PP Group Research Articles

Disease-Modifying Effect of Japanese Cedar Pollen Sublingual Immunotherapy Tablets

Japanese cedar (JC) pollinosis is a common allergic rhinitis in Japan. JC pollen sublingual immunotherapy (SLIT) tablets are licensed for the treatment of JC pollinosis. To assess the disease-modifying effects of JC pollen SLIT tablets over 5 years (2014-2019), comprising a 3-year treatment period and 2-year follow-up. A total of 1042 patients with JC pollinosis (aged 5-64 years) were included in the study. An optimal dose-finding study was performed in the first 15 months, after which 240 patients in the placebo (P) group and 236 patients in the optimalactive dose (A) group (5000 Japanese allergy units) were re-randomized to receive P or A for an additional 18 months (designated AA, AP, PA, and PP groups). Clinical efficacy was evaluated by the total nasal symptom and medication score (TNSMS) during the peak symptom period of each JC pollen season over 3 years of treatment and 2 years of observation after treatment cessation. The AA, AP, and PA groups exhibited significantly reduced TNSMS; however, the largest relative reduction was seen in the AA group both during the treatment period (third season, 46.3% vs PP, P < .001) and during the 2-year follow-up period (fourth and fifth seasons, 45.3% and 34.0% vs PP, respectively; P < .001). The most common adverse drug reactions were mild reactions at the administration site. JC pollen SLIT tablets show sustained clinical efficacy during 3 years of treatment and sustained disease-modifying effects for at least 2 years after treatment cessation.

Impact of intra-operative predictive ligament balance on post-operative balance and patient outcome in TKA: a prospective multicenter study.

New technologies exist which may assist surgeons to better predict final intra-operative joint balance. Our objectives were to compare the impact of (1) a predictive digital joint tensioning tool on intra-operative joint balance; and (2) joint balance and flexion joint laxity on patient-reported outcomes. Two-hundred Eighty patients received posterior cruciate ligament sacrificing TKA with ultra-congruent tibial inserts using a robotic-assisted navigation platform. Patients were divided into those in which a Predictive Plan with a digital joint-tensioning device was used (PP) and those in which it was not (NPP), in all cases final post-operative joint gaps were collected immediately before final implantation. Demographics and KOOS were collected pre-operatively. KOOS, complications and satisfaction were collected at 3, 6 and 12months post-operatively. Optimal balance difference between PP and NPP was defined and compared using area-under-the-curve analysis (AUC). Outcomes were then compared according to the results from the AUC. AUC analysis yielded a balance threshold of 1.5mm, in which the PP group achieved a higher rate of balance throughout flexion compared to the NPP group: extension: 83 vs 52%; Midflexion: 82 vs 55%; Flexion 89 vs 68%; Flexion to Extension 80 vs 49%; p ≤ 0.003. Higher KOOS scores were observed in knees balanced within 1.5mm across all sub-scores at various time points, however, differences did not exceed the minimum clinically important difference (MCID). Patients with > 1.5mm flexion laxity medially or laterally had an increased likelihood of 2.2 (1.1-4.4) and 2.5 (1.3-4.8), respectively, for failing to achieve the Patient Acceptable Symptom State for KOOS Pain at 12months. Patient satisfaction was high in both the PP and NPP groups (97.4 and 94.7%, respectively). Use of a predictive joint tensioning tool improved the final balance in TKA. Improved outcomes were found in balanced knees; however, this improvement did not achieve the MCID, suggesting further studies may be required to define optimal balance targets. Limiting medial and lateral flexion laxity resulted in an increased likelihood of achieving the Patient Acceptable Symptom State for KOOS Pain.

Treatment of medication overuse headache: Effect and predictors after 1year-A randomized controlled trial.

Combined withdrawal and early preventive medication was the most effective treatment for medication overuse headache (MOH) within the first 6months in a previous study, but results from a longer follow-up period are lacking. (1) To measure the efficacy at 1year of three different treatment approaches to MOH; (2) to compare withdrawal and early preventives (W+P), preventives with potential withdrawal therapy after 6months (P+pW), and withdrawal with delayed potential preventives (W+pP); and (3) to identify predictors of chronic headache after 1year. Patients with MOH and migraine and/or tension-type headache were randomly assigned to one of the three outpatient treatments. Headache calendar and questionnaires were filled out. Primary outcome was a reduction in headache days/month after 1year. Of 120 patients, 96 completed 1-year follow-up, and all were included in our analyses. Overall headache days/month were reduced from 24.6 (23.4-25.8) to 15.0 (13.0-17.0) (p<0.0001), and only 11/96 patients (11%) relapsed. Reduction in monthly headache days was 10.3days (95% CI: 6.7-13.9) in the W+P group, 10.8days (95% CI: 7.6-14) in the P+pW group, and 7.9days (95% CI: 5.1-10.7) in the W+pP group. No significant differences in treatment effect were seen between the three groups (p=0.377). After 1year, 39/96 (41%) had chronic headache. Predictors of chronic headache after 1year were higher headache frequency (aOR 1.19; 1.09-1.31), more days with acute medication (aOR 1.11; 1.03-1.19), higher pain intensity (aOR 1.04; 1.01-1.08), and depression (aOR 4.7; 1.38-18.95), whereas higher self-rated health (aOR 0.61; 0.36-0.97) and high caffeine consumption (aOR 0.40; 0.16-0.96) were predictors of a lower risk of chronic headache. No adverse events were reported. All treatment strategies proved effective in treating MOH with a low relapse rate. The W+P strategy leads to the fastest effect, confirming earlier treatment recommendations. Identification of predictors for chronic headache may help identify more complex patients.

Prostaglandin E2 Promotes Recovery of Thymus in Survivors of the Hematopoietic Acute Radiation Syndrome (H-ARS)

We have previously developed a murine model of the hematopoietic acute radiation syndrome [H-ARS, total body irradiated (TBI)] and delayed effects of acute radiation exposure (DEARE) for efficacy testing of potential medical countermeasures (MCM) against these two syndromes. Using this model, we have previously reported that prophylactic use of 16,16 dimethyl-prostaglandin E2 (dmPGE2), a long-acting formulation of PGE, before irradiation significantly increases 30-day survival rate. The current study investigated the effects of the prophylactic use of dmPGE2 with or without therapeutic use of dmPGE2 in survivors on long-term thymus recovery in H-ARS survivors at 6 and 12-months post-LD70/30 (872cGy, 137Cs, 95.2±4.8 cGy/min). Mice were irradiated at 12 weeks of age and then injected subcutaneously with dmPGE2 (1 dose of 35 ug dmPGE2/mouse) or vehicle (Veh; ethanol/PBS solution) at 30“ or -1hr pre-TBI. Survivors were injected monthly with dmPGE2 or Veh and then analyzed for evidence of thymic reconstitution at 6 and 12 months.post-TBI. The three test groups were: prophylactic dmPGE2 + monthly dmPGE2 (PP), prophylactic dmPGE2 + monthly Veh (PV), and prophylactic Veh + monthly Veh (VV), n = 3-6 mice/group. Thymus weight and cellularity of mice in the dmPGE groups, PV and PP, were increased compared to Veh both at 6-months and 12-months post-TBI (p <0.05). The difference was not related to body weight. No difference was observed between PP and PV group. The number of thymocyte subgroups (CD4 single positive, CD8 single positive, double positive and double negative) was also increased in PV and PP mice. Complete blood count (CBC) was also analyzed in the same mice. The VV group showed myeloid skewing, evidenced as an increase in neutrophils and decrease in lymphocytes. The PV and PP groups both exhibited reversal of myeloid skewing, and once again dmPGE maintenance did not provide extra benefit. Thymic progenitors in bone marrow, known as the lymphoid-primed multipotent progenitors (LMPP, Lin-Kit+Sca1+Flt3hiCD34+) and common lymphoid progenitor (CLP, Lin-IL7R+KitloSca1lo Flt3+) were also increased in PV and PP groups compared with VV group (p <0.05). No difference was observed in common myeloid progenitors (CMP), granulocyte-macrophage progenitors (GMP), and MEP (megakaryocyte-erythroid progenitor) between PP and PV group. Competitive bone marrow transplantation showed more than 10 times higher donor-derived chimerism in the thymus of PP and PV mice compared with the VV group. Again, no difference was observed between PP and PV group. In conclusion, these data show that dmPGE2, given before irradiation, protects thymic settling progenitors in bone marrow, resulting in reversal of thymic involution, increased peripheral lymphocytes, and partial alleviation of the myeloid skewing observed in radiation survivors. dmPGE maintenance does not bring extra benefit. F unded by Department of the Army PR140433P1 and NIAID 1U01AI107340-01. DisclosuresNo relevant conflicts of interest to declare.

Stress-Distribution Pattern Across the Glenohumeral Joint in Collegiate and Professional Baseball Players: A Computed Tomography Osteoabsorptiometry Study.

Background:The influence of long-term loading conditions on the articular surfaces of the glenohumeral joint can be determined by measuring stress-distribution patterns. Long-term pitching activity changes the stress distribution across the glenohumeral joint surface; however, the influence of competitive level on stress-distribution patterns remains unclear.Purpose:To use computed tomography (CT) osteoabsorptiometry (CTOAM) to evaluate the distribution of subchondral bone density across the glenohumeral joint in collegiate and professional baseball players as well as to determine the effects of pitching activity on the articular surfaces.Study Design:Descriptive laboratory study.Methods:We evaluated 73 shoulders in 50 baseball players. CT imaging data were obtained from the dominant-side shoulder of 12 professional pitchers (PP group) and 15 professional fielders (PF group). CT imaging data were also obtained from both shoulders of 12 asymptomatic collegiate pitchers (CP group) and 11 collegiate fielders (CF group). The pattern of distribution of subchondral bone density across the articular surfaces of each glenohumeral joint was assessed by CTOAM. As a measure of bone density, the mean Hounsfield units (HU) were obtained for each joint surface, and the absolute values of the dominant shoulder were compared for each group.Results:Stress-distribution patterns over the articular surfaces differed between the dominant and nondominant sides in the CP group as well as between both collegiate groups versus the PP group. In the CP group, the mean HU of the humeral head surface were greater on the nondominant versus dominant side (P = .035). On the dominant side, the mean HU of the humeral head surface and glenoid were greater in the CP versus the PP group (P = .001 and .027, respectively).Conclusion:Stress distribution on the articular surface of the glenohumeral joint was affected by pitching ability and competitive level. Our analysis indicates that the traction force on the glenohumeral joint surface might be greater than compression force during pitching.Clinical Relevance:The present findings suggest that pitching activity results in low stress to the articular surfaces of the glenohumeral joint. This supports the notion that mechanical conditions play a crucial role in the etiology of disorders specific to pitching activity.

PMH46 Treatment Patterns With Aripiprazole Lauroxil Versus Other Atypical Long-Acting Injectable Antipsychotics in Patients With Schizophrenia: A Retrospective Electronic Health Records Database Study

To describe treatment patterns among patients with schizophrenia initiating treatment with aripiprazole lauroxil (AL) versus other atypical long-acting injectable (aLAI) antipsychotics (paliperidone palmitate [PP], aripiprazole monohydrate [AM], risperidone microspheres [RIS]) using a unique web-based electronic health record (EHR) system available free to single-provider and small group outpatient practices across the US. Adults (≥18 years) with schizophrenia who had ≥1 aLAI prescription between 10/2015 and 10/2017 and continuous data for 6 months before and 12 months after initial (index) aLAI prescription were identified retrospectively. Post-index outcomes included index aLAI discontinuation, persistence, adherence (proportion of index aLAI days covered [PDC]), switching, and re-initiation. Adjusted odds ratios (ORs) were calculated using AL as the referent. Mean (SD) patient age was 45.9 (15.1) years (N=1730) and 64% of patients were male. Index treatments included AL (n=159), PP (n=954), AM (n=306), and RIS (n=311). Overall, 84% discontinued their index aLAI; adjusted ORs (95% CIs) relative to AL were 0.77 (0.48-1.25; PP), 0.67 (0.39-1.14; AM), and 2.72 (1.40-5.30; RIS). Median times to discontinuation of index aLAI were 90 (AL), 33 (PP), 85 (AM), and 14 (RIS) days. Median PDCs were 24% (AL), 8% (PP), 16% (AM), and 4% (RIS). Overall, 29% of patients switched from their index aLAI; adjusted ORs vs AL for switching were 0.89 (0.59-1.35; PP), 0.44 (0.31-0.63; AM), and 0.86 (0.64-1.17; RIS). Among patients who discontinued their index aLAI, 21% re-initiated (AL, 30%; PP, 19%; AM, 15%; RIS, 26%). Adjusted ORs vs AL for re-initiation of index aLAI were 0.62 (0.40-0.95; PP), 0.45 (0.27-0.76; AM), and 0.95 (0.59-1.53; RIS). In this real-world EHR database study, AL treatment was associated with a lower rate of discontinuation, greater persistence, and better adherence (based on PDC) versus RIS, whereas outcomes were generally comparable between AL and AM or PP groups.

Casper Versus Precise Stent for the Treatment of Patients with Idiopathic Intracranial Hypertension

PurposeWe hypothesized that due to its specific characteristics, the CasperTM RX carotid stent (CP) might be particularly suitable for venous sinus stenting (VSS) in patients with idiopathic intracranial hypertension (IIH). To test this theory, we compared it to the commonly used Precise Pro RXTM stent (PP).MethodsA total of 15 patients with IIH (median age 28.7 years) were reviewed retrospectively. Technical aspects as well as peri- and postinterventional complication rates were examined in patients treated with CP (n = 10) and the PP (n = 5). Improvements in cerebrospinal fluid opening pressure (CSF OP), transstenotic pressure gradient (TSPG) and clinical symptoms were also assessed.ResultsStent delivery was easier and more successful with the CP than the PP (difficult/failed stent delivery 0.0% versus 57.1%) and consequently achieved with less attempts (≥ 2: 0.0% versus 40.0%). No severe peri- or postinterventional complications or instances of in-stent thrombosis and/or stenosis were observed during follow-up. Improvement of CSF OP and TSPG immediately after VSS as well as at 6‑month follow-up was comparable between the CP and PP group. Both groups showed substantial and similar decreases in intensity and frequency of headache. Almost all patients with other IIH-related symptoms showed either improvement or complete resolution of those symptoms after VSS. All patients who were available for interview (n = 12/15) reported a substantial improvement in quality of life.ConclusionVSS using the CP seems to be safe and effective. The CP may reduce the risk of difficult or failed stent delivery in patients with challenging intracranial venous anatomy.

Pregnancy-related sacroiliac joint findings in females with low back pain: a four-year magnetic resonance imaging follow-up study.

Pregnancy-related pain may be associated with sacroiliac joint (SIJ) changes, detectable by magnetic resonance imaging (MRI). To analyze the prevalence and course of SIJ MRI and clinical findings in women referred with low back pain and relate these to pregnancy. A retrospective follow-up study from a longitudinally collected cohort comprising 328 women. Women reporting debut of pain in relation to a pregnancy (PP group) tended to have a higher baseline prevalence of all investigated MRI findings, cumulated positive SIJ tests, and a potential fulfilment of the spondyloarthritis diagnosis compared to remainders. The prevalence of subchondral bone marrow edema (BME), any SIJ MRI finding, and potential fulfilment of the spondyloarthritis diagnosis were significantly higher in the PP group compared to women who had not been pregnant. In the total study group, the prevalence of ≥1 MRI finding increased over the four-year study period from 34% to 47% (P<0.001), driven by increasing prevalence of BME (25% to 32%; P=0.008) and fatty marrow deposition (FMD) (20% to 25%; P=0.020). In addition, the BME volume score increased. Over time, the PP group had persisting high prevalence of buttock pain and total MRI findings and their FMD volume score increased, but there were no between-group differences in MRI variables at follow-up. Overall, the prevalence of MRI findings increased over time. Although the PP group had different clinical and SIJ MRI characteristics cross-sectional at baseline compared to remainders, longitudinal analyses revealed that these diminished over time.

Effectiveness of turmeric-enriched pellets to improve the immunity of Clarias batrachus toward motile Aeromonas septicemia disease

Background: Turmeric is known as a natural remedy to improve the immunity of organisms. This study aims to understand the effectiveness of turmeric-enriched pellets to improve the immunity of Clarias batrachus to Aeromonas hydrophila. Methods: The study was conducted from May to August 2020. C. batrachus fingerlings, 7-8 cm total length (TL) and 4-5 g (BW) at baseline, were kept in 30 L aquaria (10 fishes/aquarium; three replicated/treatment). Commercial pellets were mixed with turmeric powder. There were five treatment groups: P0 (control, no turmeric); P1 (0.5 g turmeric per Kg of pellets); P2 (0.7 g/Kg); P3 (0.9 g/Kg); Pp (positive control). Thirty days after being feed with turmeric-enriched pellets, all groups of fish were infected with 0.1 ml (108) of A. hydrophila suspension, intramuscularly. The P0 group did not receive injection, while Pp group were not fed with turmeric-enriched pellets but were infected with the bacteria. Fourteen days after infection, clinical signs and hematology of the fish were studied. Results: Pp fish showed heavy clinical signs of A. hydrophila, such as loss of balance, pigmentation, hemorrhages and ulcers. P0 fish did not show any symptoms, while the treated fish reveled some clinical signs of A. hydrophila to a lesser extent than Pp, indicating that the fish is able to face the A. hydrophila attack. Hematology for Pp fish revealed high white blood cells, indicating that the fish were infected. The blood condition of the P0 fish, as well as those of the turmeric-treated fish were normal. In general, the P3 fish showed the least clinical signs of A. hydrophila and normal blood condition, indicating that P3 treatment is best. Conclusion: The best turmeric dosage to improve the immunity of C. batrachus toward A. hydrophila infection is 0.9 g/Kg pellets.

Psychological Impact of Diabetes Technology on Type 1 Diabetes Pregnancy

Pregnant women with Type 1 Diabetes (T1D) experience challenges with glycemic management, planning for and transitioning into motherhood. Diabetes technology (DT) has been shown to improve glycemic control and pregnancy outcomes. The data on psychological aspects for the use of DT among women and their families during different stages of pregnancy is very sparse. This study characterized the perceived benefits and burdens of DT during T1D pre-, ongoing, and past-pregnancy journey. We surveyed 119 women with T1D from 12 countries (mean age 33.33 ± 5.26 years) as “Planning” (PP), “Attempting” (AP), “Previously” (PrP), or “Currently” (CP) pregnant. We explored the top three perceived “benefits” and “burdens” of DT (and their partners if relevant). Survey questions included: type of CGM device and insulin pump, use of hybrid closed-loop (Medtronic 670 G or Tandem X2 w/ Dexcom G6) or DIY system, insurance coverage, monthly out of pocket costs, breastfeeding. Results: 67 women in PrP group, 38 in CP group, and 7 in both PP and AP groups. A majority used CGM or insulin pump prior to pregnancy (n = 90 for CGM, n = 100 for pump). 11 women did not use any DT prior to pregnancy (n = 1 in CP group, n = 10 in PrP group). Five initiated DT during the first trimester, one during the second trimester, and five did not use any DT. Three women in CP group initiated CGM during the first trimester. Out of 12 women not using CGM in PP group, 7/12 initiated during pregnancy (n = 1 for 14-day Libre, n = 5 for Dexcom G5/6, n = 1 for Guardian 3). Overall these women, and their partners, perceived more benefits than burdens. Top three benefits of DT were “overall improved BS control,” improved confidence in DM control,” and “improved ease of administering insulin” (n = 86, 56, 55 respectively). Top three burdens were “alarms,” “problems with infusion sets,” and “glitches with sensors” (n = 52, 45, 43 respectively). Perceived benefits of DT for partners were the same except for a differing top-ranked benefit of “less worry about overnight hypoglycemia.” Burdens for partners were the same except for a differing top-ranked burden of “obsessiveness (more time thinking about BS).” CGM device usage showed: 68% for Dexcom (G4/5/6), 14.9% for Guardian 3, 9.9% for Libre (10 and 14 -day), and 7% reported no usage. Insulin pump usage showed: 52.2% for Medtronic, 15.7% for Tandem T:slim, 13% for Omnipod, 6% indicated other systems not listed, and 13% reported no usage. 26% of women have used a hybrid closed-loop system and 23% have used a DIY system. Our study is the first one to identify specific psychological benefits and stressors with the use of DT in women and their significant others internationally at various stages around pregnancy. It provides insight to clinicians on how to best counsel women and their families. Having the right expectations will help the with adaptability of DT and increase its use in order to improve pregnancy outcomes.

Frequency domain analysis and clinical outcomes of pulsatile and non-pulsatile blood flow energy during cardiopulmonary bypass.

The superiority of pulsatile perfusion during cardiopulmonary bypass remains controversial. We analyzed the frequency-domain characteristics and organ protection of pulsatile and nonpulsatile flow in adult patients with valvular disease. EEP and SHE were used to calculate blood flow energy in 60 patients. The Fast Fourier Transform was employed to analyze the power spectral density and power density ratio (Rvpd) of flow energy. Changes in endothelin-1, nitric oxide, interleukin-6,10, tumor necrotic factor, S100β, NSE, blood and urinary β2-microglobulin levels were investigated to assess the endothelial function, inflammatory reaction, kidney and brain injury during CPB. EEP and SHE in PP group at each time point were 1.52-1.62 times and 2.03-2.22 times higher respectively compared with NP group. Power spectral density analysis demonstrated that the blood flow energy frequencies in each group were all within 40 Hz and the low frequency energy (0-5 Hz) was dominant in physiological perfusion (>90%). The energy ratio of 0-5 Hz at radial artery was significantly decreased compared with that of post arterial filter in PP (81% vs 64%) and NP (63% vs 37%) group. The power density ratio (Rvpd) was higher than that of NP in all frequency ranges at the radial artery (9.51 vs 4.68 vs 3.59) and arterial filter (3.87 vs 2.69 vs 2.38). The S100β, NSE Urinary and plasma β2-microglobulin level were significantly increased at 6 and 24 hours after surgery in two group, and significantly higher in group NP. PP provided more energy than NP. The proportion of low frequency energy in the pulsatile or nonpulsatile flow is significantly reduced. The low-frequency energy is significantly attenuated during conduction to peripheral tissues in nonpulsatile flow. The surplus pulsatile energy influences the secretion of endothelial and inflammatory factors, and demonstrate better cerebral and kidney protective effect at the biological marker level.

Effects of three probiotic strains (Bacillus coagulans, B. licheniformis and Paenibacillus polymyxa) on growth, immune response, gut morphology and microbiota, and resistance against Vibrio harveyi of northern whitings, Sillago sihama Forsskál (1775)

The present study investigated the effects of three probiotic strains viz. Bacillus coagulans ATCC 7050 (BC), Bacillus licheniformis ATCC 11946 (BL), and Paenibacillus polymyxa ATCC 842 (PP) on growth, immune response and antioxidant enzyme activities, intestinal microbiota, and resistance against isolated Vibrio harveyi HY99 in juvenile northern whiting fish, Sillago sihama. Three hundred and sixty juvenile S. sihama fish (initial weight 0.67 ± 0.002 g) stocked in 12 fiberglass tanks were fed with basal diet void of probiotic inclusion (control, B0), and BC, BL, and PP at 1012 CFU kg−1 feed. After the 56-day experimental period, regardless of the probiotic strain used, there were significant increase (P < 0.05) in the survival rate, final weight, weight gain rate, specific growth rate, protein efficiency ratio, hepatosomatic index, viscerosomatic index; crude protein, crude lipid content in the whole body; superoxide dismutase, alkaline phosphatase, acid phosphatase, glutathione peroxidase levels in the liver and a significant decrease in the feed conversion ratio; aspartate aminotransaminase, alanine aminotransaminase, malondialdehyde levels in the liver (P < 0.05) of the probiotic treated group than the untreated. Congruently, a significantly high (P < 0.05) intestinal villi height, villi width, crypt depth, and muscle thickness, were detected in the probiotic treated groups than the control with the PP group experiencing the highest. Probiotics’ supplementations in diets also revealed a significantly high (P < 0.05) relative abundance of Proteobacteria than the control group contrast to as observed in Firmicutes. Additionally, the PP and BL groups were found to have a significant (P < 0.05) increase in Bacteroidetes and Gemmatimonadetes abundance than the BC and B0 groups. At the genus level, all fish supplemented with probiotic diet had a significantly (P < 0.05) lower abundance of some purportedly pathogenic genera such as Enterovibrio and Shewanella as well as significantly (P < 0.05) higher abundance of purportedly beneficial genera such as Ruegeria, Phyllobacterium, Sphingomonas, and Lactobacillus. Challenge with V. harveyi in a 14-day study revealed highly significant (P < 0.05) protection of probiotic groups than the control; thus, the B0, BC, BL, and PP groups obtained 78 %, 58 %, 53 %, and 43 % cumulative mortality, respectively. Collectively, these results suggest that dietary supplementation of probiotics viz. BC, BL, and PP at 1012 CFU kg−1 feed exert positive effects; however, PP at a similar dosage is recommended due to its highest improvement in the growth, immune response, antioxidant activities, intestinal health, and disease resistance against V. harveyi.

Effectiveness of turmeric-enriched pellets to improve the immunity of Clarias batrachus toward motile Aeromonas septicemia disease

Background: Turmeric is known as a natural remedy to improve the immunity of organisms. This study aims to understand the effectiveness of turmeric-enriched pellets to improve the immunity of Clarias batrachus to Aeromonas hydrophila. Methods: The study was conducted from May to August 2020. C. batrachus fingerlings, 7-8 cm total length (TL) and 4-5 g (BW) at baseline, were kept in 30 L aquaria (10 fishes/aquarium; three replicated/treatment). Commercial pellets were mixed with turmeric powder. There were five treatment groups: P0 (control, no turmeric); P1 (0.5 g turmeric per Kg of pellets); P2 (0.7 g/Kg); P3 (0.9 g/Kg); Pp (positive control). Thirty days after being feed with turmeric-enriched pellets, all groups of fish were infected with 0.1 ml (10 8) of A. hydrophila suspension, intramuscularly. The P0 group did not receive injection, while Pp group were not fed with turmeric-enriched pellets but were infected with the bacteria. Fourteen days after infection, clinical signs and hematology of the fish were studied. Results: Pp fish showed heavy clinical signs of A. hydrophila , such as loss of balance, pigmentation, hemorrhages and ulcers. P0 fish did not show any symptoms, while the treated fish reveled some clinical signs of A. hydrophila to a lesser extent than Pp, indicating that the fish is able to face the A. hydrophila attack. Hematology for Pp fish revealed high white blood cells, indicating that the fish were infected. The blood condition of the P0 fish, as well as those of the turmeric-treated fish were normal. In general, the P3 fish showed the least clinical signs of A. hydrophila and normal blood condition, indicating that P3 treatment is best. Conclusion: The best turmeric dosage to improve the immunity of C. batrachus toward A . hydrophila infection is 0.9 g/Kg pellets.

Reproductive and cost assessment of a seasonal breeding program with Bos indicus in tropical Mexico

Objective. To compare the reproductive performance of postpartum and open Bos indicus cows and to study the cost effectiveness of retaining non-pregnant animals after a short breeding season in tropical region of Mexico. Material and Methods. A total of 128 Bos indicus were included, 87 postpartum cows (PP) with ≤90 days after calving and 41 open cows (OC) with &gt;90 days open. The study was divided into three phases: 1) Estrus synchronization followed by FTAI (day 0-10), 2) Estrus detection and AI (day 11-45) and 3) Natural mating (day 46-90). For the first phase, all animals were synchronized and AI at fixed time (day 10). Cows displaying overt signs of estrus (day 11-45) were AI. Open cows during the previous two phases were exposed to the bull. Results. Pregnancy in phase 1 was different (p&lt;0.01) for PP and OC groups, 58.6% and 34.1%, respectively. Overall pregnancy percentage over the second service was 42.5% (p&gt;0.05). No differences (p&gt;0.05) were observed at phase 3, average 44.2%. By the end of the breeding season, the cost of OC, was 3 times more than PP cows. Conclusions. Pregnancy rate at first phase was higher in PP cows than OC cows. At the end of breeding season, a pregnancy rate of 80% was found. Incorporation of open cows from previous breeding season was more expensive than PP cows in all phases of the breeding program. Retaining an open cow for rebreeding one year or more could not be economically feasible.

The longitudinal outcomes of applying non-selective beta-blockers in portal hypertension: real-world multicenter study.

We investigated the effect of non-selective β-blockers (NSBB) in real-world situations and whether low-dose NSBB is beneficial compared to maximally tolerated doses. We performed a retrospective study of 740 patients with cirrhosis requiring prophylactic treatment of esophageal varices: 473 primary prophylaxis (PP: NSBB = 349, non-NSBB = 124) and 267 secondary prophylaxis (SP: NSBB = 200, non-NSBB = 67). The NSBB group was divided into low-dose (≤ 80mg/day) and high-dose (> 80mg/day). In the PP group, NSBB treatment reduced mortality and showed the most pronounced effect in patients with moderate/severe ascites (hazard ratio [HR], 0.46; p < 0.01), HVPG ≥ 16mmHg (HR, 0.53; p = 0.04), or CTP class B/C (HR, 0.46; p < 0.01) but not in those with no/mild ascites, HVPG < 16mmHg, or CTP class A. Low-dose NSBB group showed a significant reduction in mortality compared with non-NSBB (moderate/severe ascites: HR, 0.61; p = 0.02 and CTP class B/C: HR, 0.41; p < 0.01) and the effect size was stronger than the high-dose NSBB. NSBB was associated with a reduced risk of infection (HR, 0.36; p = 0.01). In the SP group, NSBB prolonged survival in patients with moderate/severe ascites (HR, 0.56; p = 0.02), HVPG ≥ 16mmHg (HR, 0.42; p < 0.01), or CTP class B/C (HR, 0.52; p < 0.01). Low-dose NSBB was more beneficial with 56% risk reduction (p < 0.01) of mortality compared with 33% risk reduction in the high-dose NSBB (p = 0.05). NSBB therapy was associated with longer survival in PP and SP groups who had an advanced stage of cirrhosis. Moreover, low-dose NSBB exhibited a better benefit than a standard-titrated high-dose NSBB with better tolerability.

EVALUATION OF TOXICITY AND EFFICACY OF ORAL ANTISEPTICS RELATED TO DENTAL CELL RESOURCES

<h3>Background</h3> The objective of this work was to verify the influence of oral antiseptics on cells from human exfoliated deciduous teeth (SHEDs), to establish antisepsis protocols of lower cytotoxicity. <h3>Methods</h3> 5 × 10⁴ cells were inserted into 24-well plates under culture conditions for 48 hours, divided as group C (control); group BM (peroxide), 3 wells with 1:1 antiseptic/culture medium solution and 3 wells with 1:10 antiseptic/culture medium solution); CP group (triclosan, 1:1 and 1:10); group PP (chlorhexidine, 1:1 and 1:10). Two microbiological tests were also performed, agar diffusion test (AD) and minimum inhibition concentration (MIC). For the AD test, 9 Petri dishes containing Müeller-Hinton agar were prepared in which strains of E. faecalis were inoculated and divided into 4 parts, in which paper discs embedded in the antiseptics were placed (peroxide, chlorhexidine and triclosan, with 50%, 75% and 100% concentrations). The MIC test was performed with Müeller-Hinton broth, with E. faecalis (to McFarland‘s 0.5 scale). 10 mμ of antiseptics were inoculated in these tubes. After 72 h, the samples were read at a spectrophotometer. Data was submitted to two way ANOVA and Tukey test (<i>p</i>≤0.05). <h3>Results</h3> At the inverted microscope, group C presented cells that appeared closer and with a spreading aspect, besides viability of 92.3% (flow cytometry). In the BM group, the identification of cellular limits were not clear (1:1 with 69% viability), with round cell morphology, closer and non-adherent cells (1:10 with 95% viability). In the CP group the cells were smaller, separated and with few elongations (1:1 with 46.8% viability) – similar with group C (1:10 with 60.1%). In the PP group, cells were small and separated, with a spreading aspect (1:1 with 95.7% viability, and 1:10 with 100% viability). At the microbiological tests, all solutions presented antiseptic properties, although the CP group presented the lowest antimicrobiological results. <h3>Conclusion</h3> The group with the least morphological influence on the cells was PP. However, due to mutagenicity effect, chlorhexidine-based antiseptics should be avoided when cells are submitted to culture processing. At 1:10 dilution, peroxide-based antiseptic provided excellent viability (95%), although important morphological changes were seen. Regarding the microbiological tests, even at different concentrations and results, all antiseptics in this study were considered effective in eliminating E. faecalis.

Effectiveness of turmeric-enriched pellets to improve the immunity of Clarias batrachus toward motile Aeromonas septicemia disease.

Background: Turmeric is known as a natural remedy to improve the immunity of organisms. This study aims to understand the effectiveness of turmeric-enriched pellets to improve the immunity of Clarias batrachus to Aeromonas hydrophila. Methods: The study was conducted from May to August 2020. C. batrachus fingerlings, 7-8 cm total length (TL) and 4-5 g (BW) at baseline, were kept in 30 L aquaria (10 fishes/aquarium; three replicated/treatment). Commercial pellets were mixed with turmeric powder. There were five treatment groups: P0 (control, no turmeric); P1 (0.5 g turmeric per Kg of pellets); P2 (0.7 g/Kg); P3 (0.9 g/Kg); Pp (positive control). Thirty days after being feed with turmeric-enriched pellets, all groups of fish were infected with 0.1 ml (10 8) of A. hydrophila suspension, intramuscularly. The P0 group did not receive injection, while Pp group were not fed with turmeric-enriched pellets but were infected with the bacteria. Fourteen days after infection, clinical signs and hematology of the fish were studied. Results: Pp fish showed heavy clinical signs of A. hydrophila, such as loss of balance, pigmentation, hemorrhages and ulcers. P0 fish did not show any symptoms, while the treated fish reveled some clinical signs of A. hydrophila to a lesser extent than Pp, indicating that the fish is able to face the A. hydrophila attack. Hematology for Pp fish revealed high white blood cells, indicating that the fish were infected. The blood condition of the P0 fish, as well as those of the turmeric-treated fish were normal. In general, the P3 fish showed the least clinical signs of A. hydrophila and normal blood condition, indicating that P3 treatment is best. Conclusion: The best turmeric dosage to improve the immunity of C. batrachus toward A. hydrophila infection is 0.9 g/Kg pellets.

Patient and public perception and experience of community pharmacy services post-discharge in the UK: a rapid review and qualitative study

ObjectivesTo investigate the perception and experience of patients and the public (PP) about community pharmacy (CP) services and other primary care services after hospital discharge back home.Design and settingA rapid...

Clinical and diagnostic findings in COVID-19 patients: an original research from SG Moscati Hospital in Taranto Italy.

The coronavirus disease 2019 (COVID-19) pandemic is a worldwide medical challenge due to the scarcity of proper information and remedial resources. The ability to efficiently avoid a further SARS-CoV-2 pandemic will, therefore, depend on understanding several factors which include host immunity, virus behavior, prevention measures, and new therapies. This is a multi-phase observatory study conducted in the SG Moscati Hospital of Taranto in Italy that was converted into COVID-19 Special Care Unit for SARS-Co-V2 risk management. Patients were admitted to the 118 Emergency Pre-Hospital and Emergency Department based on two diagnostic criteria, the nasopharyngeal swab assessed by reverse-transcriptase-polymerase-chain-reaction (RT-PCR) and CT-scan image characterized by ground glass opacity. Patients were divided into four groups, positive-positive (ER-PP), negative-positive (ER-NP), negative-negative (ER-NN) and a group admitted to the ICU (ER-IC). A further control group was added when the T and B lymphocyte subsets were analyzed. Data included gender, age, vital signs, arterial blood gas analysis (ABG), extensive laboratory results with microbiology and bronchoalveolar lavage fluid (BALF) which were analyzed and compared. Fundamental differences were reported among the groups. Males were significantly higher in PP, ICU, and NP groups, from 2 to 4-fold higher than females, while in the NN group, the number of females was mildly higher than males; the PP patients showed a marked alkalotic, hypoxic, hypocapnia ABG profile with hyperventilation at the time of admission; finally, the laboratory and microbiology results showed lymphopenia, fibrinogen, ESR, CRP, and eGFR were markedly anomalous. The total number of CD4+ and CD8+ T cells was dramatically reduced in COVID-19 patients with levels lower than the normal range delimited by 400/μL and 800/μL, respectively, and were negatively correlated with blood inflammatory responses.

Therapeutic Effects of Prolonged Release Melatonin (Circadin®) in Patients with Overactive Bladder and Chronic Insomnia in More Than 55 Years Old

Objectives Bladder storage symptoms including nocturia is the most common cause of sleep disturbance in all age groups. Sleep disturbance is also a main cause of nocturia so that sleep recovery can clinically improve nocturia. Melatonin has main action to induce sleep and additional effects of smooth muscle relaxation, free radical scavenging, anti-inflammation, et cetera. This study was evaluated the improvement of sleep quality after administrating prolonged-release melatonin in elderly patients with overactive bladder and chronic insomnia. Methods This clinical trial was performed with a randomized single open study. Thirty-seven patients with overactive bladder and chronic insomnia were initially enrolled in this study. After 4 or 12 weeks treating with 2 mg of prolonged-release melatonin, clinical outcomes were evaluated with OABSS, IPSS, PSQI and WHO 5 well-being index. Results Of the 37 patients, 34 (91.9%) were included in the ITT group and 26 (76.5%) in the PP group. In the primary outcome of PP group, significant improvements were observed in total OABSS and nocturia frequencies at 12 weeks, respectively. Secondary outcome measurement including in voiding, storage symptoms, and total IPSS scores showed the improvement at 4 and 12 weeks and in total and sleep quality PSQI scores at 12 weeks, and in quality of life scores of the WHO 5 well-being index at 12 weeks. Only one (3.8%) adverse event was observed. Conclusions These results suggest clearly that prolonged-release melatonin in elderly patients with overactive bladder and chronic insomnia has the potential to control concomitant voiding and sleep difficulty.