Nonlinear pulse compression of a 200 mJ and 1†kW ultrafast thin-disk amplifier.

We present a high-energy laser source consisting of an ultrafast thin-disk amplifier followed by a nonlinear compression stage. At a repetition rate of 5 kHz, the drive laser provides a pulse energy of up to 200 mJ with a pulse duration below 500 fs. Nonlinear broadening is implemented inside a Herriott-type multipass cell purged with noble gas, allowing us to operate under different seeding conditions. Firstly, the nonlinear broadening of 64 mJ pulses is demonstrated in an argon-filled cell, showing a compressibility down to 32 fs. Finally, we employ helium as a nonlinear medium to increase the energy up to 200 mJ while maintaining compressibility below 50 fs. Such high-energy pulses with sub-50 fs duration hold great promise as drivers of secondary sources.

Can elderly patients regain their preoperative functional level after distal radius fracture type A? Results from a fracture register study using PROM.

Introduction: Although distal radius fractures (DRFs) are the most common fractures of the human body, there are still ongoing debates concerning the treatment for type A fractures, especially in elderly patients. In spite of good clinical outcomes, it remains unclear whether elderly patients, especially, could regain the preoperative functional level of the wrist. Therefore, we have quantified wrist function within a retrospective study design using patient-reported outcome measures (PROM) and we have analyzed the influence of age between control and patient collective and young vs. old, respectively. Patients and methods: The retrospective study included all patients with a surgically treated DRF type A and a control group of healthy patients, age and gender matched. The function of the wrist was examined by using a self-assessment questionnaire called the Munich Wrist Questionnaire (MWQ) according to the patient-related outcome measurements PROM. Results: We could enroll 110 patients and controls, and the average follow-up was 66 months. Subgroup matching induced similar age group distribution: in both groups, 7 individuals <30 years, 67 between 31 and 64 years, 29 between 65 and 79 years, and 7 individuals >80 years, were enrolled, respectively. In the fracture group, women were significantly older than men (59 ± 15 vs. 47 ± 17 (M ± SD). There was no significant difference between the control and the patient groups (96 ± 6 vs. 95 ± 7). The function was significantly different between controls and patients <30 years (100 ± 1 vs. 98 ± 2). In the control group, there was a functional difference in the age group <30 compared with 65-79 and >80 and in the age group 30-64 compared with 65-79 and >80. In the control group, the function was found to be significantly decreasing with advancing age, whereas in the patient group, this influence was absent. A correlation analysis showed a worse function with increasing age in the control group and therefore a negative correlation. In the fracture group, a similar result could not be obtained. Discussion: Age has a relevant influence on wrist function. Although the wrist function decreases significantly with aging, in the patient group, this influence is absent, and the functional results after surgery are excellent. Even elderly patients can regain their preoperative functional level.

A Phase 1 Proof of Concept Study Evaluating the Addition of an LSD1 Inhibitor to Nab-Paclitaxel in Advanced or Metastatic Breast Cancer (EPI-PRIMED).

Objective: Lysine-Specific Demethylase-1 (LSD1) is overexpressed in breast cancer cells and facilitate mesenchymal properties which may contribute to therapeutic resistance and cancer progression. The purpose of this study was to investigate the safety of combination, nab-paclitaxel and phenelzine, an irreversible LSD1 inhibitor in patients with metastatic breast cancer (mBC). Methods: Eligible patients with mBC were treated with nab-paclitaxel (100mg/m2) weekly for 3 weeks with one week break in a 28-day cycle. Dose escalation of phenelzine followed the Cumulative Cohort Design and phenelzine treatment commenced from day 2 of first cycle. Eleven patients were screened, and eligible patients were enrolled in cohorts with the dose of phenelzine ranging from 45mg to 90mg. Results: The Optimum Biological Dose was established at 60mg of phenelzine daily in combination with nab-paclitaxel and considered as the recommended phase 2 dose. Most (95%) of adverse events were grade 1 or 2 with two grade 3 events being diarrhea and neutropenia at 45mg and 60mg phenelzine respectively, with no unexpected toxicity/deaths. Commonly reported toxicities were fatigue (n=4,50%), dizziness (n=6,75%), neutropenia (n=3,37.5%), peripheral neuropathy (n=3,37.5%), diarrhea (n=2,25%), and hallucination (n=2,25%). After a median follow up of 113 weeks, all patients showed disease progression on trial with 4 patients being alive at the time of data cut off, including one patient with triple negative breast cancer. Median progression-free survival was 34 weeks. Significant inhibition of LSD1 and suppression of mesenchymal markers in circulating tumor cells were noted. Conclusion: Phenelzine in combination with nab-paclitaxel was well tolerated, without any unexpected toxicities in patients with mBC and demonstrated evidence of antitumor activity. For the first time, this proof-of-concept study showed in-vivo inhibition of LSD1 suppressed mesenchymal markers, which are known to facilitate generation of cancer stem cells with metastatic potential. Clinical Trial Registration: ClinicalTrials.Gov NCT03505528, UTN of U1111-1197-5518.

Nonlinear pulse compression of a thin-disk amplifier and contrast enhancement via nonlinear ellipse rotation.

We demonstrate pulse compressibility from 840 fs to 38 fs of 10 mJ pulses from a thin-disk amplifier at a repetition rate of 3 kHz after nonlinear broadening in a multipass cell. In addition, the temporal-intensity contrast is enhanced via nonlinear ellipse rotation of more than a factor 50 with an optical efficiency of 56%. We believe this is the first published experimental combination of multipass cell-based nonlinear compression and nonlinear ellipse rotation-based contrast enhancement preserving both pulse compressibility and beam quality.

Selective Targeting of Protein Kinase C (PKC)-θ Nuclear Translocation Reduces Mesenchymal Gene Signatures and Reinvigorates Dysfunctional CD8+ T Cells in Immunotherapy-Resistant and Metastatic Cancers.

Protein kinase C (PKC)-θ is a serine/threonine kinase with both cytoplasmic and nuclear functions. Nuclear chromatin-associated PKC-θ (nPKC-θ) is increasingly recognized to be pathogenic in cancer, whereas its cytoplasmic signaling is restricted to normal T-cell function. Here we show that nPKC-θ is enriched in circulating tumor cells (CTCs) in patients with triple-negative breast cancer (TNBC) brain metastases and immunotherapy-resistant metastatic melanoma and is associated with poor survival in immunotherapy-resistant disease. To target nPKC-θ, we designed a novel PKC-θ peptide inhibitor (nPKC-θi2) that selectively inhibits nPKC-θ nuclear translocation but not PKC-θ signaling in healthy T cells. Targeting nPKC-θ reduced mesenchymal cancer stem cell signatures in immunotherapy-resistant CTCs and TNBC xenografts. PKC-θ was also enriched in the nuclei of CD8+ T cells isolated from stage IV immunotherapy-resistant metastatic cancer patients. We show for the first time that nPKC-θ complexes with ZEB1, a key repressive transcription factor in epithelial-to-mesenchymal transition (EMT), in immunotherapy-resistant dysfunctional PD1+/CD8+ T cells. nPKC-θi2 inhibited the ZEB1/PKC-θ repressive complex to induce cytokine production in CD8+ T cells isolated from patients with immunotherapy-resistant disease. These data establish for the first time that nPKC-θ mediates immunotherapy resistance via its activity in CTCs and dysfunctional CD8+ T cells. Disrupting nPKC-θ but retaining its cytoplasmic function may offer a means to target metastases in combination with chemotherapy or immunotherapy.

The percentage of Monocytes CD39+ is higher in Pregnant COVID-19 than in Non-Pregnant COVID-19 patients

Current medical guidelines consider COVID-19 pregnant women a high-risk group. Physiological gestation down regulates the immunological response to maintain "maternal-fetal tolerance"; hence, a SARS-CoV-2 infection constitutes a potentially threatening condition to both the mother and the fetus. To establish the immune profile in pregnant COVID-19+ patients a cross-sectional study was conducted. Leukocyte immunophenotype, mononuclear leukocyte response to polyclonal stimulus and cytokine/chemokine serum concentration were analyzed in pregnant fifteen COVID-19+ and control groups (fifteen non-pregnant COVID-19+, and thirteen pregnant COVID-19-women). Pregnant COVID-19+ patients exhibit lower percentages of monocytes HLA-DR+ compared with control groups. Nevertheless, pregnant COVID-19+ women show a higher percentage of monocytes CD39+ than controls. Furthermore, a higher concentration of TNF-, IL-6, MIP1b and IL-4 was observed within the pregnant COVID-19+ group. Our result shows that pregnant women express immunological characteristics that potentially mediate the immune response in COVID-19.

Targeting Nuclear LSD1 to Reprogram Cancer Cells and Reinvigorate Exhausted T Cells via a Novel LSD1-EOMES Switch.

Lysine specific demethylase 1 (LSD1) is a key epigenetic eraser enzyme implicated in cancer metastases and recurrence. Nuclear LSD1 phosphorylated at serine 111 (nLSD1p) has been shown to be critical for the development of breast cancer stem cells. Here we show that circulating tumor cells isolated from immunotherapy-resistant metastatic melanoma patients express higher levels of nLSD1p compared to responders, which is associated with co-expression of stem-like, mesenchymal genes. Targeting nLSD1p with selective nLSD1 inhibitors better inhibits the stem-like mesenchymal signature than traditional FAD-specific LSD1 catalytic inhibitors such as GSK2879552. We also demonstrate that nLSD1p is enriched in PD-1+CD8+ T cells from resistant melanoma patients and 4T1 immunotherapy-resistant mice. Targeting the LSD1p nuclear axis induces IFN-γ/TNF-α-expressing CD8+ T cell infiltration into the tumors of 4T1 immunotherapy-resistant mice, which is further augmented by combined immunotherapy. Underpinning these observations, nLSD1p is regulated by the key T cell exhaustion transcription factor EOMES in dysfunctional CD8+ T cells. EOMES co-exists with nLSD1p in PD-1+CD8+ T cells in resistant patients, and nLSD1p regulates EOMES nuclear dynamics via demethylation/acetylation switching of critical EOMES residues. Using novel antibodies to target these post-translational modifications, we show that EOMES demethylation/acetylation is reciprocally expressed in resistant and responder patients. Overall, we show for the first time that dual inhibition of metastatic cancer cells and re-invigoration of the immune system requires LSD1 inhibitors that target the nLSD1p axis.

Nuclear-Biased DUSP6 Expression is Associated with Cancer Spreading Including Brain Metastasis in Triple-Negative Breast Cancer.

DUSP6 is a dual-specificity phosphatase (DUSP) involved in breast cancer progression, recurrence, and metastasis. DUSP6 is predominantly cytoplasmic in HER2+ primary breast cancer cells, but the expression and subcellular localization of DUSPs, especially DUSP6, in HER2-positive circulating tumor cells (CTCs) is unknown. Here we used the DEPArray system to identify and isolate CTCs from metastatic triple negative breast cancer (TNBC) patients and performed single-cell NanoString analysis to quantify cancer pathway gene expression in HER2-positive and HER2-negative CTC populations. All TNBC patients contained HER2-positive CTCs. HER2-positive CTCs were associated with increased ERK1/ERK2 expression, which are direct DUSP6 targets. DUSP6 protein expression was predominantly nuclear in breast CTCs and the brain metastases but not pleura or lung metastases of TNBC patients. Therefore, nuclear DUSP6 may play a role in the association with cancer spreading in TNBC patients, including brain metastasis.

Lysine-Specific Histone Demethylase 1A Regulates Macrophage Polarization and Checkpoint Molecules in the Tumor Microenvironment of Triple-Negative Breast Cancer.

Macrophages play an important role in regulating the tumor microenvironment (TME). Here we show that classical (M1) macrophage polarization reduced expression of LSD1, nuclear REST corepressor 1 (CoREST), and the zinc finger protein SNAIL. The LSD1 inhibitor phenelzine targeted both the flavin adenine dinucleotide (FAD) and CoREST binding domains of LSD1, unlike the LSD1 inhibitor GSK2879552, which only targeted the FAD domain. Phenelzine treatment reduced nuclear demethylase activity and increased transcription and expression of M1-like signatures both in vitro and in a murine triple-negative breast cancer model. Overall, the LSD1 inhibitors phenelzine and GSK2879552 are useful tools for dissecting the contribution of LSD1 demethylase activity and the nuclear LSD1-CoREST complex to switching macrophage polarization programs. These findings suggest that inhibitors must have dual FAD and CoREST targeting abilities to successfully initiate or prime macrophages toward an anti-tumor M1-like phenotype in triple-negative breast cancer.

Infección del torrente sanguíneo en pacientes receptores de trasplante de precursores hematopoyéticos. Siete años de experiencia con adultos y niños / Bloodstream infection in patients receiving hematopoietic stem cell transplant. Seven years of experience with adults and children

Resumen Introducción: La infección del torrente sanguíneo es una complicación usual, que puede comprometer la vida de los pacientes que recibieron trasplante de precursores hematopoyéticos. Objetivo: Analizar las características de las infecciones del torrente sanguíneo en receptores de trasplante de precursores hematopoyéticos. Materiales y Métodos: Estudio observacional, retrospectivo. Se revisaron los registros de 451 pacientes (trasplantes autólogos y alogénicos), desde enero de 2009 a octubre de 2015. Resultados: Hubo 99 hemocultivos positivos en 73 pacientes con infección del torrente sanguíneo (16%). Mortalidad atribuible a causas infecciosas: 17%. De las 99 infecciones sanguíneas, 63% fueron provocados por bacilos gramnegativos (Escherichia coli 45%, Klebsiella spp 23%, Pseudomonas spp 11%, Acinetobacter spp 6% y otros bacilos gramnegativos 15%), 33% por cocáceas grampositivas, 3% por hongos y 1% por bacilos grampositivos. Se observó resistencia a ciprofloxacina (81%), piperacilina/tazobactam (48%), Enterobacteriaceae productoras de β-lactamasa de espectro extendido (BLEE) (40%), cefepime (39%) y ausencia de resistencia a amikacina. Discusión: Existe mayor frecuencia de infección por bacilos gramnegativos, con un importante porcentaje de aislados multi-resistentes, y consecuente, alta resistencia al tratamiento antimicrobiano empírico.

Background: Bloodstream infection is a common complication, which can be life-threatening for hematopoietic stem cells transplant recipients. Objective: To analyze the characteristics of bloodstream infections in hematopoietic stem cell transplant recipients. Materials and Methods: Observational, retrospective study. We reviewed the records of 451 patients (autologous and allogeneic transplants) from January 2009 to October 2015. Results: 99 positive blood cultures in 73 patients with bloodstream infection (16%) were found. Mortality attributable to infectious causes was 17%. From the 99 bloodstream infection, 63% were caused by gram-negative bacilli (Escherichia coli 45%, Klebsiella spp 23%, Pseudomonas spp 11% Acinetobacter spp % and other bacilli 15%), 33% by gram-positive cocci, 3% by fungi and 1% by gram-positive bacilli. The gram-negative bacilli were ciprofloxacin resistant (81%), piperacillin/tazobactam resistant (48%), extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (40%), cefepime resistant (39%) and there was no resistance noted to amikacin. Discussion: There is a higher frequency of gram-negative bacilli infection, with a high percentage of multiresistant microorganisms and high resistance to empirical antibiotic treatment.

[Bloodstream infection in patients receiving hematopoietic stem cell transplant. Seven years of experience with adults and children]. / Infección del torrente sanguíneo en pacientes receptores de trasplante de precursores hematopoyéticos. Siete años de experiencia con adultos y niños.

BACKGROUND: Bloodstream infection is a common complication, which can be life-threatening for hematopoietic stem cells transplant recipients. OBJECTIVE: To analyze the characteristics of bloodstream infections in hematopoietic stem cell transplant recipients. MATERIALS AND METHODS: Observational, retrospective study. We reviewed the records of 451 patients (autologous and allogeneic transplants) from January 2009 to October 2015. RESULTS: 99 positive blood cultures in 73 patients with bloodstream infection (16%) were found. Mortality attributable to infectious causes was 17%. From the 99 bloodstream infection, 63% were caused by gram-negative bacilli (Escherichia coli 45%, Klebsiella spp 23%, Pseudomonas spp 11% Acinetobacter spp % and other bacilli 15%), 33% by gram-positive cocci, 3% by fungi and 1% by gram-positive bacilli. The gram-negative bacilli were ciprofloxacin resistant (81%), piperacillin/tazobactam resistant (48%), extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (40%), cefepime resistant (39%) and there was no resistance noted to amikacin. DISCUSSION: There is a higher frequency of gram-negative bacilli infection, with a high percentage of multiresistant microorganisms and high resistance to empirical antibiotic treatment.

Reactivation of Chagas Disease in a Patient With Follicular Lymphoma Diagnosed by Means of Quantitative Real-Time Polymerase Chain Reaction.

We report a case of Chagas disease reactivation in a patient with stage IIb follicular lymphoma in the cecum. He was admitted to the hospital with neutropenia and fever. He had a history of right hemicolectomy 6 months earlier and had received the sixth cycle of chemotherapy with cyclophosphamide/doxorubicin/vincristine/prednisone/rituximab. Blood and urine cultures were negative, but the fever persisted. Reactivation of Chagas disease was confirmed by means of quantitative real-time polymerase chain reaction (qRT-PCR). Parasitic load was 577 950 parasite equivalents/mL. The patient began treatment with benznidazole 5 mg/k per day every 12 hours. After 1 month, the qRT-PCR control was undetectable. The patient completed 60 days of treatment and is currently asymptomatic. Trypanosoma cruzi qRT-PCR may become a useful diagnostic method for reactivation of Chagas disease.

Comparison of the effectiveness of a milk-free soy-maize-sorghum-based ready-to-use therapeutic food to standard ready-to-use therapeutic food with 25% milk in nutrition management of severely acutely malnourished Zambian children: an equivalence non-blinded cluster randomised controlled trial.

Community-based Management of Acute Malnutrition using ready-to-use therapeutic food (RUTF) has revolutionised the treatment of severe acute malnutrition (SAM). However, 25% milk content in standard peanut-based RUTF (P-RUTF) makes it too expensive. The effectiveness of milk-free RUTF has not been reported hitherto. This non-blinded, parallel group, cluster randomised, controlled, equivalence trial that compares the effectiveness of a milk-free soy-maize-sorghum-based RUTF (SMS-RUTF) with P-RUTF in treatment of children with SAM, closes the gap. A statistician randomly assigned health centres (HC) either to the SMS-RUTF (n = 12; 824 enrolled) or P-RUTF (n = 12; 1103 enrolled) arms. All SAM children admitted at the participating HCs were enrolled. All the outcomes were measured at individual level. Recovery rate was the primary outcome. The recovery rates for SMS-RUTF and P-RUTF were 53.3% and 60.8% for the intention-to-treat (ITT) analysis and 77.9% and 81.8% for per protocol (PP) analyses, respectively. The corresponding adjusted risk difference (ARD) and 95% confidence interval, were -7.6% (-14.9, 0.6%) and -3.5% (-9,6., 2.7%) for ITT (P = 0.034) and PP analyses (P = 0.257), respectively. An unanticipated interaction (interaction P < 0.001 for ITT analyses and 0.0683 for PP analyses) between the study arm and age group was observed. The ARDs were -10.0 (-17.7 to -2.3)% for ITT (P = 0.013) and -4.7 (-10.0 to 0.7) for PP (P = 0.083) analyses for the <24 months age group and 2.1 (-10.3,14.6)% for ITT (P = 0.726) and -0.6 (-16.1, 14.5) for PP (P = 0.939) for the ≥24 months age group. In conclusion, the study did not confirm our hypothesis of equivalence between SMS-RUTF and P-RUTF in SAM management.

Development and acceptability of a novel milk-free soybean-maize-sorghum ready-to-use therapeutic food (SMS-RUTF) based on industrial extrusion cooking process.

Peanut milk-based ready-to-use therapeutic food (P-RUTF) primarily used to treat severe acute malnutrition at community setting is expensive. We developed an alternative milk-free soybean-maize-sorghum-based RUTF (SMS-RUTF) using locally grown ingredients that have the potential to support local economy and reduce the cost of RUTF. We describe the production process and results of acceptability of the new product. Acceptability and tolerance of SMS-RUTF was compared with P-RUTF among 45 children aged 4-11 years old based on a cross-over design. Each child consumed 250 g RUTF for 10 days followed by a five-day washout period and a subsequent 10-day period on the second RUTF. The SMS-RUTF was as acceptable as the P-RUTF among normal children aged 4-11 years of age with no associated adverse effects. SMS-RUTF was stable for at least 12 months without detectable microbiological or chemical deterioration. The major challenge encountered in SMS-RUTF development was the difficulty to accurately determine key nutrient composition due to its high oil content. Use of diversified locally available ingredients to produce RUTF is feasible. The SMS-RUTF meets expected standards and is acceptable to children aged 4-11 months old. Effectiveness and cost-effectiveness of SMS-RUTF is required.

Anthropometric predictors of mortality in undernourished adults in the Ajiep Feeding Programme in Southern Sudan.

BACKGROUND: Various nutritional assessment tools are available to assess adult undernutrition, but few are practical in poorly served areas of low-income countries. OBJECTIVE: The objective was to assess the relation between midupper arm circumference (MUAC), weight, body mass index (BMI), and clinical assessment for edema in predicting mortality in adults with severe acute undernutrition. DESIGN: Demographic and anthropometric data that were collected in an observational study of 197 adults were analyzed. Participants were aged 18-59 y and were admitted to a therapeutic feeding center in Ajiep, Southern Sudan, during the height of the 1998 famine. Receiver operating curves were calculated and compared. RESULTS: The mean (±SD) age of the participants was 40.1 ±10.8 y, and the mean (±SD) MUAC, weight, and BMI (in kg/m(2)) were 16.4 ± 1.3 cm, 35.1 ± 5.2 kg, and 12.6 ± 1.5, respectively. The area under the receiver operating curve for MUAC (0.71) was higher (P = 0.01) than those of BMI (0.57) and weight (0.51). Mean age, weight, and BMI on admission did not differ between survivors and nonsurvivors (P > 0.17). MUAC and edema were independently associated with mortality. For every 1-cm increase in admission MUAC, the odds of subsequent mortality decreased by 58% (adjusted OR: 0.42; 95% CI: 0.28, 0.63; P < 0.001). CONCLUSIONS: In this study, which was conducted at the height of a major famine among adults with extremely severe grades of undernutrition, MUAC and edema were better indicators of short-term prognosis than was BMI. Further studies are needed to define a critical MUAC threshold for the diagnosis of acute adult undernutrition.

The effects of dietary non-starch polysaccharides on Ascaridia galli infection in grower layers.

This study examined whether Ascaridia galli infection can be controlled by dietary non-starch polysaccharides (NSP) in chickens. One-day-old chicks were fed either a basal diet (CON) or CON plus insoluble NSP (I-NSP), or CON plus soluble NSP (S-NSP) for 11 weeks. Three weeks later, birds from half of each feeding group were inoculated with 250 embryonated eggs of A. galli, and slaughtered 8 weeks post-infection to determine worm counts. Both NSP diets, particularly S-NSP, increased prevalence of infection (P<0·05) and worm burden (roughly +50%) of the birds (P<0·001). A. galli infection caused a less efficient (P=0·013) feed utilization for body weight gain (BWG) resulting in lower body weights (P<0·001) irrespective of type of diet consumed. NSP-fed birds, particularly those on I-NSP, consumed more (+8%) feed per unit BWG and showed retarded (P<0·001) BW development compared to CON-fed birds. Intracaecal pH was lowered by S-NSP (P<0·05). Both NSP diets increased the volatile fatty acids pool size in caeca (P<0·001) with S-NSP exerting a greater effect (+46%) than I-NSP (+24%). It is concluded that both NSPs supplemented diets alter gastrointestinal environment in favour of the nematode establishment, and thus have no potential for controlling A. galli infection in chickens.

Diarrhea is a major killer of children with severe acute malnutrition admitted to inpatient set-up in Lusaka, Zambia.

INTRODUCTION: Mortality of children with Severe Acute Malnutrition (SAM) in inpatient set-ups in sub-Saharan Africa still remains unacceptably high. We investigated the prevalence and effect of diarrhea and HIV infection on inpatient treatment outcome of children with complicated SAM receiving treatment in inpatient units. METHOD: A cohort of 430 children aged 6-59 months old with complicated SAM admitted to Zambia University Teaching Hospital's stabilization centre from August to December 2009 were followed. Data on nutritional status, socio-demographic factors, and admission medical conditions were collected up on enrollment. T-test and chi-square tests were used to compare difference in mean or percentage values. Logistic regression was used to assess risk of mortality by admission characteristics. RESULTS: Majority, 55.3% (238/430) were boys. The median age of the cohort was 17 months (inter-quartile range, IQR 12-22). Among the children, 68.9% (295/428) had edema at admission. The majority of the children, 67.3% (261/388), presented with diarrhea; 38.9% (162/420) tested HIV positive; and 40.5% (174/430) of the children died. The median Length of stay of the cohort was 9 days (IQR, 5-14 days); 30.6% (53/173) of the death occurred within 48 hours of admission. Children with diarrhea on admission had two and half times higher odds of mortality than those without diarrhea; Adjusted OR = 2.5 (95% CI 1.50-4.09, P < 0.001). The odds of mortality for children with HIV infection was higher than children without HIV infection; Adjusted OR = 1.6 (95% CI 0.99-2.48 P = 0.5). CONCLUSION: Diarrhea is a major cause of complication in children with severe acute malnutrition. Under the current standard management approach, diarrhea in children with SAM was found to increase their odds of death substantially irrespective of other factors.

Fiber-related digestive processes in three different breeds of pigs.

The hypothesis examined in this experiment was that, because of intensive selection for greater daily BW gains and efficient utilization of concentrated low-fiber diets, modern pig breeds differ from old local breeds in their physiological ability to respond to soluble dietary fiber. Thus, the old local breeds, Schwaebisch Haellisches Schwein (SH) and Bunte Bentheimer (BB), and a modern crossbred pig (CB) were used in metabolism trials to study fiber-related digestion, including microbial hindgut fermentation, by applying a colon simulation technique (Cositec) and measuring intestinal glucose transport in Ussing chambers. A basal diet or basal plus 20% dried sugar beet pulp (SBP) as a soluble fiber source was fed to 6 pigs/breed in a 2 x 3 factorial arrangement of treatments. Four pigs of each breed per treatment were used for intestinal anatomical measurements at the end of the metabolism trials. The pigs had an initial average BW of 33.9 +/- 3.7 kg. The basal diet was formulated to meet 80% of energy and 100% of nutrient requirements for pigs with 700 g of ADG. Feeding the SBP diet reduced total intestinal tract, but it increased colon length, water-holding capacity of the digesta, and fecal bulk (P < 0.01). The digestibility of OM, CP, and ether extract decreased, whereas that of NDF and ADF increased, by SBP (P = 0.001). Pigs receiving SBP excreted less urinary N and retained more N (P = 0.001). The fecal proportions of undigested dietary and water soluble N increased and those of bacterial and endogenous debris N decreased (P < 0.05) in SBP-fed pigs. The SH pigs had lighter empty cecum weight, shorter colons, and less NDF digestibility than BB and CB pigs (P < 0.05). Fecal N excretion did not differ (P = 0.659) among breeds, but SH pigs excreted more urinary N (P = 0.001) than the other breeds. In Cositec, OM, NDF, and ADF disappearance rates from cecal chyme of SBP-fed pigs increased (P < 0.05) irrespective of pig breed. Cecal chyme of SBP-fed BB pigs produced more VFA with a smaller proportion of propionate and a larger acetate to propionate ratio than chyme of SBP-fed SH and CB pigs. The intestinal epithelial glucose transport was greater for ileal than for jejunal tissues (P < 0.001) but was not influenced by diet and pig breed. In conclusion, the modern and intensely selected pig breed can utilize SBP fiber as efficiently as the old pig breeds under the present experimental conditions.

Endoscopic removal of eroded adjustable gastric band: lessons learned after 5 years and 78 cases.

BACKGROUND: One of the complications of laparoscopic adjustable gastric banding is intragastric erosion, leading to a revisional procedure to remove the band. Our aim was to present the procedure and results of endoscopic band removal in a 5-year multicenter experience from the Gastro Obeso Center and Universidade de São Paulo, São Paulo, and Universidade Federal de Pernambuco, Recife, Brazil. METHODS: From 2003 to 2008, 82 patients were diagnosed with band erosion. The clinical data concerning the endoscopic procedure were prospectively recorded and retrospectively reviewed. RESULTS: The average preoperative body mass index was 43.2 kg/m(2) (range 34-50). At the diagnosis of intragastric erosion, the body mass index was 24-41 kg/m(2) (average 31.8). The erosion occurred an average of 16.3 months (range 6-36) postoperatively. The symptoms included pain in 25 (31%), port infection in 21 patients (27%), and weight regain in 20 (25%), and 12 patients (15%) were asymptomatic. Endoscopic removal was possible for 78 patients (95%). In 85% of patients, the band was removed in the first session, with an average duration of 55 minutes (range 25-150). Five cases of pneumoperitoneum occurred after the procedure. Of these, 3 were treated conservatively, 1 was treated by laparoscopy, and 1 was treated by abdominal puncture using the Veress needle. CONCLUSION: Endoscopic removal of eroded laparoscopic adjustable gastric banding is safe and effective. It can be used as a first choice procedure in clinical practice.