,86, quando obtidas aos 0, 26, 53, 84, 109, 125 e 142 dias de confinamento. Equações de regressão múltipla entre raças para estimar a EGSC apresentaram R² = 0,10 e Sy,x = 2,04 quando realizadas 142 dias antes do abate e R² = 0,78 e Sy,x = 0,10 imediatamente antes do abate. Medidas de ultra-som podem ser úteis para classificar grupos de animais para abate em igual acabamento.

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ABSTRACT The aim of this study was to evaluate the effect of thermally dried sewage sludge on soil fertility, growth and yield of sunflower. The experiment was conducted in a Nitosol area of the Institute of Agricultural Sciences of the Federal University of Minas Gerais, in Montes Claros-MG, Brazil. The treatments consisted of four doses of sewage sludge (0, 10, 20 or 30 t ha-1, dry weight basis), with six replicates in a randomized block design. The levels of nutrients in soil and plant, soil fertility indices, stem diameter, plant height, head diameter and grain yield were evaluated. Stem diameter, plant height, head diameter and grain yield increased with increasing doses of sewage sludge. The application of the residue increased linearly the contents of soil organic matter and N in sunflower leaves. On the other hand, pH, the exchangeable bases, total and effective cation exchange capacity, base saturation, H+Al, Al, soil contents of P, K, Ca, Mg, S, Zn, Cu, Mn, Fe and B, and the leaf contents of P, K, Ca, Mg, S, Zn, Cu, Mn, Fe and B were not influenced by the application of sewage sludge doses of up to 30 t ha-1.

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Abstract Background Transumbilical laparoscopic-assisted appendectomy (TULAA) is fast and cost-effective since no endoloops, staplers or wound protection devices are used. We analyzed the effects of TULAA as first approach for perforated (PA) and non-perforated (NPA) appendicitis in children. Patients We performed a retrospective analysis of 181 children for whom TULAA was the first approach for appendicitis between October 2010 and March 2016. Methods Morbidity, additional laparoscopic instrument insertion (AI), conversions to open extraumbilical appendectomy (OC), and complications were evaluated. Results TULAA was initiated in 181 (87.4%) children (113 boys: 68 girls). Median age was 10.3 years (3.3–13.9 years) and BMI 16.8 kg/m2 (12.4–30.8). Appendicitis was non-perforated in 157 (86.7%) and perforated in 24 (13.3%) patients. TULAA was finalized in 142 (78.5%) patients, AI were inserted in 20 (11%) and OC were performed in 19 (10.5%) patients. Duration of surgery did not exceed 20 min for 12.8%, and 30 min for 43.6% of patients with TULAA and NPA. The rate of wound infections did not differ between procedures (TULAA 3/142 (2.1%), AI 0 (0%), OC 1/19 (5.3%), P=1.000). Further postoperative course was uneventful in 179 (98.9%) patients. Conclusion TULAA can be used as first approach for appendicitis in all children with a low rate of complications. Extracorporeal appendix stump closure can be safely achieved in the majority of children without using laparoscopic disposable devices.

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676 Background: We have previously reported that clodronate prevents bone loss in breast cancer patients (JCO 1997;15:1341, BJC 1997;75(4):602 and EJC 2001;37:2373). Here we report the 10-year follow-up data. Methods: 268 pre- (PRE) and postmenopausal (POST) node positive breast cancer patients were randomized to clodronate (CL), orally 1.6 g daily, or control groups for 3 years. PRE were treated with adjuvant chemotherapy and POST with antiestrogens (AE), tamoxifen 20 mg or toremifene 60 mg, for 3 years. The BMD of the lumbar vertebrae L1–4 (BMDLS) and femoral neck (BMDFN) was measured before the treatment and at 1, 2, 3, 5 and 10 years. 93 patients were eligible for 10-year analyses: 53 PRE and 40 POST. 132 patients had metastatic disease or died and 39 were either lost to follow-up or had to be excluded because having diseases or medications that influences bone metabolism. Results: PRE: BMDLS decreased -12.4% in the control and −8.7% in the CL group in 10 years: from 0 to 3 years −6.9 % vs. −4.2% and from 3 to 10 years −5.5% and −4.5%, respectively. BMDFN decreased −8.8% and −7.2%: from 0 to 3 years −2.9% vs. −2.6% and from 3 to 10 years −5.9% vs. −4.6%, respectively. POST: BMDLS decreased −3.0% in the AE and −1.7% in the AE+CL group in 10 years: from 0 to 3 years −1.5% vs. + 1.2% and from 3 to 10 years −1.5% vs. −2.9%, respectively. BMDFN decreased −7.7% and −6.0%: from 0 to 3 years −0.1% vs. +1.9% and from 3 to 10 years −7.6% vs. −7.9%, respectively. These differences do not reach statistical significance. At 10-years 18 patients had osteoporosis in LS and 15 in FN. Only 4 patients who had osteoporosis at 10 years had normal BMD before the therapy. Conclusions: As reported previously, clodronate prevents the bone loss during treatment in pre- and postmenopausal women. This beneficial effect seems to be maintained at least for 7 years after treatment termination in premenopausal. In postmenopausal women the effect seems to diminish within time. Due to small numbers of patients these differences are no longer statistically significant. Patients at risk of developing osteoporosis are among those who has pretreatment osteopenia i.e. baseline BMD measurement has predictive value. No significant financial relationships to disclose.

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ABSTRACTThree types of straw were used, a spring barley (variety Corgi) untreated (UC), ammonia-treated Corgi (AC) and an ammonia-treated winter wheat (variety Longbow) (AW). Each straw was included in a complete diet containing either 350 (L), 450 (M) or 550 (H) g/kg straw. The other principal ingredients were rolled barley, molassed sugar-beet pulp and fish meal. Hereford cross steers approximately 16 months old and weighing 350 kg live weight were given the diets ad libitum in both a main trial lasting 80 days, to assess intakes, live-weight gains and food efficiency, and in a subsidiary trial to measure in vivo apparent digestibility.The live-weight gains during 80 days for steers given the UC diet at L, M and H inclusion were 117, 102 and 0·70 kg/day respectively. The respective live-weight gains for AC were 1·32, 1·27 and 1 02 kg/day and for AW 1 ·26, 1 ·20 and 0·95 kg/day.While experimental comparisons were terminated at 80 days when the first steers were slaughtered, all except five with the lowest growth rate reached the target fat class for slaughter before 6 months on the diets. While differences in intake and performance between steers given the straws closely reflected differences in degradation characteristics determined by in sacco measurements, the increase in in vivo apparent digestibility between untreated (0·510) and treated (0·545) was small. It is concluded that a large proportion of high quality or treated straw can be incorporated and utilized in diets for finishing cattle.

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Recycling wastewater sludge as fertilizer in short-rotation intensive culture of willows offers a viable opportunity to increase biomass productivity. Salix discolor Mühl. and Salix viminalis L. were planted at two densities (20 000 and 30 000 cuttings/ha), on two sites: a well and a poorly drained site. Three doses of dried and granulated sludge (100, 200, 300, and 0 kg/ha of "available" N) were applied in the spring of the first and the second seasons of growth. The aims of the experiment were to (i) investigate growth and nutritional plant response to fertilization and (ii) estimate the impact of sludge application on the soil. Over two seasons, aboveground biomass was similar for S. discolor and S. viminalis on both sites and for all sludge treatments. Every increment in the sludge dose applied induced an increase in willow productivity. Vector analysis of stem and branch nutrient concentration suggested that nitrogen was the most limiting nutrient. At the end of the second season, plots fertilized with the highest doses of sludge indicated soil enrichment in organic matter. However, nitrate concentration in the soil increased with increasing sludge doses. The accumulation of heavy metals from sludge was not hazardous to the environment according to provincial limits. A moderate dose of dried and pelleted sludge (100 kg/ha "available" N) may reduce nitrate leaching and appears to be a good fertilizer during the establishment of willows.

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ObjectivesFor very preterm births, to compare alternative policies for umbilical cord clamping and immediate neonatal care.DesignParallel group randomised (1:1) trial, using sealed opaque numbered envelopes.SettingEight UK tertiary maternity units.Participants261 women expected to have a live birth before 32 weeks, and their 276 babies.InterventionsCord clamping after at least 2 min and immediate neonatal care with cord intact, or clamping within 20 s and immediate neonatal care after clamping.Main outcome measuresIntraventricular haemorrhage (IVH), death before discharge.Results132 women (137 babies) were allocated clamping ≥2 min and neonatal care cord intact, and 129 (139) clamping ≤20 s and neonatal care after clamping; six mother-infant dyads were excluded (2, 4) as birth was after 35+6 weeks, one withdrew (death data only available) (0, 1). Median gestation was 28.9 weeks for those allocated clamping ≥2 min, and 29.2 for those allocated clamping ≤20 s. Median time to clamping was 120 and 11 s, respectively. 7 of 135 infants (5.2%) allocated clamping ≥2 min died and 15 of 135 (11.1%) allocated clamping ≤20 s; risk difference (RD) −5.9% (95% CI −12.4% to 0.6%). Of live births, 43 of 134 (32%) had IVH vs 47 of 132 (36%), respectively; RD −3.5% (−14.9% to 7.8%). There were no clear differences in other outcomes for infants or mothers.ConclusionsThis is promising evidence that clamping after at least 2 min and immediate neonatal care with cord intact at very preterm birth may improve outcome; a large trial is urgently needed.Trial registrationISRCTN 21456601.

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The benefits of underseeding cereals with legumes and grasses have been established. However, research is required to determine the effects of underseeding spring wheat with red clover on yield and milling quality. The objectives of this study were: (1) to determine the rates of supplemental N required to obtain 13.5% or greater grain protein of three spring milling wheat (Triticum aestivum L. em Thell.) cultivars underseeded to red clover (Trifolium pratense L.); (2) to determine the effect of supplemental N on establishment of red clover , and (3) to relate the N status of the soil after harvest to grain protein. Field experiments were conducted from 1998 to 2000 on three sites: Hartland, New Brunswick; Truro, Nova Scotia; and Harrington, Prince Edward Island. Grain yield and protein content increased with increasing amounts of supplemental N. In most years, supplemental N above a base application of 55 kg N ha-1 applied at 52.5 kg N ha-1 at Zadoks GS 30 resulted in 13.5% protein in the grain of Grandin and AC Barrie, but 70 kg N ha-1 was r equired for AC Walton. Based on the N content of the straw, Grandin was less effective in partitioning N into the grain than AC Barrie and AC Walton. Increasing rates of supplemental N caused a reduction in red clover establishment. Soil pH decreased with increasing rates of supplemental N. Nitrate N in the soil at 0–5 and 0–20 cm depths increased with supplemental N, but there was no effect on ammonium N. Differences in pH or levels of soil N after harvest did not account for differences in grain protein. In the Maritime provinces, to reach a desirable milling protein level in spring wheat of 13.5%, producers will need to add supplemental N at a rate of at least 100 kg N ha-1 over and above background levels; however, this will be at the risk of reducing red clover establishment and increasing levels of soil N available for leaching. Key words: Spring wheat, Triticum aestivum, red clover, Trifolium pratense, underseeding, protein, nitrogen

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Abstract Introduction: in the last 5 years new "target drugs" to treat lymphoproliferative disorders have been introduced in clinical practice, such as monoclonal antibodies (obinutuzumab, ofatumumab, brentuximab), BTK inhibitors (ibrutinib) and PI3K inhibitors (idelalisib). Efficacy and safety of these drugs were assessed in registrative trials and data regarding infectious complications in the "real life" experience are currently unavailable. We aimed to assess the incidence of major infections in patients treated with the above mentioned drugs. Methods: 555 patients were treated, for registered indications, with idelalisib, ibrutinib, brentuximab, ofatumumab and obinutuzumab (single agents or in combination as licensed) in 13 hematology centres in Italy, from time of their commercial availability to December 2016. The observation period was one year after study entry. Patients in clinical trials or treated within patient named programs were excluded as well as patients with active infections at beginning of treatment. Results: in 132/555 patients (24%) infections occurred for a total number of 187 events, 56% of whom were of grade 3. The median age was 64 years (range 20-86), 46,2% (61/132) of patients were treated with 3 or more previous lines of therapy, 55/132 (42%) experienced 2 or more infective episodes. A bacterial cause of infection was reported in 35% of cases, viral in 22% and an invasive fungal infection (IFI) in 9% (17/187). In 2% of cases the infection was of mixed origin (bacterial/viral or bacterial/fungal) while in 32% of cases there was not microbiological documentation. The lower respiratory tract was the most frequent site of infection in 39% of cases (73/187) while the upper respiratory tract was involved in 30% of events (39/187). The urinary tract infections were 13% (24/187). Other sites involved were skin and soft tissue 7%, sepsis 7%, gastrointestinal site 5%, central nervous system 2% and fever of unknown origin 6%. Patients treated with idelalisib were 106 (80% affected by chronic lymphocytic leukemia - CLL- and 20% follicular lymphoma) and 35 (33%) experienced one ore more infections for a total of 49 episodes. The incidence of bacterial infections was 37%, of viral infections 37% and of IFI 6%. In 235 patients treated with ibrutinib, 70 (30%) had one ore more events for a total of 102 infective episodes. 60/70 (86%) patients had CLL and 10/70 (14%) had indolent or mantle cell lymphoma The incidence of bacterial infections was 50%, viral 20% and IFI 16%. Focusing on IFI, 17 events were reported in 15 patients. According to the EORTC criteria, 11 cases (4 possible, 1 probable, 6 proven) were reported in patients treated with ibrutinib, 3 cases of possible IFI in patients treated with idelalisib and 3 cases of proven IFI in patients treated with brentuximab. The incidence of IFI in patients treated with ibrutinib (11/102 events) and idelalisib (3/49 events) was not different (11% vs. 6% respectively; p-value = 0.55) even considering proven/probable cases only (3% in ibrutinib vs. 0% in idelalisib p-value = 0.11). The incidence of bacterial infections in patients treated with ibrutinib (35/102) was not statistically different compared to patients treated with idelalisib (18/49) (34% vs. 37% respectively p-value =0.87). Noteworthy, the incidence of viral infections in patients treated with idelalisib (18/49) was significantly higher compared to patients treated with ibrutinib (14/102) (37% vs. 14% respectively; p-value =0.015). Brentuximab was used in 175 patients, 70% of cases for Hodgkin Lymphoma and 30% for T cell lymphoma. The rate of infections was 11% for a total of 27 infection episodes. The incidence of bacterial, viral and fungal infections was 37%, 30% and 11% respectively. In 22% of cases the cause of infection could not be established. Patients treated with ofatumumab or obinutuzumab were 39 and in 7/39 (18%) an infective episode was reported (four of bacterial origin, one viral and four undetermined). All patients were affected by CLL. Conclusions: this "real life" experience confirm that the incidence of infections in patients treated with "target drugs" is not negligible. Ongoing analysis that take into account patient's clinical and demographical characteristics, may give insights on risk factors that will contribute to better characterizing patients at different risk levels. Figure. Figure. Disclosures Cattaneo: GILEAD: Other: Advisory Board. Candoni:Pfizer: Honoraria, Speakers Bureau; Janssen: Honoraria, Speakers Bureau; Celgene: Honoraria, Speakers Bureau; Merck SD: Honoraria, Speakers Bureau; Gilead: Honoraria, Speakers Bureau. Fanci:Gilead: Honoraria; Pfizer Pharmaceuticals: Honoraria; Merck: Consultancy, Honoraria, Speakers Bureau. Del Principe:Gilead: Membership on an entity's Board of Directors or advisory committees. Busca:Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Merk: Honoraria, Speakers Bureau; Pfizer Pharmaceuticals: Honoraria, Speakers Bureau; Jazz Pharmaceuticals: Honoraria; Novartis: Speakers Bureau.

Abstract:

Buscando o aumento da produtividade do algodoeiro, várias pesquisas vêm sendo realizadas com o uso de reguladores de crescimento e novas fontes nutricionais, com a finalidade de acelerar o desenvolvimento da cultura. O objetivo do trabalho foi avaliar o efeito da adubação foliar com doses de níquel associado ou não a aplicação do regulador de crescimento no algodoeiro cultivado em condições edafoclimáticas do cerrado. O experimento foi conduzido na Fazenda de Ensino, Pesquisa e Extensão (FEPE), da Faculdade de Engenharia de Ilha Solteira – UNESP, localizada no município de Selvíria-MS. O delineamento experimental utilizado foi o de blocos ao acaso em esquema fatorial 5x2, com quatro repetições. A aplicação do níquel foi via foliar e parcelada em três aplicações 47, 60 e 75 dias após a emergência (DAE) nas doses (0, 50, 150, 300 e 400 g ha-1). O regulador de crescimento utilizado foi o cloreto de mepiquat aplicado uma única vez, aos 70 DAE. O aumento das doses de níquel não influenciou os teores dos macronutrientes, inclusive de nitrogênio, porém, a utilização do regulador de crescimento juntamente com a dose de 400 g ha-1 de Ni ocasionou o menor acúmulo dos teores foliares de Ca+2 e Mg+2. A aplicação das doses de Ni elevaram a concentração deste nutriente nas folhas do algodoeiro. A produtividade de algodão em caroço e de fibra não foram influenciadas pelo aumento das doses de níquel. No entanto, para massa de 20 capulhos, doses acima de 200 g ha-1 se mostraram prejudiciais. A aplicação do regulador de crescimento diminuiu a massa de 20 capulhos, porcentagem e produtividade de fibra do algodoeiro.

Abstract:

Abstract Abstract 3171 Introduction: Changes in plasma volume, the intravascular portion of the extracellular fluid volume, can be estimated by measuring changes in the levels of hemoglobin and hematocrit in the blood. In addition to hemoglobin & hematocrit levels, we are also able to use standard dilution techniques with radiolabeled albumin to accurately measure plasma volume changes. It is not known if plasma volume changes influence outcomes in patients with acute coronary syndromes. The aim of this study was to evaluate the effects of plasma volume changes in patients presenting with the acute coronary syndromes. Methods: Consecutive patients presenting to a single tertiary care center from January 2001 to December 2010 with non ST elevation myocardial infarction (NSTEMI) or ST elevation myocardial infarction (STEMI) were enrolled. Admission hemoglobin (Hbpre) & hematocrit (Hctpre) and discharge hemoglobin (Hbpost) and hematocrit levels (Hctpost) were obtained. Plasma volume changes were measured and a validated formula (ΔPV = ((Hbpre/Hbpost) × (100-Hctpost/100-Hctpre)-1) × 100%) was used to calculate the changes in plasma volumes. A detailed chart review was performed to collect information about baseline variables such as age, gender, hypertension, diabetes, hyperlipidemia, smoking status, and congestive heart failure. The Framingham Risk score was also calculated for each individual. Survival analysis was carried out for plasma volume changes of -20% - 0%, 0 – 20%, and ≥20%. Mortality data was collected from the social security death index for the first 60 days post-discharge. Results: A total of 9770 patients with confirmed NSTEMI or STEMI (mean age 61.8 ± 4.8 years, 48.8% women) were included in the final analysis. Mean pre admission hemoglobin (Hbpre) was 10.2 ± 1.4 g/dl and post admission hemoglobin (Hbpost) was 10.4 ± 1.3 g/dl. Change in plasma volume, ΔPV, was categorized into one of four categories, with 131 (1.3%) ≤20%, 6126 (62.7%) -20% - 0%, 3393 (34.7%) 0 – 20%, and 120 (1.2%) ≥20%. There were 509 deaths within 60 days of discharge. Change in plasma volume was found to be an independent predictor of mortality (HR 5.71; 95% CI 4.75 – 6.86, p = 0.0001) in a Cox proportional hazard model. Most of the deaths occurred during the first thirty days as demonstrated by the Kaplan – Meier's survival curve (Figure 1). Receiver operating curve showed an area under the curve of 0.876 for changes in plasma volume. Conclusion: This study shows that hemoglobin and hematocrit, although simple tests, can provide important prognostic information strongly predictive of short term mortality in patients with acute coronary syndromes. Further studies are required to see if monitoring of plasma volume and correction with pharmacological agents such as diuretics may lead to better outcomes. Disclosures: No relevant conflicts of interest to declare.

Abstract:

Abstract Background: In MCL, early intensification and consolidation of the first line therapy by ASCT is the treatment of choice. Elderly age and co-existing co-morbidities makes it however feasible for less than a third of patients. Methods: All MCL cases consulted in 8 PLRG centers within the last 5 years (n=140) were included in a retrospective analysis. Only 23% (n=32) were consolidated with ASCT, further 28% (n=40) by radioimmunotherapy (Ibritumomab), while in 49% (n=68) neither consolidation was performed. Rituximab was used in 36/72 patients subjected to consolidation and 25/68 treated without consolidation. There were no statistically significant differences in IPI, CS (clinical stage), frequency of extranodal manifestations and B symptoms between analyzed subgroups (Table 1) although patients subjected to ASCT were younger (median age 54 vs 62) and tend to have higher LDH (556 IU vs 473), while those who were not consolidated more frequently had a large tumor burden (defined as a mass &gt; 7 cm, 24 vs 15%). Results: There was a clear impact of consolidation on Overall and Progression Free Survival (OS,PFS): at 5 years OS 65 vs 20 % (p= 0.0003 in Gehan Wilcoxon test); and PFS 40 vs 0 % (p= 0.0003 in Gehan Wilcoxon test). Rituximab used in the first line therapy further increased it’s efficiency in terms of PFS, prolonging median time to progression from 15 to 26 months, however the OS benefit was seen only in consolidated patients (at 5 years 75% OS in those with Rituximab including induction followed by consolidation). Conclusion: With all limitations of retrospective analysis, it strongly supports the necessity of post induction therapy in MCL patients. The role of ASCT is established in younger patients, radioimmunotherapy may prove to be a feasible approach for the elderly and unfit ones. N IPI Age LDH WHO CS (IV) Extra-nodal B sympt. X (&gt;7 cm) Radioimmunotherapy 40 2,49 61,7 542 1,43 83% 78% 63% 12% ASCT 32 2,62 54 556 1,24 80% 84% 68% 17% No Consolidation 68 2,98 62,8 473 1,74 85% 83% 68% 24% All cases 140 2,76 60,13 497 1,55 81% 81% 67% 20%

Abstract:

<p>Two experiments to study responses of resistance of maize germplasm to downy mildew (Peronosclerospora philipinensis) have been conducted. Both experiments were arranged in randomized block design with two replication. The treatments in each experiment (2014 and 2016) were 70 maize accessions. The accessions were planted in planting distant of 75 cm × 20 cm, in 5 m rows, resulting in 20 plants per row. In every 10 rows, two check varieties were planted, i.e. one susceptible and one resistant variety. Ten days prior to planting, the soil was fertilized with mixed fertilizers consisted of urea, ZA, SP36, and KCl at a dose of 100, 100, 100, and 100 kg/ha, respectively. Fertilization II and III was given at 30 days after planting, and 45 days after planting with a dose of 100 kg urea/ha. As a source of inoculum downy mildew, around the repeated plot was planted with varieties Anoman variety (susceptible variety) that was inoculated with a suspension of downy mildew pathogen. Observation was conducted at 25, 35, and 55 days after planting, with the standard score of resistant to downy mildew, followed: 0–10% = resistant, 11–25% = moderately resistant, 26–50% = moderately susceptible, &gt;50% = susceptible. The result of the experiments showed that there were 5 accessions resistant to downy mildew (P. philipinensis), i.e. CML 440×MR4-9-30-3, 664, 60, 572, and 554 with the intensity of downy mildew infection ranged from 5 to 10%. Twelve other accessions were classified as moderately resistant, i.e. CML 440×MR4-9-98-2, 440×MR4-9-98-4 CML, CML 440×MR4-9-124-1, 66, 71, 319, 108, 73, 48, 105, 554, and 682 with intensity of infection ranged from 13 to 25%. At the same experiments, the average intensity of downy mildew infection on susceptible check varieties reached 100 percent.</p>