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CVD and associated metabolic diseases are linked to chronic inflammation, which can be modified by diet. The objective of the present study was to determine whether there is a difference in inflammatory markers, blood metabolic and lipid panels and lymphocyte gene expression in response to a high-fat dairy food challenge with or without milk fat globule membrane (MFGM). Participants consumed a dairy product-based meal containing whipping cream (WC) high in saturated fat with or without the addition of MFGM, following a 12 h fasting blood draw. Inflammatory markers including IL-6 and C-reactive protein, lipid and metabolic panels and lymphocyte gene expression fold changes were measured using multiplex assays, clinical laboratory services and TaqMan real-time RT-PCR, respectively. Fold changes in gene expression were determined using the Pfaffl method. Response variables were converted into incremental AUC, tested for differences, and corrected for multiple comparisons. The postprandial insulin response was significantly lower following the meal containing MFGM (P < 0·01). The gene encoding soluble epoxide hydrolase (EPHX2) was shown to be more up-regulated in the absence of MFGM (P = 0·009). Secondary analyses showed that participants with higher baseline cholesterol:HDL-cholesterol ratio (Chol:HDL) had a greater reduction in gene expression of cluster of differentiation 14 (CD14) and lymphotoxin β receptor (LTBR) with the WC+MFGM meal. The protein and lipid composition of MFGM is thought to be anti-inflammatory. These exploratory analyses suggest that addition of MFGM to a high-saturated fat meal modifies postprandial insulin response and offers a protective role for those individuals with higher baseline Chol:HDL.
Introduction: To describe dosing, duration, and pre- and post-infusion analgesic administration of continuous intravenous sub-dissociative dose ketamine (SDK) infusion for managing a variety of painful conditions in the emergency department (ED). Methods: Retrospective chart review of patients aged 18 and older presenting to the ED with acute and chronic painful conditions who received continuous SDK infusion in the ED for a period over 6 years (2010-2016). Primary data analyses included dosing and duration of infusion, rates of pre- and post-infusion analgesic administration, and final diagnoses. Secondary data included pre- and post-infusion pain scores and rates of side effects. Results: 104 patients were enrolled in the study. Average dosing of ketamine infusion was 11.26 mg/hr, the mean duration of infusion was 135.87 minutes with 38% increase in patients not requiring post-infusion analgesia. The average decrease in pain score was 5.04. There were 12 reported adverse effects with nausea being the most prevalent. Conclusion: Continuous intravenous SDK infusion has a role in controlling pain of various etiologies in the ED with a potential to reduce need for co-analgesics or rescue analgesic administration. There is a need for more robust, prospective, randomized trials that will further evaluate the analgesic efficacy and safety of this modality across wide range of pain syndromes and different age groups in the ED.
Wet feeding beneficially affects feed intake and growth rates of poultry in hot climates (Forbes 2003). Fermenting liquid feeds for pigs has been shown to reduce microbial contamination of the feed (Beal et al., 2002) and this could be an added advantage in hot climates. The most desired property of fermented feed is a high lactic acid concentration produced by lactic acid bacteria (LAB) as the fermenting organisms. This high lactic acid concentration resulting in a low pH is responsible for the antimicrobial activity of fermented feeds. This activity is important for food and environmental safety. Grain sorghum is widely used as a food and animal feed cereal in many parts of Africa, Asia and the semi-arid tropics world-wide. It is recognised that differences in the colour of sorghum varieties are due mainly to their concentration of polyphenol compounds mainly tannins. These compounds have some antimicrobial properties and may affect the activity of lactic acid bacteria used to ferment liquid feeds. Little is known about the lactic acid fermentation of sorghum grain for fermented feeds in monogastric nutrition. The present study was designed to compare the fermentation of red and white sorghum with LAB for inclusion as a component of poultry diets.
Due to the practical advantages of fermenting the carbohydrate-rich cereal component of fermented feeds separately and combining it with the protein-rich components just before feeding (Beal et al., 2005; Moran et al., 2006), it is desirable to have a high lactic acid concentration in the fermented cereal component so as to minimise the dilution effect on the acid concentration and pH of the feed when mixed with the protein-rich component at feeding. With the same cereal substrate and lactic acid bacteria (LAB), a key factor that might influence lactic acid production is the particle sizes produced at milling which could affect the amount of sugars available for microbial enzymatic fermentation. Further more, Anguita et al. (2006) indicated that technological processing of ingredients promotes higher starch hydrolysis in addition to increasing the amount of soluble non-starch polysaccharides and modifications in the physicochemical properties depending on the nature of the feed ingredients. The present study was designed to investigate the effect of particle size on fermentation of sorghum for poultry feed.
Introduction: Collaborative Emergency Centres (CECs) provide access to care in rural communities. After hours, registered nurses (RNs) and paramedics work together in the ED with telephone support by an emergency medical services (EMS) physician. The safety of such a model is unknown. Relapse visits are often used as a proxy measure for safety in emergency medicine. The primary outcome of this study is to measure unscheduled relapses to emergency care. Methods: The electronic patient care record (ePCR) database was queried for all patients who visited two CECs from April 1, 2012 to April 1, 2013. Abstracted data included demographics, time, acuity score, clinical impression, chief complaint, and disposition. Records were searched for each discharged CEC patient to identify unscheduled relapses to emergency care, defined as presenting back to EMS, CEC, or any other ED within the Health Authority within 48 hours of CEC discharge. Results: There were 894 CEC visits, of which 66 were excluded due to missing data. The dispositions from CEC were: 131/828 (15.8%) transferred to regional ED; 264/828 (31.9%) discharged home; 488/828 (58.9%) discharged with follow up visit booked; and 11/82 (1.2%) left the CEC without being seen. There was 37/828 (4.5%) visits which relapsed back to emergency care, all of whom were discharged from CEC or left without being seen: 3/828 (0.4%) relapsed back to EMS (two taken to regional ED and one to CEC); 16/828 (1.9%) relapsed to regional ED (by walking-in); and 18/828 (2.2%) had a relapse to the CEC (walk-in). 516/828 (62.3%) CEC visits were resolved in a single visit. Conclusion: This study was based on only two of the 7 operating CECs due to accessing paper-based charts for multiple health regions. We also acknowledge the limitations of using relapse as a proxy for safety, and that low volumes and acuity will make detection of adverse events challenging. Albeit a proxy measure, the rate of patients who relapse to emergency care was under 5% in this case series of two CECs. Most patients had their concern resolved in a single visit to a CEC. Further research is underway to determine the effectiveness, optimal utilization and safety of this collaborative model of rural emergency care.
The 2013 multistate outbreaks contributed to the largest annual number of reported US cases of cyclosporiasis since 1997. In this paper we focus on investigations in Texas. We defined an outbreak-associated case as laboratory-confirmed cyclosporiasis in a person with illness onset between 1 June and 31 August 2013, with no history of international travel in the previous 14 days. Epidemiological, environmental, and traceback investigations were conducted. Of the 631 cases reported in the multistate outbreaks, Texas reported the greatest number of cases, 270 (43%). More than 70 clusters were identified in Texas, four of which were further investigated. One restaurant-associated cluster of 25 case-patients was selected for a case-control study. Consumption of cilantro was most strongly associated with illness on meal date-matched analysis (matched odds ratio 19·8, 95% confidence interval 4·0–∞). All case-patients in the other three clusters investigated also ate cilantro. Traceback investigations converged on three suppliers in Puebla, Mexico. Cilantro was the vehicle of infection in the four clusters investigated; the temporal association of these clusters with the large overall increase in cyclosporiasis cases in Texas suggests cilantro was the vehicle of infection for many other cases. However, the paucity of epidemiological and traceback information does not allow for a conclusive determination; moreover, molecular epidemiological tools for cyclosporiasis that could provide more definitive linkage between case clusters are needed.
A sphenoethmoidal cell is a posterior ethmoid cell that pneumatises superiorly and/or laterally to the sphenoid sinus. Disease within such a cell may cause visual symptoms because of the close relationship of the optic nerve.
This paper reports four cases of chronic rhinosinusitis involving a sphenoethmoidal cell, two with visual loss. The management of such cases is discussed and the current literature is reviewed.
Pathology within a sphenoethmoidal cell must be considered in cases of optic neuropathy. The presence of these cells may be relevant even in cases of seemingly uncomplicated rhinosinusitis as they are associated with a higher rate of optic nerve protrusion and dehiscence.
We report a missed case of otosyphilis presenting as otic capsule lucencies on temporal bone computed tomography.
A 58-year-old woman presented with a 15-year history of bilateral, mixed hearing loss together with otic capsule lucencies, subsequently confirmed as otosyphilis. A literature review of otosyphilis was undertaken based on a PubMed search of studies published between 1988 and 2012, using the key words ‘otosyphilis’, ‘otodystrophy’, ‘otic capsule lucencies’ and ‘luetic osteitis’.
Results and conclusion:
Although rare, otosyphilis is important to recognise as it is one of the few treatable causes of deafness when diagnosed early. The differentiating computed tomography features of luetic osteitis (otosyphilis) of the temporal bone have only rarely been described. We emphasise how these imaging features can be used to distinguish the rare but treatable condition of luetic osteitis from other, more common conditions with similar imaging findings.
Nasal polyposis is characterised by opacification of the nasal cavities, paranasal sinuses and ostiomeatal complexes on computed tomography scanning. Sinonasal bony changes have been reported as disease sequelae.
To assess the prevalence of sinonasal bone expansion, erosion and thickening in patients with nasal polyposis, and to correlate disease severity with the prevalence of bony changes.
A retrospective radiological study was conducted comprising pre-operative computed tomography scans of 104 patients with nasal polyposis and scans of 44 age- and gender-matched individuals (control group) without sinonasal disease. Lund–Mackay scores and bony changes were quantified.
Ninety-three per cent of the study group scans showed sinonasal bony change, with no changes in the control group. Radiological severity of nasal polyposis correlated positively with the prevalence of bony changes (rs = 0.31; p < 0.01).
Sinonasal bony changes were common in the study group. This highlights the importance of pre- and intra-operative imaging, which can help to prevent intra-operative complications. As bony changes may mimic invasive disease, the importance of histological assessment of polyps is emphasised.
The depth dependence of the photoluminescence (PL) spectrum, both in terms of intensity and wavelength of the peak, is correlated with the electrochemical and chemical processes occurring during the formation of the porous silicon. The depth dependence of the intensity of the electroluminescence (EL) under both anodic bias and cathodic bias, in solutions containing 1M H2SO4 and 0.1M Na2S2O8, is found to be identical with that of the PL. These observations strongly suggest that the silicon skeleton is highly conductive during electrolytic EL, in marked contrast to its high resistivity in air. Strong evidence is provided linking the electrolytic EL to the PL. We extend the quantum confinement based model for PL to the case of electrolytic EL.
Magnetoacoustic emission (MAE) and Barkhausen emission (BE) measurements have been carried out on steel specimens heat treated to produce various microstructures ranging from martensitic/bainitic to ferritic/pearlitic. The magnetic domain structure of the specimens has been studied using transmission electron microscopy, and micromagnetic processes have been observed using an in-situ magnetizing device. The results are used in the interpretation of the MAE and BE measurements.
The maxillary sinus haematoma is an uncommon cause of a maxillary sinus mass. It presents with a variety of symptoms, the most common being epistaxis. Although histologically benign, it may be clinically progressive. Radiological findings can range from a benign appearance to a more aggressive process, including bony erosion. Surgical evacuation is the mainstay of therapy. We describe our experience in managing this condition and review available literature on the subject.
A granular cell tumour is a rare lesion of probable nerve sheath origin. It is typically benign but up to seven per cent may be malignant. Since its original description in the tongue in 1926, the tumour has been reported to occur at many other sites in the body. The authors report a case of a 49-year-old African woman with an oronaso-parapharyngeal granular cell neoplasm causing mild dysphagia. The location of this tumour, which has not been reported previously, posed a unique surgical challenge. An initial attempt to remove the lesion transorally was only partially successful because it was too tough and adherent for conventional surgical dissecting instruments. Complete resection, however, was achieved with a carbon dioxide laser via the same approach. This information may be helpful in the management of other similar cases in the future.
When a gravity current meets an obstacle a proportion of the flow may continue over the obstacle while the rest is reflected back as a hydraulic jump. There are many examples of this type of flow, both in the natural and man-made environment (e.g. sea breezes meeting hills, dense gas and liquid releases meeting containment walls). Two-dimensional currents and obstacles, where the reflected jump is in the opposite direction to the incoming current, are examined by laboratory experiment and theoretical analysis. The investigation concentrates on the case of no net flow, so that there is a return flow in the (finite depth) upper layer. The theoretical analysis is based on shallow-water theory. Both a rigid lid and a free surface condition for the top of the upper layer are considered. The flow may be divided into several regions: the inflow conditions, the region around the hydraulic jump, the flow at the obstacle and the flow downstream of the obstacle. Both theoretical and empirical inflow conditions are examined; the jump conditions are based on assuming that the energy dissipation is confined to the lower layer; and the flow over the obstacle is described by hydraulic control theory. The predictions for the proportion of the flow that continues over the obstacle, the speed of the reflected jump and the depth of the reflected flow are compared with the laboratory experiments, and give reasonable agreement. A shallower upper layer (which must result in a faster return velocity in the upper layer) is found to have a significant effect, both on the initial incoming gravity current and on the proportion of the flow that continues over the obstacle.