The role of cardiopulmonary exercise testing and echocardiography prior to elective endovascular aneurysm repair.

INTRODUCTION: Cardiopulmonary exercise testing (CPET) and transthoracic echocardiography (TTE) are common preparative investigations prior to elective endovascular aneurysm repair (EVAR). Whether these investigations can predict survival following EVAR and contribute to shared decision making is unknown. METHODS: Patients who underwent EVAR at a tertiary centre between June 2007 and December 2014 were identified from the National Vascular Registry. Variables obtained from preoperative investigations were assessed for their association with survival at three years. Regression analysis was used to determine variables that independently predicted survival at three years. RESULTS: A total of 199 patients underwent EVAR during the study period. Of these, 120 had preoperative CPET and 123 had TTE. Lower forced expiratory ventilation (FEV1), ratio of FEV1 to forced vital capacity, work at peak oxygen consumption and higher ventilatory equivalent for carbon dioxide were associated with increased mortality. Variables obtained from TTE were not associated with survival at three years although there was a low incidence of left ventricular systolic dysfunction and significant valvular disease in this cohort. CONCLUSIONS: CPET might be a useful adjunct to assist in shared decision making in patients undergoing elective EVAR and may influence anaesthetic technique. TTE does not appear to be able to discriminate between high and low risk individuals. However, a low rate of significant ventricular dysfunction and valvular disease in patients undergoing elective EVAR may account for these findings.

The effects of high metal concentrations in soil-compost mixtures on soil enzymes.

The study was undertaken to determine the impact of high-metal composts on the activities of four soil enzymes. High concentrations of metal salts (Cr, Cu, Ni or a Co-Mo-Pb combination) were added to feedstocks during the thermophilic stage of composting. These four metal-enriched composts and an unamended control compost were then mixed with soil collected from long-term agriculture plots under organic management or conventional management. The compost-soil mixtures were prepared at two rates (1:1 or 1:3 compost:soil, v/v) and incubated at 20 degrees C for three weeks. These 20 combinations plus the five composts and the two soils were added to pots and incubated for three weeks. Following incubation, soil enzyme activities (acid phosphatase, arysulfatase, dehydrogenase, phosphodiesterase) were measured using traditional assay procedures. Compared to the control, none of the high-metal composts inhibited soil enzyme activity. Notably, the Cu compost treatment produced significantly higher activity of all four enzymes in the soil compared to the control. Previous soil management influenced the activity of three enzymes, arysulfatase and dehydrogenase had greater activity in the organic soil while phosphatase activity was greater in the conventional soil. Increasing the proportion of compost in the pot had a positive effect on phosphodiesterase activity only. In conclusion, the high-metal compost treatments either enhanced or caused no adverse effects on soil enzyme activity.

Vermicompost derived from different feedstocks as a plant growth medium.

This study determined feedstock effects on earthworm populations and the quality of resulting vermicomposts produced from different types of feedstocks using different vermicomposting durations. Feedstock combinations (Kitchen Paper Waste (KPW), Kitchen Yard Waste (KYW), Cattle Manure Yard Waste (CMY)), three durations of vermicomposting (45, 68 or 90 days), and two seed germination methods (with two concentrations of vermicompost) for radish, marigold and upland cress, served as the independent variables. The worms (Eisenia fetida) doubled their weight by day 68 in KPW and CMY vermicomposts and day 90 KPW vermicompost produced the greatest weight of worms. The direct seed germination method (seeding into soil or vermicompost-soil mixtures) indicated that KPW and KYW feedstocks decreased germination compared to the control, even in mature vermicompost. Seed germination was greater in the water extract method; however, most of the vermicompost extracts suppressed germination of the three seed species compared to the water controls. Vermicomposts from all three feedstocks increased leaf area and biomass compared to the control, especially in the 10% vermicompost:soil mix. Thus, seed germination and leaf area or plant biomass for these three species are contrasting vermicompost quality indicators.

Assessing fitness for surgery: a comparison of questionnaire, incremental shuttle walk, and cardiopulmonary exercise testing in general surgical patients.

BACKGROUND: Morbidity and mortality are higher in patients with poor preoperative cardiorespiratory reserve. This study aimed to ascertain fitness and therefore risk in elective patients, comparing three measures: Duke Activity Status Index (DASI) questionnaire, incremental shuttle walk test (ISWT), and cycle cardiopulmonary exercise testing (CPET). We looked for correlation between the measures and for thresholds on the questionnaire or shuttle test which could identify fit patients and render CPET unnecessary. METHODS: A prospective cohort trial of 50 patients having intra-abdominal surgery. Each performed DASI, ISWT, and CPET during a single visit to the hospital. RESULTS: There was a significant correlation between measured oxygen consumption and both ISWT and DASI. Receiver operator curve showed both the shuttle walk test and the DASI are sensitive and specific predictors of VO(2)peak >15 ml O(2) kg(-1) min(-1) and anaerobic threshold (AT) >11 ml O(2) kg(-1) min(-1). Thirty-two patients would be considered lower risk, having achieved both VO(2)peak and AT cut-offs. Setting an ISWT threshold of 360 m identified 13 of the lower risk patients [positive predictive value (PPV) 1.0, negative predictive value (NPV) 0.49]. Setting a DASI threshold score of 46 identified nine lower risk patients (PPV 1.0, NPV 0.44). CONCLUSIONS: We found a significant correlation between the tests. However, many patients with poor questionnaire scores or shuttle walks had satisfactory CPET results. Hence, the ability of either simple test to determine risk in a heterogeneous surgical population is poor. CPET provides an objective measurement of cardiopulmonary fitness; however, evidence for this information improving patient outcome is limited and requires further research.

Evaluation of sewage sludge, septic waste and sludge compost applications to corn and forage: Ca, Mg, S, Fe, Mn, Cu, Zn and B content of crops and soils.

This is the second of two papers presenting the data from an experiment on the application of aerobically-digested sewage sludge (AES), anaerobic lagoon septic wastes (ANS), sewage sludge compost and fertilizer to soils for grass forage and feed corn production at two different sites in Nova Scotia. Crop yields, plant tissue and Mehlich-1 extractable soil nutrients were evaluated; 15 elements were analyzed in the plant tissue and 9 elements in the soil extracts. This paper describes the Ca, Mg, S, Fe, Mn, Cu, Zn and B content of the crops and the Mehlich-1 extractable content of the soils. The response to the amendments was not consistent at the two sites with the two different crops. We found that the septic sludge (ANS) produced the highest forage Fe, Cu and Zn levels and was equal to compost in elevating corn stover and forage S and the forage B content. The compost produced the highest forage Ca and corn Zn, the AES produced the highest corn Mn, and fertilizer produced the highest forage Mn. None of the amendments produced excessive levels of the above nutrients; rather, the amendments improved the feed quality of the forage and corn stover. Lastly, it was noted that the Mehlich-1 extract only had a significantly positive correlation with forage Cu content.

Evaluation of sewage sludge, septic waste and sludge compost applications to corn and forage: yields and N, P and K content of crops and soils.

This paper presents the data from two years of experiments concerned with the application of aerobically-digested sewage sludge, anaerobic lagoon septic sludge, sewage sludge compost or fertilizer to soils for grass forage and feed corn (Zea mays L.) production at two different sites 45 km from Truro, Nova Scotia. Crop yields, plant tissue and Mehlich-1 extractable soil nutrients were evaluated; 15 elements were analyzed in the plant tissue and nine elements in the soil extracts. This paper describes the results of crop yields, plant N, P and K content and Mehlich-1 extractable P and K. The research demonstrated the fertilizer produced higher yields of grass forage than the sludge and the compost but equivalent to the sludge in corn yields. Forage and corn N, P and K contents, however, varied with treatment, crop and year, while the compost-amended soils were highest in extractable nutrients. Both sludges and the compost, therefore, could be effective sources of N, P and K for crop production. Compared to the conventional fertilizer, the nutrient availability from the organic amendments (especially N and P) was considerably lower than the 50% assumed at the start of the experiment; the sludges however, provided higher nutrient availability than the compost.

Nitrogen availability from composts for humid region perennial grass and legume-grass forage production.

Perennial forages may be ideally suited for fertilization with slow N release amendments such as composts, but difficulties in predicting N supply from composts have limited their routine use in forage production. A field study was conducted to compare the yield and protein content of a binary legume-grass forage mixture and a grass monocrop cut twice annually, when fertilized with diverse composts. In all three years from 1998-2000, timothy (Phleum pratense L.)-red clover (Trifolium pratense L.) and timothy swards were fertilized with ammonium nitrate (AN) at up to 150 and 300 kg N ha(-1) yr(-1), respectively. Organic amendments, applied at up to 600 kg N ha(-1) yr(-1) in the first two years only, included composts derived from crop residue (CSC), dairy manure (DMC), or sewage sludge (SSLC), plus liquid dairy manure (DM). Treatments DM at 150 kg N ha(-1) yr(-1) and CSC at 600 kg N ha(-1) yr(-1) produced cumulative timothy yields matching those obtained for inorganic fertilizer. Apparent nitrogen recovery (ANR) ranged from 0.65% (SSLC) to 15.1% (DMC) for composts, compared with 29.4% (DM) and 36.5% (AN). The legume component (approximately 30%) of the binary mixture acted as an effective "N buffer" maintaining forage yield and protein content consistently higher, and within a narrower range, across all treatments. Integrating compost utilization into livestock systems that use legume-grass mixtures may reduce the risk of large excesses or deficits of N, moderate against potential losses in crop yield and quality, and by accommodating lower application rates of composts, reduce soil P and K accumulation.

CT vs MRI in diagnosis of recurrent rectosigmoid carcinoma.

OBJECTIVE: Our goal was to compare the relative values of MRI vs. CT in diagnosing recurrent rectosigmoid cancer. MATERIALS AND METHODS: We conducted a retrospective review of 18 patients who had surgical resection of primary rectosigmoid carcinoma and suspected recurrence. They were studied with CT and MR and followed for up to 4 years. RESULTS: At the time of the initial imaging, 10 patients had recurrent tumor and 4 of the remaining 8 patients later demonstrated local recurrence. Magnetic resonance demonstrated 91% sensitivity, 100% specificity, a positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 89% with a 95% accuracy. Computed tomography demonstrated a sensitivity of 82% and a specificity of 50% with a PPV of 69% and an NPV of 67% with an accuracy of 68%. In three cases interpreted on CT as presacral masses, all were shown on MR to represent displaced but normal pelvic structures. In four cases MR revealed tumor involving the sacrum and sacral nerves not apparent on CT. CONCLUSION: Magnetic resonance showed superior sensitivity, specificity, and accuracy to CT and better definition of the extent of tumor.