Déficits dans les apports nutritionnels chez les candidats a la chirurgie bariatrique [Nutritional deficiencies in candidates for bariatric surgery]

98% of patients who have undergone a gastric bypass for treating severe obesity develop multiple micronutrient deficits. However, prior to surgery, it isn't rare to find nutrient deficiencies. Indeed, the dietary intakes of surgery candidates are often unbalanced, lacking in variety especially in high vitamin and mineral nutrients. We present the preliminary results concerning the qualitative and quantitative analysis in a group of patients waiting for a gastric bypass. The recommended daily amounts in vitamin B9, vitamin D and iron are insufficient in the majority of the patients. The correction of nutritional intakes is advisable, even before the surgery, in order to reduce the risks of developing biological deficiencies.

Thrombin-receptor antagonist vorapaxar in acute coronary syndromes

Background: Vorapaxar is a new oral protease-activatedreceptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet activation. Methods: In this multinational, double-blind, randomized trial, we compared vorapaxar with placebo in 12,944 patients who had acute coronary syndromes without ST-segment elevation. The primary end point was a composite of death from cardiovascular causes, myocardial infarction, stroke, recurrent ischemia with rehospitalization, or urgent coronary revascularization. RESULTS: Follow-up in the trial was terminated early after a safety review. After a median follow-up of 502 days (interquartile range, 349 to 667), the primary end point occurred in 1031 of 6473 patients receiving vorapaxar versus 1102 of 6471 patients receiving placebo (KaplanMeier 2-year rate, 18.5% vs. 19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to 1.01; P = 0.07). A composite of death from cardiovascular causes, myocardial infarction, or stroke occurred in 822 patients in the vorapaxar group versus 910 in the placebo group (14.7% and 16.4%, respectively; hazard ratio, 0.89; 95% CI, 0.81 to 0.98; P = 0.02). Rates of moderate and severe bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo group (hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P<0.001). Intracranial hemorrhage rates were 1.1% and 0.2%, respectively (hazard ratio, 3.39; 95% CI, 1.78 to 6.45; P<0.001). Rates of nonhemorrhagic adverse events were similar in the two groups. Conclusions: In patients with acute coronary syndromes, the addition of vorapaxar to standard therapy did not significantly reduce the primary composite end point but significantly increased the risk of major bleeding, including intracranial hemorrhage. (Funded by Merck; TRACER ClinicalTrials.gov number, NCT00527943.)

The effect of n-3 enriched nutrition therapy on post-operative cognitive dysfunction after cardiac surgery

Background: Postoperative cognitive dysfunction (POCD) occurs frequently after cardiac surgery. Some data suggest that inflammation plays a key role in the development of POCD. N-3 fatty acids have been shown to have a beneficial effect on inflammation. We hypothesised that perioperative n-3 enriched nutrition therapy would reduce the incidence of POCD in this group of patients. Methods: Randomized, double blind placebo controlled trial in patients aged 65 or older undergoing elective cardiac surgery with cardiopulmonary bypass. 2x 250 mL placebo (Ensure Plus™, Abbott Nutrition) or n-3 enriched nutrition therapy (ProSure™ Abbott Nutrition) were administered for ten days starting 5 days prior to surgery. Cognition was assessed preoperatively and 7 days after surgery with the Consortium to Establish a Registry for Alzheimer's Disease - Neuropsychological Assessment Battery (CERAD-NAB) [1]. Results: 16 patients were included. Mean age was 72 } 5.3 for placebo and 75 } 4.8 for ProSure™ respectively. CRP and IL-6 did not differ significantly between groups preoperatively and on postoperative days 1, 3, and 7. Preoperative CERAD total scores were 86 } 10 and 81 } 9 (p = n.s.) for Placebo and ProSure™, respectively. Postoperative scores were 88 } 12, and 77 } 19 (p = n.s.) The change in score was not different between the two groups (Placebo: +3 } 5; ProSure: -5 } 11). Conclusion: In this very small sample no effect of preoperatively started n-3 enriched nutritional supplements on inflammation or cognitive functions were detected. However, there is a large likelihood of a type II error and more patients need to be included to assess possible beneficial effects of this intervention in elderly patients undergoing elective cardiac surgery. 1 Chandler MJ, et al. Neurology. 2005;65:102-6.

The Use of Fly Ash in Highway Construction, HR-1031, 1990

In 1982 the Iowa DOT allowed a successful bidder the option of submitting materials and proportions using fly ash to produce a portland cement concrete (PCC) paving mixture to meet a specified compressive strength. The contractor, Irving F. Jensen, received approval for the use of a concrete mixture utilizing 500 lbs. of portland cement and 88 lbs. of fly ash as a replacement of 88 lbs. of portland cement. The PCC mixture was utilized on the Muscatine County US 61 relocation bypass paved as project F-61-4(32)--20-70. A Class "C" fly ash obtained from the Chillicothe electric generating plant approximately 100 miles away was used in the project. This use of fly ash in lieu of portland cement resulted in a cost savings of $64,500 and an energy savings of approximately 16 billion BTU. The compressive strength of this PCC mixture option was very comparable to concrete mixtures produced without the use of fly ash. The pavement has been performing very well. The substitution of fly ash for 15% of the cement has been allowed as a contractor's option since 1984. Due to the cost savings, it has been used in almost all Iowa PCC paving since that time.

Hyperkalemia. A prognostic factor during acute severe hypothermia.

When hypothermic patients appear to be dead, the decision to resuscitate may be difficult due to lack of reliable criteria of death. To discover useful prognostic indicators, we reviewed the hospital charts of nine hypothermic victims of snow avalanches (group A: median value of rectal temperature, 29.6 degrees C; range, less than 12 degrees C to 34 degrees C) and of 15 patients with hypothermia following acute drug intoxication and/or cold exposure (group B: 28.8 degrees C; range, 25.5 degrees C to 32 degrees C. In group A, plasma potassium level on admission was extremely high (14.5 mmol/L; range, 6.8 to 24.5 mmol/L) compared with that obtained in group B (3.5 mmol/L; range, 2.7 to 5.3 mmol/L). All patients in group A were in cardiorespiratory arrest. None could be successfully resuscitated despite effective rewarming by cardiopulmonary bypass or peritoneal lavage. In contrast, all of the patients in group B recovered from hypothermia, including two in cardiorespiratory arrest. Thus, extreme hyperkalemia during acute hypothermia appears to be a reliable marker of death. It might be used to select those patients in whom heroic resuscitation efforts can be useful.

Evaluation of the Iowa Department of Transportation's Compensatory Wetland Mitigation Program, TR-500, 2004

The purpose of this investigation was to evaluate the Compensatory Wetland Mitigation Program at the Iowa Department of Transportation (DOT) in terms of regulatory compliance. Specific objectives included: 1) Determining if study sites meet the definition of a jurisdictional wetland. 2) Determining the degree of compliance with requirements specified in Clean Water Act Section 404 permits. A total of 24 study sites, in four age classes were randomly selected from over 80 sites currently managed by the Iowa DOT. Wetland boundaries were delineated in the field and mitigation compliance was determined by comparing the delineated wetland acreage at each study site to the total wetland acreage requirements specified in individual CWA Section 404 permits. Of the 24 sites evaluated in this study, 58 percent meet or exceed Section 404 permit requirements. Net gain ranged from 0.19 acre to 27.2 acres. Net loss ranged from 0.2 acre to 14.6 acres. The Denver Bypass 1 site was the worst performer, with zero acres of wetland present on the site and the Akron Wetland Mitigation Site was the best performer with slightly more than 27 acres over the permit requirement. Five of the 10 under-performing sites are more than five years post construction, two are five years post construction, one is three years post construction and the remaining two are one year post construction. Of the sites that meet or exceed permit requirements, approximately 93 percent are five years or less post construction and approximately 43 percent are only one year old. Only one of the 14 successful sites is more than five years old. Using Section 404 permit acreage requirements as the criteria for measuring success, 58 percent of the wetland mitigation sites investigated as part of this study are successful. Using net gain/loss as the measure of success, the Compensatory Wetland Mitigation Program has been successful in creating/restoring nearly 44 acres of wetland over what was required by permits.

Rivascolarizzazione miocardica con arteria radiale: tecniche chirurgiche a confronto e risultati a breve termine [Myocardial revascularization and radial artery: different surgical strategies and short-term results]

BACKGROUND: The radial artery is routinely used as a graft for surgical arterial myocardial revascularization. The proximal radial artery anastomosis site remains unknown. In this study, we analyzed the short-term results and the operative risk determinants after having used four different common techniques for radial artery implantation. METHODS: From January 2000 to December 2004, 571 patients underwent coronary artery bypass grafting with radial arteries. Data were analyzed for the entire population and for subgroups following the proximal radial artery anastomosis site: 140 T-graft with the mammary artery (group A), 316 free-grafts with the proximal anastomosis to the ascending aorta (group B), 55 mammary arteries in situ elongated with the radial artery (group C) and 60 radial arteries elongated with a piece of mammary artery and anastomosed to the ascending aorta (group D). RESULTS: The mean age was 53.8 +/- 7.7 years; 55.5% of patients had a previous myocardial infarction and 73% presented with a satisfactory left ventricular function. A complete arterial myocardial revascularization was achieved in 532 cases (93.2%) and 90.2% of the procedures were performed under cardiopulmonary bypass and cardioplegic arrest. The operative mortality rate was 0.9%, a postoperative myocardial infarction was diagnosed in 19 patients (3.3%), an intra-aortic balloon pump was used in 10 patients (1.7%) and a mechanical circulatory device was implanted in 2 patients. The radial artery harvesting site remained always free from complications. The proximal radial artery anastomosis site was not a determinant of early hospital mortality. Group C showed a higher risk of postoperative myocardial infarction (p = 0.09), together with female gender (p = 0.003), hypertension (p = 0.059) and a longer cardiopulmonary bypass time. CONCLUSIONS: The radial artery and the mammary artery can guarantee multiple arterial revascularization also for patients with contraindications to double mammary artery use. The four most common techniques for proximal radial artery anastomosis are not related to a higher operative risk and they can be used alternatively to reach the best surgical results

Crossed ataxia: a case report and a diffusion tensor imaging tractography study.

Background and Purpose-Ever since the seminal description of ataxic hemiparesis contralateral to a pontine lesion by Miller-Fisher, the question of why contralesional crossing pontocerebellar fibers do not more frequently produce ipsilesional hemiataxia was raised. The few cases of "quadrataxic hemiparesis" or bilateral leg ataxia remain exceptions.Summary of Case-We report an even more unusual variant, namely "crossed ataxia" of the contralesional arm and the ipsilesional leg subsequent to an anteromedial pontine ischemic stroke.Conclusions-MRI diffusion tensor imaging tractography shows that caudal contralesional crossing pontocerebellar fibers (those for the leg) travel trough the lesion, whereas more rostral fibers (those for the arm) are spared. (Stroke. 2011; 42:e571-e573.)

Evidence for morphological and adaptive genetic divergence between lake and stream habitats in European minnows (Phoxinus phoxinus, Cyprinidae).

Natural selection drives local adaptation, potentially even at small temporal and spatial scales. As a result, adaptive genetic and phenotypic divergence can occur among populations living in different habitats. We investigated patterns of differentiation between contrasting lake and stream habitats in the cyprinid fish European minnow (Phoxinus phoxinus) at both the morphological and genomic levels using geometric morphometrics and AFLP markers, respectively. We also used a spatial correlative approach to identify AFLP loci associated with environmental variables representing potential selective forces responsible for adaptation to divergent habitats. Our results identified different morphologies between lakes and streams, with lake fish presenting a deeper body and caudal peduncle compared to stream fish. Body shape variation conformed to a priori predictions concerning biomechanics and swimming performance in lakes vs. streams. Moreover, morphological differentiation was found to be associated with several environmental variables, which could impose selection on body and caudal peduncle shape. We found adaptive genetic divergence between these contrasting habitats in the form of 'outlier' loci (2.9%) whose genetic divergence exceeded neutral expectations. We also detected additional loci (6.6%) not associated with habitat type (lake vs. stream), but contributing to genetic divergence between populations. Specific environmental variables related to trophic dynamics, landscape topography and geography were associated with several neutral and outlier loci. These results provide new insights into the morphological divergence and genetic basis of adaptation to differentiated habitats.

Neoangiogênese de retalhos cutâneos em ratos tratados com óleo de copaíba

O objetivo deste trabalho foi avaliar morfometricamente a neoangiogênese de retalhos cutâneos subdérmicos em ratos tratados com óleo de copaíba (Copaifera langsdorffii) em pomada a 10%. O delineamento experimental foi inteiramente casualizado, composto por três recursos farmacológicos. Foram utilizadas dez repetições para cada recurso, e cada animal foi considerado uma unidade experimental. Trinta ratos Wistar foram submetidos à elevação do retalho cutâneo dorsal subdérmico e distribuídos em três grupos: grupo controle absoluto, no qual os animais não receberam nenhum tratamento; grupo controle, no qual os animais receberam tratamento tópico diário com pomada com apenas veículo (glicerina e vaselina); e grupo tratado, no qual os animais foram tratados diariamente com óleo de copaíba em pomada a 10%. Os ratos foram tratados e observados por oito dias após o ato operatório. No oitavo dia de pós-operatório, realizou-se a análise macroscópica do retalho e foram coletados fragmentos das porções cranial, média e caudal do retalho cutâneo para análise histopatológica. A análise morfométrica mostrou diferença significativa para o número de novos vasos sanguíneos nas partes média e caudal do retalho cutâneo no grupo tratado. O óleo de copaíba mostra-se eficiente no aumento da neoangiogênese em retalhos cutâneos subdérmicos de ratos.

Polimorfismo no gene GH1-PstI associado a características corporais de linhagens de tilápia-do-nilo

O objetivo deste trabalho foi determinar a associação de polimorfismos no gene do hormônio crescimento GH1 às características corporais, em linhagens de tilápia-do-nilo (Oreochromis niloticus). Foram coletados fragmentos da nadadeira caudal de exemplares das linhagens, aos cinco meses de idade, para as análises de "polymerase chain reaction-restriction fragment lenght polymorphism" (PCR-RFLP). Foram realizadas as seguintes mensurações: comprimento total, comprimento padrão, altura, largura e comprimento da cabeça. Realizou-se a amplificação de um fragmento com 652 pb do gene GH1, com subsequente restrição com a enzima PstI. Para a análise de associação do marcador molecular com as características quantitativas, utilizou-se o procedimento GLM do SAS. O polimorfismo descrito para o íntron 1, do gene GH1 da tilápia-do-nilo, apresentou correlação significativa com o comprimento total, comprimento padrão, altura e largura corporal. Foi verificado que o genótipo PstI+/- está associado ao melhor crescimento, independentemente da linhagem. A associação verificada pode ter ocorrido em razão do efeito direto da regulação do próprio gene GH.

Managing Decisions Regarding Rural Expressway Routes and Associated Highway Bypasses, 2009

For several years, the Iowa Department of Transportation has constructed bypasses along rural highways. Most bypasses were constructed on the state’s Commercial Industrial Network (CIN). Now that work on the CIN has been completed and the system is open to traffic, it is possible to study the impacts of bypasses. In the past, construction of highway bypasses has led community residents and business people to raise concerns about the loss of business activity. For policy development purposes, it is essential to understand the impacts that a bypass might have on safety, the community, and economics. By researching these impacts, policies can be produced to help to alleviate any negative impacts and create a better system that is ultimately more cost-effective. This study found that the use of trade area analysis does not provide proof that a bypass can positively or negatively impact the economy of a rural community. The analysis did show that, even though the population of a community may be stable for several years and per capita income is increasing, sales leakage still occurs. The literature, site visits, and data make it is apparent that a bypass can positively affect a community. Some conditions that would need to exist in order to maximize a positive impact include the installation of signage along the bypass directing travelers to businesses and services in the community, community or regional plans that include the bypass in future land development scenarios, and businesses adjusting their business plans to attract bypass users. In addition, how proactive a community is in adapting to the bypass will determine the kinds of effects felt in the community. Results of statistical safety analysis indicate that, at least when crashes are separated by severity, bypasses with at-grade accesses appear to perform more poorly than either the bypasses with fully separated accesses or with a mix of at-grade and fully separated accesses. However, the benefit in terms of improved safety of bypasses with fully separated accesses relative to bypasses with a mixed type of accesses is not statistically conclusive.

Enteral nutrition and cardiovascular failure: from myths to clinical practice.

Cardiovascular failure and low flow states may arise in very different conditions from both cardiac and noncardiac causes. Systemic hemodynamic failure inevitably alters splanchnic blood flow but in an unpredictable way. Prolonged low splanchnic blood flow causes intestinal ischemia, increased mucosal permeability, endotoxemia, and distant organ failure. Mortality associated with intestinal ischemia is high. Why would enteral nutrition (EN) be desirable in these complex patients when parenteral nutrition could easily cover energy and substrate requirements? Metabolic, immune, and practical reasons justify the use of EN. In addition, continuous enteral feeding minimizes systemic and myocardial oxygen consumption in patients with congestive heart failure. Further, early feeding in critically ill mechanically ventilated patients has been shown to reduce mortality, particularly in the sickest patients. In a series of cardiac surgery patients with compromised hemodynamics, absorption has been maintained, and 1000-1200 kcal/d could be delivered by enteral feeding. Therefore, early EN in stabilized patients should be attempted, and can be carried out safely under close clinical monitoring, looking for signs of incipient intestinal ischemia. Energy delivery and balance should be monitored, and combined feeding considered when enteral feeds cannot be advanced to target within 4-6 days.

Dissociation between components of spatial memory in rats after recovery from the effects of retrohippocampal lesions

A series of 4 experiments examined the performance of rats with retrohippocampal lesions on a spatial water-maze task. The animals were trained to find and escape onto a hidden platform after swimming in a large pool of opaque water. The platform was invisible and could not be located using olfactory cues. Successful escape performance required the rats to develop strategies of approaching the correct location with reference solely to distal extramaze cues. The lesions encompassed the entire rostro-caudal extent of the lateral and medial entorhinal cortex, and included parts of the pre- and para-subiculum, angular bundle and subiculum. Groups ECR 1 and 2 sustained only partial damage of the subiculum, while Group ECR+S sustained extensive damage. These groups were compared with sham-lesion and unoperated control groups. In Expt 1A, a profound deficit in spatial localisation was found in groups ECR 1 and ECR+S, the rats receiving all training postoperatively. In Expt 1B, these two groups showed hyperactivity in an open-field. In Expt 2, extensive preoperative training caused a transitory saving in performance of the spatial task by group ECR 2, but comparisons with the groups of Expt 1A revealed no sustained improvement, except on one measure of performance in a post-training transfer test. All rats were then given (Expt 3) training on a cueing procedure using a visible platform. The spatial deficit disappeared but, on returning to the normal hidden platform procedure, it reappeared. Nevertheless, a final transfer test, during which the platform was removed from the apparatus, revealed a dissociation between two independent measures of performance: the rats with ECR lesions failed to search for the hidden platform but repeatedly crossed its correct location accurately during traverses of the entire pool. This partial recovery of performance was not (Expt 4) associated with any ability to discriminate between two locations in the pool. The apparently selective recovery of aspects of spatial memory is discussed in relation to O'Keefe and Nadel's (1978) spatial mapping theory of hippocampal function. We propose a modification of the theory in terms of a dissociation between procedural and declarative subcomponents of spatial memory. The declarative component is a flexible access system in which information is stored in a form independent of action. It is permanently lost after the lesion. The procedural component is "unmasked" by the retrohippocampal lesion giving rise to the partial recovery of spatial localisation performance.