Long diagnostic delay in Crohn's disease is associated with complicated disease course and increased operation rate

Background: We have recently shown that the median diagnostic delay to establish Crohn's disease (CD) diagnosis in the Swiss IBD Cohort (SIBDC) was 9 months. Seventy five percent of all CD patients were diagnosed within 24 months. The clinical impact of a long diagnostic delay on the natural history of CD is unknown. Aim: To compare the frequency and type of CD-related complications in the patient groups with long diagnostic delay (>24 months) vs. the ones diagnosed within 24 months. Methods: Retrospective analysis of data from the SIBDCS, comprising a large sample of CD patients followed in hospitals and private practices across Switzerland. Results: Two hundred CD patients (121 female, mean age 44.9 ± 15.0 years, 38% smokers, 71% ever treated with immunomodulators and 35% with anti-TNF) with long diagnostic delay were compared to 697 CD patients (358 female, mean age 39.1 ± 14.9 years, 33% smokers, 74% ever treated with immunomodulators and 33% with anti-TNF) diagnosed within 24 months. No differences in the outcomes were observed between the two patient groups within year one after CD diagnosis. Among those diagnosed 2-5 years ago, CD patients with long diagnostic delay (n = 45) presented more frequently with internal fistulas (11.1% vs. 3.1%, p = 0.03) and bowel stenoses (28.9% vs. 15.7%, p = 0.05), and they more frequently underwent CD-related operations (15.6% vs. 5.0%, p = 0.02) compared to the patients diagnosed within 24 months (n = 159). Among those diagnosed 6-10 years ago, CD patients with long diagnostic delay (n = 48) presented more frequently with extraintestinal manifestations (60.4% vs. 34.6%, p = 0.001) than those diagnosed within 24 months (n = 182). For the patients diagnosed 11-15 years ago, no differences in outcomes were found between the long diagnostic delay group (n = 106) and the one diagnosed within 24 months (n = 32). Among those diagnosed >= 16 years ago, the group with long diagnostic delay (n = 71) more frequently underwent CD-related operations (63.4% vs. 46.5%, p = 0.01) compared to the group diagnosed with CD within 24 months (n = 241). Conclusions: A long diagnostic delay in CD patients is associated with a more complicated disease course and higher number of CD-related operations in the years following the diagnosis. Our results indicate that efforts should be undertaken to shorten the diagnostic delay in CD patients in order to reduce the risk for progression towards a complicated disease phenotype.

Assessment of rubber tree panels under crowns resistant to South American leaf blight

The objective of this work was to assess the performance of panel clones under crowns resistant to South American leaf blight (Microcyclus ulei). The experiment was carried out with 18 panel clones crown-budded with Hevea pauciflora x H. guianensis, in a Xanthic Ferralsol (Oxisol) in Manaus, AM, Brazil. The following parameters were evaluated: dry rubber yield, plant nutritional status, and anatomical and physiological characteristics of the latex vessels. In the first three years of evaluation, the panel clones IAN 2878, IAN 2903, CNS AM 7905, CNS AM 7905 P1, and PB 28/59 showed the highest dry rubber yield potential, while the clones IAN 6158, IAN 6590, and IAN 6515 should not be recommended for crown budding. Higher potassium and copper foliar content in panel clones were associated to an increase in dry rubber yield. The simultaneous evaluation of anatomical and physiological characteristics of latex is fundamental for the selection of panel clones in the Amazon region. Crown budding is an efficient technology for South American leaf blight management in endemic regions.

Success rate of airway management by residents in a pre-hospital emergency setting: a retrospective study

Abstract Objective: The objective of this retrospective study over a 5-year period was to assess the success rate of airway management by residents. Criteria of successful airway management were both the adherence to a standardized protocol of pre-hospital airway.

Factors associated with 56-day non-return rate in dairy cattle

The objective of this work was to identify factors associated with the 56-day non-return rate (56-NRR) in dairy herds in the Galician region, Spain, and to estimate it for individual Holstein bulls. The experiment was carried out in herds originated from North-West Spain, from September 2008 to August 2009. Data of the 76,440 first inseminations performed during this period were gathered. Candidate factors were tested for their association with the 56-NRR by using a logistic model (binomial). Afterwards, 37 sires with a minimum of 150 first performed inseminations were individually evaluated. Logistic models were also estimated for each bull, and predicted individual 56-NRR rate values were calculated as a solution for the model parameters. Logistic regression found four major factors associated with 56-NRR in lactating cows: age at insemination, days from calving to insemination, milk production level at the time of insemination, and herd size. First-service conception rate, when a particular sire was used, was higher for heifers (0.71) than for lactating cows (0.52). Non-return rates were highly variable among bulls. Asignificant part of the herd-level variation of 56-NRR of Holstein cattle seems attributable to the service sire. High correlation level between observed and predicted 56-NRR was found.

Outcrossing rate between 'Haden' and 'Tommy Atkins' mangoes estimated using microsatellite and AFLP markers

The objective of this work was to estimate outcrossing rates between Haden and Tommy Atkins mango cultivars, using AFLP and microsatellite markers. Progenies of an isolated 'Haden' plant, identified in a 'Tommy Atkins' commercial orchard, in Petrolina, PE, Brazil, were analyzed. Total DNA was isolated from the progeny leaves and used for AFLP and microsatellite reactions. Multilocus outcrossing rates (t m) were estimated by direct count of AFLP or microsatellite markers and by the mLTR software. Outcrossing rates ranged from 0.85 to 0.87 with the analysis based on seven AFLP markers, and from 0.83 to 0.91 based on three microsatellite primers. No unexpected band patterns were observed for 'Haden' and 'Tommy Atkins'. The estimates obtained with the mLTR software were close to those obtained by direct AFLP and microsatellite allele counting, which indicates that the multilocus model was appropriate for this kind of study. The microsatellites mMiCIR005, mMiCIR030, and mMiCIR036 can be used to elucidate the origin of 'Haden' and 'Tommy Atkins' seedlings.

Acclimatization of Tapeinochilos ananassae plantlets in association with arbuscular mycorrhizal fungi

The objective of this work was to assess the potential of three isolates of arbuscular mycorrhizal fungi to promote growth of micropropagated plantlets of Tapeinochilos ananassae during acclimatization. The experiment was carried out in greenhouse, in a completely randomized block design, with four inoculation treatments: non‑inoculated control and plants inoculated with Glomus etunicatum, Acaulospora longula or Gigaspora albida, with ten replicates. After 90 days, the following parameters were evaluated: survival rate, height, leaf and tiller number, leaf area, fresh and dry biomass, contents of macro‑ and micronutrients in the root and shoot, glomerospore number, and mycorrhizal colonization. The survival percentage was 100%, except for plants inoculated with G. albida (80%). The isolate G. etunicatum is more suitable for plant development, since it improves survival, growth, dry matter production, nutritional status, and vigor of T. ananassae micropropagated plants.

Influence of infusion line compliance on drug delivery rate during acute line loop formation.

OBJECTIVE: To determine whether infusion line compliance contributes to irregular drug delivery during vertical displacement of syringe pumps. DESIGN: Five different commercially available infusion lines were studied at infusion rates of 0.5, 1.0, and 1.5 ml/h. Zero drug delivery time was measured after acute line loop formation (70 cm) using an electronic balance. Compliance of each infusion line was calculated using a pressure transducer and measurement of the occlusion release bolus at 300 mmHg occlusion pressure. Finally, the influence of infusion line compliance on drug delivery during acute lowering of the syringe pump was studied using low- and high-compliance infusion lines. RESULTS: Acute line loop formation resulted in zero drug delivery time from 5.1 +/- 1.5 to 44.0 +/- 6.8 s at flow rates of 0.5 ml/h. Increased flow rates significantly reduced loop-induced flow variability. A close correlation was found between zero drug delivery time and calculated infusion line compliance at 0.5 ml/h (linear regression R2 = 0.79). Lowering of the syringe pump 50 cm prolonged zero drug delivery time from 295.8 +/- 20.7 s with the low-compliance tube to 463.3 +/- 24.0 s with the high-compliance infusion line. CONCLUSIONS: Infusion line compliance contributes to irregular drug delivery associated with vertical displacement of syringe pumps. Siphoning of the infusion line during patient care should be avoided, and flow rates of 1 ml/h or higher are recommended. Low-compliance infusion lines are indicated whenever highly short-acting vasoactive drugs at low delivery rates are administered.

Prepregnancy body mass index and resting metabolic rate during pregnancy.

AIM: The resting metabolic rate (RMR) varies among pregnant women. The factors responsible for this variability are unknown. This study aimed to assess the influence of the prepregnancy body mass index (BMI) on the RMR during late pregnancy. METHODS: RMR, height, weight, and total (TEE) and activity (AEE) energy expenditures were measured in 46 healthy women aged 31 ± 5 years (mean ± SD) with low (<19.8), normal (19.8-26.0), and high (>26.0) prepregnancy BMI at 38.2 ± 1.5 weeks of gestation (t(gest)) and 40 ± 7 weeks postpartum (t(post)) (n = 27). RESULTS: The mean t(gest) RMR for the low-, normal-, and high-BMI groups was 1,373, 1,807, and 2,191 kcal/day, respectively (p = 0.001). The overall mean t(gest) RMR was 316 ± 183 kcal/day (21%), higher than the overall mean t(post) value and this difference was correlated with gestational weight gain (r = 0.78, p < 0.001). The scaled metabolic rate by allometry (RMR/kilograms⁰·⁷³) was similar in the low-, normal-, and high-BMI groups, respectively (p = 0.45). Changes in t(gest) TEE closely paralleled changes in t(gest) RMR (r = 0.84, p < 0.001). AEE was similar among the BMI groups. CONCLUSION: The RMR is significantly increased in the third trimester of pregnancy. The absolute gestational RMR is higher in women with high prepregnancy BMI due to increased body weight. The scaled metabolic rate (RMR/kilograms⁰·⁷³) is similar among the BMI groups of pregnant women.

Microsatellite markers in analysis of resistance to coffee leaf miner in Arabica coffee

The objective of this work was to analyze coffee (Coffea arabica) genotypes resistant to the coffee leaf miner (Leucoptera coffeella) using microsatellite markers. Sixty-six loci were evaluated, of which 63 were obtained from the Brazilian Coffee Expressed Sequence Tag (EST) database. These loci were amplified in bulks of individuals from F5 progenies of 'Siriema' (C. arabica x C. racemosa) resistant and susceptible to the insect, in eight samples of C. racemosa, and in a F6 population of 'Siriema' with 91 individuals segregating for resistance to the leaf miner. Polymorphisms were verified for two simple sequence repeat (SSR) loci in bulks of the susceptible progenies. The two polymorphic alleles were present in around 70% of the susceptible genotypes in F5 and in approximately 90% of the susceptible individuals in F6. However, the polymorphic EST-SSR markers among populations contrasting for resistance to leaf miner were not correlated to the evaluated characteristics. SSR markers show inter- and intraspecific polymorphism in C. arabica and C. racemosa.

Leaf miner incidence in coffee plants under different drip irrigation regimes and planting densities

The objective of this work was to evaluate the effect of different drip irrigation regimes and planting densities on the incidence of the leaf miner, Leucoptera coffeella, in arabica coffee plants for one year. The experiment was carried out in 2008, in a complete randomized block design, in a split-plot in time arrangement, with four replicates. The treatments consisted of four drip irrigation regimes - soil water balance, irrigations at 20 and 60 kPa soil tensions, and a nonirrigated treatment -, which were distributed at three plant densities: 2, 500, 5, 000, and 10, 000 plants per hectare. The evaluations were made on a monthly basis between January and December 2008. The highest pest occurrence period was from August to November, a season with low-air relative humidity preceded by a drought period. Irrigated coffee plants showed an incidence of intact mines 2.2 times lower than that of nonirrigated plants. Irrigation and increasing of plant density contribute to the reduction of coffee leaf miner occurrence.

Leaf-cutting ant attack in initial pine plantations and growth of defoliated plants

The objective of this work was to evaluate the natural attack by Acromyrmex crassispinus in initial Pinus taeda plantations without control measures against ants, as well as the effect of defoliation in seedlings of P. taeda. Evaluations of the attack of leaf-cutting ants on P. taeda plantations were done monthly in the first six months, then 9 and 12 months after planting. The percentages of plants that were naturally attacked by ants were registered. The effect of defoliation was evaluated by artificial defoliation, simulating the natural patterns of attack by A. crassispinus on P. taeda seedlings. The natural attack of A. crassispinus was greater during the first months after planting, being more intense in the first 30 days. Artificial defoliation indicated that there were no significant losses in diameter and height in plants with less than 75% defoliation. However, there were significant losses in diameter and height in plants with 100% defoliation, independently of the cut of the apical meristem, and also plant death. The control of leaf-cutting ants in P. taeda plantings, in which A. crassispinus is the most frequent leaf-cutting ant, should be intense only at the beginning of planting, since the most severe attacks occur during this time.

Translocation of cyanogenic glycosides in rubber tree crown clones resistant to South American leaf blight

The objective of this work was to assess the possible transport of cyanogenic glycosides from leaves of rubber tree crown clones (Hevea spp.) resistant to South American leaf blight to the trunk of the panel clones in which they are grafted. The cyanogenic potential (HCNp) of the crown clones was determined in the trunk bark, at different distances from the cambium, and its gradient was evaluated along the trunk. The correlation between the HCNp of the crown leaves and that of the trunk bark was also evaluated. HCNp determined in leaves showed a wide range variation in the species studied as crown clones, with the lowest values registered in H. nitida clones, and the highest ones in H. rigidifolia. In the trunk bark, the tissue layer nearer the cambium showed higher HCNp values. A positive basipetal gradient was observed along the trunk, i.e., there was an increase in HCNp from the apex toward the base. Although the grafted crowns influence the cyanogenic potential of the trunk bark of panel clones, the absence of correlation between the HCNp of the leaves and trunk bark indicates that the crown is not the main source of the cyanogenic glycosides found in the trunk.

Association of urethral toxicity with dose exposure in combined high-dose-rate brachytherapy and intensity-modulated radiation therapy in intermediate- and high-risk prostate cancer.

INTRODUCTION: To report acute and late toxicities in patients with intermediate- and high-risk prostate cancer treated with combined high-dose-rate brachytherapy (HDR-B) and intensity-modulated radiation therapy (IMRT). MATERIALS AND METHODS: From March 2003 to September 2005, 64 men were treated with a single implant HDR-B with 21 Gy given in three fractions, followed by 50 Gy IMRT along with organ tracking. Median age was 66.1 years, and risk of recurrence was intermediate in 47% of the patients or high in 53% of the patients. Androgen deprivation therapy was received by 69% of the patients. Toxicity was scored according to the CTCAE version 3.0. Median follow-up was 3.1 years. RESULTS: Acute grade 3 genitourinary (GU) toxicity was observed in 7.8% of the patients, and late grades 3 and 4 GU toxicity was observed in 10.9% and 1.6% of the patients. Acute grade 3 gastrointestinal (GI) toxicity was experienced by 1.6% of the patients, and late grade 3 GI toxicity was absent. The urethral V(120) (urethral volume receiving &gt; or =120% of the prescribed HDR-B dose) was associated with acute (P=.047) and late &gt; or = grade 2 GU toxicities (P=.049). CONCLUSIONS: Late grades 3 and 4GU toxicity occurred in 10.9% and 1.6% of the patients after HDR-B followed by IMRT in association with the irradiated urethral volume. The impact of V(120) on GU toxicity should be validated in further studies.

Forage production of elephant grass under intermittent stocking

The objective of this work was to evaluate the dry matter production of elephant grass (Pennisetum purpureum) genotypes, managed under intermittent stocking. A completely randomized design was used, with two genotypes and three replicates. The treatments consisted of factorial combinations (2x2x2) of genotypes ('BRS Kurumi' and the clone CNPGL 00‑1‑3), two light interception levels (LI) at the onset of grazing (90 and 95%), and two post‑grazing canopy heights (30 and 50 cm). A total of 24 Holstein x Zebu crossbred heifers were used. The stocking density varied in order to finish the grazing periods in two days. The interval between the defoliation, based on 95% LI, resulted in a higher leaf mass per grazing cycle. The post‑grazing height of 30 cm did not affect the number of grazing cycles but provided a greater herbage accumulation rate. The cultivar BRS Kurumi has higher pasture growth, lower rest period, and greater number of grazing cycles, which results in increased forage production in the growing season.

Toxicity of organic farming‑compatible products to the coffee leaf miner

The objective of this work was to evaluate the toxicity of organic farming‑compatible products to the coffee leaf miner Leucoptera coffeella. Lime sulphur, enriched Bordeaux mixture (Viça Café Plus), and the "supermagro" biofertilizer were first tested in laboratory. The most promising product was tested afterwards under field conditions. In laboratory, different concentrations of each product were applied on L. coffeella eggs and on infested coffee‑mined leaves. Only lime sulphur had ovicidal effects at an acceptable concentration (1.6%) for field applications, but no significant effect on larvae mortality was found. Enriched Bordeaux mixture and the "supermagro" biofertilizer had no effect on L. coffeella eggs and larvae. In the field trial, biweekly or monthly sprayings of lime sulphur at different concentrations caused population decrease after 30 days; however, this effect was not significant after 60 or 90 days.