Comparing Management Strategies in Patients With Clot-in-Transit.

BACKGROUND: Clot-in-transit is associated with high mortality, but optimal management strategies remain uncertain. The aim of this study was to compare the outcomes of different treatment strategies in patients with clot-in-transit. METHODS: This is a retrospective study of patients with documented clot-in-transit in the right heart on echocardiography across 2 institutions between January 2020 and October 2023. The primary outcome was a composite of in-hospital mortality, resuscitated cardiac arrest, or hemodynamic decompensation. RESULTS: Among 35 patients included in the study, 10 patients (28.6%) received anticoagulation alone and 2 patients (5.7%) received systemic thrombolysis, while 23 patients (65.7%) underwent catheter-based therapy (CBT; 22 mechanical thrombectomy and 1 catheter-directed thrombolysis). Over a median follow-up of 30 days, 9 patients (25.7%) experienced the primary composite outcome. Compared with anticoagulation alone, patients who received CBT or systemic thrombolysis had significantly lower rates of the primary composite outcome (12% versus 60%; log-rank P<0.001; hazard ratio, 0.13 [95% CI, 0.03-0.54]; P=0.005) including a lower rate of death (8% versus 50%; hazard ratio, 0.10 [95% CI, 0.02-0.55]; P=0.008), resuscitated cardiac arrest (4% versus 30%; hazard ratio, 0.12 [95% CI, 0.01-1.15]; P=0.067), or hemodynamic deterioration (4% versus 30%; hazard ratio, 0.12 [95% CI, 0.01-1.15]; P=0.067). CONCLUSIONS: In this study of CBT in patients with clot-in-transit, CBT or systemic thrombolysis was associated with a significantly lower rate of adverse clinical outcomes, including a lower rate of death compared with anticoagulation alone driven by the CBT group. CBT has the potential to improve outcomes. Further large-scale studies are needed to test these associations.

Effects of heating soybeans on postruminal amino acid bioavailability, performance, and ruminal fermentation in lactating cows.

Soybeans can provide ruminally degradable protein, lipid, and metabolizable amino acid (AA) to lactating dairy cows; however, soy-based trypsin inhibitors can limit protein digestion in nonruminants. Eight ruminally cannulated lactating Holstein cows were used to evaluate the impacts of soy-based trypsin inhibitors on nutrient disappearance, lactation, and plasma AA bioavailability. Treatments were abomasal infusion of 0 or 400 g/d casein or a crystalline AA analog of casein with unroasted or roasted soybeans fed at 10% dry matter (DM). Data were analyzed using the MIXED procedure of SAS. Measures of digestion were determined from fecal output determined with acid detergent insoluble ash and urine output determined from measures of urine creatinine. Neither soybean processing (P ≥ 0.20) nor the source of abomasal infusion (P ≥ 0.60) impacted nutrient digestibility. Ruminal ammonia, isobutyrate, and isovalerate were increased (P ≤ 0.01) among cattle consuming unroasted soybeans. Source of infusion did not affect (P ≥ 0.38) ruminal volatile fatty acids or nitrogen metabolism. Ruminal N metabolism was largely unaffected by soybean processing although microbial N efficiency was greater (P < 0.01) among cows fed unroasted soybeans. DM intake and energy-corrected milk were greater (P < 0.01) in cows fed roasted compared to unroasted soybeans. The proportion of fat, protein, lactose, and solids not fat (SNF) in milk did not differ between soybean processing or postruminal AA source, but fat, protein, lactose, and SNF yield was greater (P ≤ 0.01) when cows were fed roasted soybeans because milk yields were greater when cows were fed roasted vs. unroasted soybeans. As expected, infusion of casein or its crystalline AA analog increased plasma essential AA and milk urea nitrogen concentration. The rate of increase in essential AA concentration in plasma was 2.9× greater for casein than for crystalline AA. These data seem to indicate that soy-based trypsin inhibitors have no impacts on postruminal AA bioavailability when fed to cows and that metabolizable protein from casein is greater than from crystalline AA.

Soybeans contain antinutritional factors that may influence amino acid (AA) bioavailability to cattle. Holstein cows were used to evaluate if roasting whole soybeans influenced bioavailability of AA in diets containing soybeans. Roasting whole soybeans decreased ruminal ammonia and branched-chain volatile fatty acids. Yet, feeding unroasted soybeans decreased dry matter intake and energy-corrected milk yield. Roasting of soybeans had no impact on measures of postruminal AA bioavailability. Interestingly, however, bioavailability of milk specific proteins was greater than that of a crystalline AA analog of casein. Overall, roasting soybeans does not seem to increase AA bioavailability by mitigating antinutritional factors in soybeans; however, form of postruminal AA (i.e., protein vs. crystalline AA) may be important to efficiently providing metabolizable AA to cows.

Pharmacological management of acute spinal cord injury: a longitudinal multi-cohort observational study.

Multiple types and classes of medications are administered in the acute management of traumatic spinal cord injury. Prior clinical studies and evidence from animal models suggest that several of these medications could modify (i.e., enhance or impede) neurological recovery. We aimed to systematically determine the types of medications commonly administered, alone or in combination, in the transition from acute to subacute spinal cord injury. For that purpose, type, class, dosage, timing, and reason for administration were extracted from two large spinal cord injury datasets. Descriptive statistics were used to describe the medications administered within the first 60 days after spinal cord injury. Across 2040 individuals with spinal cord injury, 775 unique medications were administered within the two months after injury. On average, patients enrolled in a clinical trial were administered 9.9 ± 4.9 (range 0-34), 14.3 ± 6.3 (range 1-40), 18.6 ± 8.2 (range 0-58), and 21.5 ± 9.7 (range 0-59) medications within the first 7, 14, 30, and 60 days post-injury, respectively. Those enrolled in an observational study were administered on average 1.7 ± 1.7 (range 0-11), 3.7 ± 3.7 (range 0-24), 8.5 ± 6.3 (range 0-42), and 13.5 ± 8.3 (range 0-52) medications within the first 7, 14, 30, and 60 days post-injury, respectively. Polypharmacy was commonplace (up to 43 medications per day per patient). Approximately 10% of medications were administered acutely as prophylaxis (e.g., against the development of pain or infections). To our knowledge, this was the first time acute pharmacological practices have been comprehensively examined after spinal cord injury. Our study revealed a high degree of polypharmacy in the acute stages of spinal cord injury, raising the potential to impact neurological recovery. All results can be interactively explored on the RXSCI web site ( https://jutzelec.shinyapps.io/RxSCI/ ) and GitHub repository ( https://github.com/jutzca/Acute-Pharmacological-Treatment-in-SCI/ ).

Effects of long-term postgastric infusion of casein or glutamic acid on small intestinal starch digestion and energy balance in cattle.

The objective of this experiment was to evaluate effects of postruminal flows of casein or glutamic acid on small intestinal starch digestion and to quantify changes in energy and nutrient balance. Twenty-four steers (body weight = 179 ± 4 kg) were duodenally infused with raw cornstarch (1.46 ± 0.04 kg/d) and either 413 ± 7.0 g casein/d, 121 ± 3.6 g glutamic acid/d or water (control). Measures of small intestinal starch digestion and nutrient excretion were collected across 4 d after 42 d of infusion and measures of respiration via indirect calorimetry were collected across 2 d after 48 d of infusion. Ileal starch flow was least among calves provided casein, but ileal starch flow was not different between glutamic acid or control. Small intestinal starch digestion tended to be greatest among calves provided casein, least for glutamic acid and intermediate for control. Casein increased ileal flow of ethanol soluble oligosaccharides compared to glutamic acid and control. Large intestinal starch digestion was not different among treatments. By design, N intake was greatest among cattle provided casein, intermediate among calves provided glutamic acid and least for control. Nitrogen retention was greater in response to casein compared to control and glutamic acid. Intake of gross energy from feed was similar across treatments, and gross energy from infusate was greatest for casein, intermediate for glutamic acid and least for control. Variation in gross energy intake from feed resulted in no difference in overall gross energy intake across treatments. Similar to measures of small intestinal starch digestion and N retention, casein increased calories of digestible energy and metabolizable energy, compared to glutamic acid and control, which did not differ. Postruminal infusions did not influence methane production, but heat production was greatest in steers infused with casein, intermediate for steers provided glutamic acid, and least for control. Overall, amounts of energy retained by casein tended to be nearly 34% greater than control, but glutamic acid had no impact on energy balance. Improvement in small intestinal starch digestion in response to casein increased energy and N retained; however, glutamic acid did not influence small intestinal starch digestion and energy or N balance in cattle, which seems to suggest that responses in small intestinal starch digestion to greater postruminal flows of glutamic acid become refractory across greater durations of time.

Small intestinal digestion of starch can provide greater energy from dietary starch in comparison to ruminal fermentation, which can increase performance and improve feed efficiency in cattle fed starch-based diets; however, small intestinal starch digestion in cattle is restricted in comparison to nonruminant animals or to ruminal fermentation of starch. In this experiment, long-term increases in postruminal protein but not glutamic acid increased small intestinal starch digestion, and increases in small intestinal starch digestion resulted in improvements in nitrogen and energy balance. Responses in this study compared to previous reports may suggest effects of increased postgastric flows of glutamic acid in cattle are transient, but that effects of casein are not.

Mild-to-Moderate COVID-19 Infection and Myocarditis: A Review.

The coronavirus disease 2019 (COVID-19) pandemic has taken a massive toll on healthcare systems internationally. Severe illness has been seen in a range of patient populations, but those living with cardiovascular disease have suffered to a greater extent, likely because of their comorbidities. In patients with diabetes, hypertension, heart failure, and other chronic illnesses, COVID-19 has manifested severe illnesses such as coagulopathies, myocarditis, and arrhythmias, complicating the disease course for those already suffering from underlying illness. There have been numerous studies done exploring the cardiovascular complications of COVID-19. Some of the more concerning findings have revealed a correlation between severe illness and the increasing likelihood for developing cardiovascular manifestations. However, what is more concerning were the studies revealing the presence of myocarditis and other cardiac sequelae in previously healthy patients with mild or asymptomatic COVID-19. The goal of this article is to review the literature to compile information available about whether there is a significant risk of myocarditis in those patients who do not develop severe initial COVID-19 disease.

Effects of corn processing and cattle size on total tract digestion and energy and nitrogen balance.

This study used 18 calves (295 ± 29 kg) and 18 yearlings (521 ± 29 kg) fed whole, cracked, or steam-flaked corn (SFC) to evaluate nutrient digestion and energy balance across different types of processed corn and sizes of cattle. Cattle were fed a diet comprised of 75% corn (dry matter [DM]-basis) from whole, cracked, or SFC to 2.5-times maintenance energy requirements. Subsequently, cattle were placed in individual stanchions, and urine and feces were collected together with measures of gas production via indirect calorimetry. Data were analyzed using the MIXED procedure of SAS. There was no interaction between corn processing and cattle size (P ≥ 0.40). Time spent ruminating (min/d) and rumination rate (min/kg DM intake [DMI]) were not affected by corn processing or cattle size. The eating rate (min/kg DMI) was faster (P < 0.01) for yearlings compared with calves. Total tract starch digestion was greatest (P = 0.01) for cattle fed SFC (97.5%), intermediate in cattle fed cracked (92.4%), and least in cattle fed whole corn (89.5%). Dietary digestible energy and metabolizable energy (Mcal/kg DMI) were greater (P ≤ 0.05) for cattle fed SFC compared with cracked or whole. A greater proportion of digestible energy was lost to heat production (P = 0.01) in cattle fed whole corn compared with cracked and tended to be greater (P = 0.08) in cattle fed SFC than cracked. Conversion of digestible energy to metabolizable energy in this study was more closely related to a dynamic model used to estimate metabolizable energy of feeds to dairy cows than to a linear model used to predict metabolizable energy of feeds to beef cattle. If library estimates of net energy for maintenance are correct, then retained energy (Mcal/d) should have been similar between each type of processed corn; however, retained energy was greater (P < 0.01) for cattle fed cracked compared with whole corn and tended to be greater (P = 0.06) compared with SFC. Yet, observed amounts of net energy based on measures of retained energy were not different (P ≥ 0.60) between cracked and SFC. Nitrogen balance was not affected (P ≥ 0.30) by corn processing or cattle size, although cattle fed cracked had numerically greater (P ≤ 035) N retention. These data indicate that physical processing of corn provides greater net energy to cattle in comparison to whole corn.

Effects of protein supplementation to steers consuming low-quality forages on greenhouse gas emissions.

Providing supplements that enhance the efficiency of feed utilization can reduce methane (CH4) emissions from ruminants. Protein supplementation is widely used to increase intake and digestion of low-quality forages, yet little is known about its impact on CH4 emissions. British-cross steers (n = 23; initial body weight [BW] = 344 ± 33.9 kg) were used in a three-period crossover design to evaluate the effect of protein supplementation to beef cattle consuming low-quality forage on ruminal CH4, metabolic carbon dioxide (CO2) emissions, forage intake, and ruminal fermentation. Steers individually had ad libitum access to low-quality bluestem hay (4.6% crude protein [CP]) and were provided supplemental protein based on (dry matter basis): cottonseed meal (CSM; 0.29% of BW daily; 391 g/d CP), dried distillers grains with solubles (DDGS; 0.41% of BW daily 563 g/d CP), or none (CON). Urea was added to DDGS to match rumen degradable protein provided by CSM. Ruminal CH4 and metabolic CO2 fluxes were obtained 2.4 ± 0.4 times per steer daily using an automated open-circuit gas quantification system (GreenFeed emission monitoring system; C-Lock Inc., Rapid City, SD). Forage intake increased (P < 0.01) with protein supplementation; however, no difference in forage intake (P = 0.14) was observed between CSM and DDGS treatments. Flux of CO2 (g/d) was greater (P < 0.01) for steers fed CSM and DDGS than for steers fed CON. Steers supplemented with CSM had greater (P < 0.01) CH4 emissions (211 g/d) than DDGS (197 g/d) both of which were greater (P < 0.01) than CON (175 g/d). Methane emissions as a proportion of gross energy intake (GEI) were lowest (P < 0.01) for DDGS (7.66%), intermediate for CSM (8.46%) steers, and greatest for CON (10.53%). Steers fed DDGS also had the lowest (P < 0.01) ruminal acetate:propionate ratio (3.60), whereas CSM (4.89) was intermediate, and CON (5.64) steers were greatest. This study suggests that the common practice of supplementing protein to cattle consuming low-quality forage decreases greenhouse gas emissions per unit of GEI.

Posteroanterior cervical transcutaneous spinal stimulation targets ventral and dorsal nerve roots.

OBJECTIVE: We aim to non-invasively facilitate activation of spared neural circuits after cervical spinal cord injury (SCI) and amyotrophic lateral sclerosis (ALS). We developed and tested a novel configuration for cervical transcutaneous spinal stimulation (cTSS). METHODS: cTSS was delivered via electrodes placed over the midline at ~T2-T4 levels posteriorly and ~C4-C5 levels anteriorly. Electromyographic responses were measured in arm and hand muscles across a range of stimulus intensities. Double-pulse experiments were performed to assess homosynaptic post-activation depression (PAD). Safety was closely monitored. RESULTS: More than 170 cTSS sessions were conducted without major safety or tolerability issues. A cathode-posterior, 2 ms biphasic waveform provided optimal stimulation characteristics. Bilateral upper extremity muscle responses were easily obtained in subjects with SCI and ALS. Resting motor threshold at the abductor pollicis brevis muscle ranged from 5.5 to 51.0 mA. As stimulus intensity increased, response latencies to all muscles decreased. PAD was incomplete at lower stimulus intensities, and decreased at higher stimulus intensities. CONCLUSIONS: Posteroanterior cTSS has the capability to target motor neurons both trans-synaptically via large-diameter afferents and non-synaptically via efferent motor axons. SIGNIFICANCE: Posteroanterior cTSS is well tolerated and easily activates upper extremity muscles in individuals with SCI and ALS.

What is the digestibility and caloric value of different botanical parts in corn residue to cattle?1.

Two experiments were conducted to measure rates of ruminal disappearance, and energy and nutrient availability and N balance among cows fed corn husks, leaves, or stalks. Ruminal disappearance was estimated after incubation of polyester bags containing husks, leaves or stalks in 2 separate ruminally cannulated cows in a completely randomized design. Organic matter (OM) that initially disappeared was greatest for stalks and least for husks and leaves (P < 0.01), but amounts of NDF that initially disappeared was greatest for husks, intermediate for stalks, and least for leaves (P < 0.01). Amounts of DM and OM that slowly disappeared were greatest in husks, intermediate in leaves, and least in stalks (P < 0.01). However, amounts of NDF that slowly disappeared were greatest in leaves, intermediate in husks, and least in stalks (P < 0.01). Rate of DM and OM disappearance was greater for leaves, intermediate for husks and least for stalks, but rate of NDF disappearance was greatest for stalks, intermediate for leaves, and least for husks (P < 0.01). Energy and nutrient availability in husks, leaves, or stalks were measured by feeding ruminally cannulated cows husk-, leaf-, or stalk-based diets in a replicated Latin square. Digestible energy lost as methane was less (P = 0.02) when cows were fed leaves in comparison to husks or stalks, and metabolizable energy (Mcal/kg DM) was greater (P = 0.03) when cows were fed husks and leaves compared with stalks. Heat production (Mcal/d) was not different (P = 0.74) between husks, leaves, or stalks; however, amounts of heat produced as a proportion of digestible energy intake were less (P = 0.05) among cows fed leaves in comparison to stalks or husks. Subsequently, there was a tendency (P = 0.06) for net energy available for maintenance from leaves (1.42 Mcal/kg DM) to be greater than stalks (0.91 Mcal/kg DM), and husks (1.30 Mcal/kg DM) were intermediate. Nitrogen balance was greater when cows were fed leaves, intermediate for husks, and least for stalks (P = 0.01). Total tract digestion of NDF was greater (P < 0.01) for husks and leaves compared with stalks. Husks had greater (P = 0.04) OM digestibility in comparison to stalks, and leaves were intermediate. Apparently, greater production of methane from husks in comparison to leaves limited amounts of energy available for maintenance from husks even though total-tract nutrient digestion was greatest when cows were fed husks or leaves.

Multimodal cortical and subcortical exercise compared with treadmill training for spinal cord injury.

BACKGROUND AND PURPOSE: Spared fibers after spinal cord injury (SCI) tend to consist predominantly of subcortical circuits that are not under volitional (cortical) control. We aim to improve function after SCI by using targeted physical exercises designed to simultaneously stimulate cortical and spared subcortical neural circuits. METHODS: Participants with chronic motor-incomplete SCI enrolled in a single-center, prospective interventional crossover study. Participants underwent 48 sessions each of weight-supported robotic-assisted treadmill training and a novel combination of balance and fine hand exercises, in randomized order, with a 6-week washout period. Change post-intervention was measured for lower extremity motor score, soleus H-reflex facilitation; seated balance function; ambulation; spasticity; and pain. RESULTS: Only 9 of 21 enrolled participants completed both interventions. Thirteen participants completed at least one intervention. Although there were no statistically significant differences, multimodal training tended to increase short-interval H-reflex facilitation, whereas treadmill training tended to improve dynamic seated balance. DISCUSSION: The low number of participants who completed both phases of the crossover intervention limited the power of this study to detect significant effects. Other potential explanations for the lack of significant differences with multimodal training could include insufficient engagement of lower extremity motor cortex using skilled upper extremity exercises; and lack of skill transfer from upright postural stability during multimodal training to seated dynamic balance during testing. To our knowledge, this is the first published study to report seated posturography outcomes after rehabilitation interventions in individuals with SCI. CONCLUSION: In participants with chronic incomplete SCI, a novel mix of multimodal exercises incorporating balance exercises with skilled upper extremity exercises showed no benefit compared to an active control program of body weight-supported treadmill training. To improve participant retention in long-term rehabilitation studies, subsequent trials would benefit from a parallel group rather than crossover study design.

Estimates of diet selection in cattle grazing cornstalk residues by measurement of chemical composition and near infrared reflectance spectroscopy of diet samples collected by ruminal evacuation.

Six ruminally cannulated cows (570 ± 73 kg) fed corn residues were placed in a 6 × 6 Latin square to evaluate predictions of diet composition from ruminally collected diet samples. After complete ruminal evacuation, cows were fed 1-kg meals (dry matter [DM]-basis) containing different combinations of cornstalk and leaf and husk (LH) residues in ratios of 0:100, 20:80, 40:60, 60:40, 80:20, and 100:0. Diet samples from each meal were collected by removal of ruminal contents after 1-h and were either unrinsed, hand-rinsed or machine-rinsed to evaluate effects of endogenous compounds on predictions of diet composition. Diet samples were analyzed for neutral (NDF) and acid (ADF) detergent fiber, acid detergent insoluble ash (ADIA), acid detergent lignin (ADL), crude protein (CP), and near infrared reflectance spectroscopy (NIRS) to calculate diet composition. Rinsing type increased NDF and ADF content and decreased ADIA and CP content of diet samples (P < 0.01). Rinsing tended to increase (P < 0.06) ADL content of diet samples. Differences in concentration between cornstalk and LH residues within each chemical component were standardized by calculating a coefficient of variation (CV). Accuracy and precision of estimates of diet composition were analyzed by regressing predicted diet composition and known diet composition. Predictions of diet composition were improved by increasing differences in concentration of chemical components between cornstalk and LH residues up to a CV of 22.6 ± 5.4%. Predictions of diet composition from unrinsed ADIA and machine-rinsed NIRS had the greatest accuracy (slope = 0.98 and 0.95, respectively) and large coefficients of determination (r2 = 0.86 and 0.74, respectively). Subsequently, a field study (Exp. 2) was performed to evaluate predictions of diet composition in cattle (646 ± 89 kg) grazing corn residue. Five cows were placed in 1 of 10 paddocks and allowed to graze continuously or to strip-graze corn residues. Predictions of diet composition from ADIA, ADL, and NIRS did not differ (P = 0.99), and estimates of cornstalk intake tended to be greater (P = 0.09) in strip-grazed compared to continuously grazed cows. These data indicate that diet composition can be predicted by chemical components or NIRS by ruminal collection of diet samples among cattle grazing corn residues.

A New Online Strategy in Teaching Racial and Ethnic Health and Health Disparities to Public Health Professionals.

In the fall 2010, East Carolina University's Department of Public Health in the Brody School of Medicine introduced a new graduate certificate online program to its curriculum-the Ethnic and Rural Health Disparities (ERHD) program. By the spring 2014, the Ethnic and Rural Health Disparities (ERHD) program graduated 20 public health professionals with expertise in ethnic and rural health disparities. In order to examine its effectiveness, we conducted a qualitative and quantitative study of our graduates. The major objectives of our ERHD alumni study were: (1) to evaluate the effectiveness of the ERHD program, and (2) to assess new strategies for improving our ERHD program. Quantitative and qualitative results from our small sample of alumni indicate that the ERHD program is fulfilling its objectives. The ERHD program has developed a new online strategy in teaching racial and ethnic health and health disparities for public health professionals who are ready to not only address health disparities in a different approach but also ready to develop new culturally competent public health programs for increasing diverse racial, ethnic, and rural populations in the U.S.A.

Tobacco Taxes in the Southeastern US States: Views from Former Legislators.

OBJECTIVES: We examine influences on southeastern state legislators' actions related to tobacco tax increases. METHODS: In 2014, we interviewed 26 former state legislators in southeastern states via phone. RESULTS: Themes regarding factors impeding increasing tobacco taxes included: tobacco's legacy in the South, protecting vulnerable populations from increased cigarette costs, concern about economic impact, opposing "sin" taxes, concern about impact on reelection, and perceptions that constituents oppose all taxes. The major theme in support of increasing tobacco taxes was health concern. Prior attempts at passing legislation resulted in political leveraging, deal-making, or compromising. CONCLUSIONS: Legislators' misperceptions of constituent opposition and impact on economy, among other impediments to increased tobacco taxes, must be addressed.

Experimental verification of sparse frequency linearly frequency modulated ladar signals modeling.

We present the results of an experiment designed to verify the results of a previously published theoretical model that predicts the range resolution and peak-to-side lobe ratio of sparse frequency linearly frequency modulated (SF-LFM) ladar signals. We use two ultra stable diode lasers which are frequency locked and can be current tuned in order to adjust the difference frequency between the two lasers. The results of the experiment verify the previously developed model proving that SF-LFM ladar signals have the ability to increase the range resolution of a ladar system without the need for larger bandwidth modulators. Finally we simulate a target at a range of approximately 150 meters through the use of a fiber optic delay line, and demonstrate the ability of SF-LFM ladar signals to detect a target at range.