2023 Undetectable = Untransmittable global policy roundtable report: a multistakeholder perspective on Undetectable = Untransmittable research and policy priorities.

Background Launched in 2016 by Prevention Access Campaign, the 'Undetectable=Untransmittable' (U=U) campaign empowers people living with HIV to live full social, sexual and reproductive lives, dismantle stigma, promote increased treatment access, and advocate for updated HIV guidelines. Methods Key priorities for promoting improvements to community-centred, evidence-informed U=U policy and research were the focus of a half-day global roundtable held in 2023 alongside the 12th International AIDS Society Conference in Brisbane, Australia. After a series of presentations, experts in U=U research, policymaking, advocacy and HIV clinical care participated in facilitated discussions, and detailed notes were taken on issues related to advancing U=U policy and research. Results Expert participants shared that knowledge and trust in U=U remains uneven, and is largely concentrated among people living with HIV, particularly those connected to gay and bisexual networks. It was agreed that there is a need to ensure all members of priority populations are explicitly included in U=U policies that promote U=U. Participants also identified a need for policymakers, healthcare professionals, advocates and researchers to work closely with community-based organisations to ensure the U=U message is relevant, useful, and utilised in the HIV response. Adopting language, such as 'zero risk', was identified as crucial when describing undetectable viral load as an effective HIV prevention strategy. Conclusion U=U can have significant benefits for the mental and physical wellbeing of people living with HIV. There is an urgent need to address the structural barriers to HIV care and treatment access to ensure the full benefits of U=U are realised.

Warming and redistribution of nitrogen inputs drive an increase in terrestrial nitrous oxide emission factor.

Anthropogenic nitrogen inputs cause major negative environmental impacts, including emissions of the important greenhouse gas N2O. Despite their importance, shifts in terrestrial N loss pathways driven by global change are highly uncertain. Here we present a coupled soil-atmosphere isotope model (IsoTONE) to quantify terrestrial N losses and N2O emission factors from 1850-2020. We find that N inputs from atmospheric deposition caused 51% of anthropogenic N2O emissions from soils in 2020. The mean effective global emission factor for N2O was 4.3 ± 0.3% in 2020 (weighted by N inputs), much higher than the surface area-weighted mean (1.1 ± 0.1%). Climate change and spatial redistribution of fertilisation N inputs have driven an increase in global emission factor over the past century, which accounts for 18% of the anthropogenic soil flux in 2020. Predicted increases in fertilisation in emerging economies will accelerate N2O-driven climate warming in coming decades, unless targeted mitigation measures are introduced.

Influence of artificial drainage system design on the nitrogen attenuation potential of gley soils: Evidence from hydrochemical and isotope studies under field-scale conditions.

In North Atlantic Europe intensive dairy farms have a low nitrogen (N) use efficiency, with high N surpluses often negatively affecting water quality. Low feed input systems on heavy textured soils often need artificial drainage to utilise low cost grassland and remain profitable. Heavy textured soils have high but variable N attenuation potential, due to soil heterogeneity. Furthermore, drainage system design can influence the potential for N attenuation and subsequent N loadings in waters receiving drainage from such soils. The present study utilises end of pipe, open ditch and shallow groundwater sampling points across five sites in SW Ireland to compare and rank sites based on N surplus, water quality and "net denitrification", and to develop a conceptual framework for the improved management of heavy textured dairy sites to inform water quality N sustainability. This includes both drainage design and "net denitrification" criterion, as developed within this study.N surplus ranged from 211 to 292 kg N/ha (mean of 252 kg N/sourha) with a common source of organic N across all locations. The predicted soil organic matter (SOM) N release potential from top-subsoil layers was high, ranging from 115 to >146 kg N/ha. Stable isotopes analyses showed spatial variation in the extent of specific N-biotransformation processes, according to drainage location and design. Across all sites, nitrate (NO3-N) was converted to ammonium (NH4+-N), which migrated offsite through open ditch and shallow groundwater pathways. Using the ensemble data the potential for soil N attenuation could be discriminated by 3 distinct groups reflecting the relative dominance of in situ N-biotransformation processes deduced from water composition: Group 1 (2 farms, ranked with high sustainability, NH4+ < 0.23 mg N/l, δ15N-NO3- > 5‰ and δ18O-NO3- > 10‰), low NH4+-N concentration coupled with a high denitrification potential; Group 2 (1 farm with moderate sustainability, NH4+ < 0.23 mg N/l, δ15N-NO3- < 8‰ and δ18O-NO3- < 8‰), low NH4+-N concentration with a high nitrification potential and a small component of complete denitrification; Group 3 (2 farms, ranked with low sustainability, NH4+ > 0.23 mg N/l, 14‰ > Î´15N-NO3- > 5‰ and 25‰ > Î´18O-NO3- > -2‰), high NH4+-N concentration due to low denitrification. The installation of a shallow drainage system (e.g. mole or gravel moles at 0.4 m depth) reduced the "net denitrification" ranking of a site, leading to water quality issues. From this detailed work an N sustainability tool for any site, which presents the relationship between drainage class, drainage design (if present), completeness of denitrification, rate of denitrification and NH4-N attenuation was developed. This tool allows a comparison or ranking of sites in terms of their N sustainability. The tool can also be used pre-land drainage and presents the consequences of future artificial land drainage on water quality and gaseous emissions at a given site.

Anthropometric trends from 1997 to 2012 in infants born at ⩽28 weeks' gestation or less.

OBJECTIVE: Postnatal growth failure is common after preterm birth, in particular for infants born at ⩽28 weeks' gestation, but it is unknown if growth-to-term equivalent age has improved over the years as neonatal intensive care in general, and infant nutrition in particular, have improved. The objective of the study was to evaluate anthropometric trends at NICU discharge for infants born at ⩽28 weeks' gestation using a large national database. STUDY DESIGN: Analysis of growth in weight, length, head circumference and body mass index (kg m2) in 23 005 infants born in 1997 to 2012 who survived to neonatal intensive care unit discharge at ⩽41 weeks' postmenstrual age. RESULTS: Discharge weight, length, head circumference and body mass index were converted to Z-scores using a reference database, and growth trends over the 16 years were summarized. Discharge results also were summarized for common neonatal morbidities, including chronic lung disease. Gestational age at birth and postmenstrual age at discharge were similar across the 16 years. Discharge weight, length and head circumference Z-scores were all below the median, but head circumference Z-scores consistently were closer to the median than were weight and length. In 1997 compared with 2012, the weight Z-score improved from -1.5 to -0.6; the length Z-score increased the least, from -1.68 to just -1.16; the head circumference Z-score improved from -0.68 to -0.30; and the body mass index Z-score increased from -0.66 to 0.19. Percent small-for-gestational age at birth was stable across the years at 8.4 to 9.3%, and the frequency of postnatal growth failure at discharge improved from 55.4% in 1997 to 19.6% in 2012. CONCLUSIONS: Growth-to-discharge progressively improved from 1997 to 2012, but Z-scores remained below the reference median for weight, length and head circumference. Length Z-scores were consistently significantly less than for weight, and body mass index Z-scores have been above the reference median since 2002. Prospective studies are needed to quantify anthropometric trends in relation to body composition and to current nutritional strategies.

Towards quantifying the role of hydrogen bonding within amphiphile self-association and resultant aggregate formation.

Herein, we present a series of five tetrabutylammonium (TBA) sulfonate-urea amphiphilic salts. In solution these amphiphilic salts have been shown to form a variety of self-associated species. The proportion and type of which are both solvent and concentration dependent. In DMSO-d6 a variety of NMR experiments provide evidence towards the formation of mainly dimeric over larger aggregate species. Increasing the percentage of water was shown to increase the concentration of the larger aggregates over dimers in solution. A correlation was established between critical micelle concentration (CMC) values obtained in a 1 : 19 EtOH : H2O mixture, dimeric self-association constants obtained in a DMSO-d6 - 0.5% H2O and the results of simple semi-empirical PM6 computational modelling methods. This approach begins to quantify the role of hydrogen bonding in amphiphile self-association and the effects it imparts on surfactant properties. This consequently provides preliminary evidence that these properties maybe predicted by simple low level computational modelling techniques.

Smart, reusable labels for assessing self-cleaning films.

Novel, reversible (reusable) photocatalyst activity indicator labels, which undergo a rapid colour change when in contact with a photocatalytic film via the photoreduction of methylene blue contained within the label's adhesive, are explored as a method for assessing the activity of self-cleaning glass in situ and the laboratory, using digital photography.

Air-stable full-visible-spectrum emission from silicon nanocrystals synthesized by an all-gas-phase plasma approach.

A novel dual-plasma system has been developed to combine the synthesis of silicon nanocrystals (Si-NCs), the etching to controllably tailor the Si-NC size, and the surface functionalization of Si-NCs into one simple all-gas-phase process. Si-NCs are synthesized in SiH(4)-based plasma; they then travel through CF(4)-based plasma, where Si-NCs are etched and passivated by C and F. The resulting Si-NCs exhibit air-stable emission across the full visible spectrum. Structural and optical characterization indicates that the emission in the red-to-green range is based on the recombination of quantum-confined excitons in Si-NCs, while the blue emission originates from defect states. The quantum yields of stabilized photoluminescence from Si-NCs range from 16% at the red end to 1% at the blue end.

Asian-Pacific Islander adolescent methamphetamine use: does ice increase aggression and sexual risks?

Using a probability sample from a 2001 Youth Risk Behavior Survey of Asian-Pacific Islander youths in Guam, this brief study examined the outcomes for methamphetamine use on aggression and risky sexual activities. The results of the study indicated that both male and female adolescents who used methamphetamine were significantly more likely to participate in aggressive behaviors and sexual risks (i.e., numerous sex partners). The inclusion of grade point averages in a logistic regression equation revealed that White adolescents were more likely than other ethnicities to indicate that they had used methamphetamine and the inclusion of student grade point averages reduced male gender to nonsignificance. We also discuss the limitations of the study.

The US radiation dosimetry standards for 60Co therapy level beams, and the transfer to the AAPM accredited dosimetry calibration laboratories.

This work reports the transfer of the primary standard for air kerma from the National Institute of Standards and Technology (NIST) to the secondary laboratories accredited by the American Association of Physics in Medicine (AAPM). This transfer, performed in August of 2003, was motivated by the recent revision of the NIST air-kerma standards for 60Co gamma-ray beams implemented on July 1, 2003. The revision involved a complete recharacterization of the two NIST therapy-level 60Co gamma-ray beam facilities, resulting in new values for the air-kerma rates disseminated by the NIST. Some of the experimental aspects of the determination of the new air-kerma rates are briefly summarized here; the theoretical aspects have been described in detail by Seltzer and Bergstrom ["Changes in the U.S. primary standards for the air-kerma from gamma-ray beams," J. Res. Natl. Inst. Stand. Technol. 108, 359-381 (2003)]. The standard was transferred to reference-class chambers submitted by each of the AAPM Accredited Dosimetry Calibration Laboratories (ADCLs). These secondary-standard instruments were then used to characterize the 60Co gamma-ray beams at the ADCLs. The values of the response (calibration coefficient) of the ADCL secondary-standard ionization chambers are reported and compared to values obtained prior to the change in the NIST air-kerma standards announced on July 1, 2003. The relative change is about 1.1% for all of these chambers, and this value agrees well with the expected change in chambers calibrated at the NIST or at any secondary-standard laboratory traceable to the new NIST standard.

Cirugía de control de daños: análisis fisiopatológico e implicancias / Demage control surgery: phisio-pathologic analysis and involves

Antecedentes: La cirugía "por etapas" o "de control de daños" ha cambiado conceptualmente el manejo de pacientes en estado "in tremis". estos pueden tener una patología de base traumática, ginecoobstétrica o bien de cualquier otro origen que descompese su sistema cardiovascular o metabólico. Si bien es un concepto fisiopatológico moderno, el origen se remonta a los primeros años del siglo XX. Objetivos: Evaluar la experiencia de nuestro hospital en el manejo de pacientes sometidos a la táctica del "control de daño". Diseño: Estudio de evaluación retrospectiva. Población: pacientes que ingresaron con traumatismos en abdomen y que fueron declarados "in extremis" ante el estado metabólico y/o cardiovascular. Método: Se evaluaron 41 pacientes de los cuales veinte eran traumatismos hepáticos, siete traumatismos pelvianos, cinco traumatismos de hipocondrio izquierdo, otros cinco con traumatismos retroperitoneales en zona ll y otros cuatro con traumatismo duodenopancreático. Resultados: Con una mortalidad global de 18 casos (43,9 por ciento), los que presentaron mayor mortalidad grupal fueron los de hipocondrio izquierdo (60 por ciento) y los retroperitoneales (60 por ciento), finalmente los pelvianos con 57,1 por ciento y los duodenopancreáticos con 50 por ciento. Los traumatismos hepáticos presentaron una mortalidad del 30 por ciento. Conclusiones: Es una táctica clinicoquirúrgica para un grupo reducido de pacientes cuyo estado hemodinámico y/o metabólico presenta alta mortalidad. La indicación de la incorporación del paciente a la sistemática del control del daño es del cirujano. Los resultados obtenidos dependen además de la calidad profesional y técnica de los Servicios de Terapia Intensiva, Anestesia y Hemoterapia. El control del daño mantiene elevada aún la mortalidad. El hecho está relacionado con la condición de extrema gravedad de cada uno de los pacientes. Debe tenerse presente que sólo entre un 5 y un 9 por ciento de los traumatizados graves reúne criterios de aplicación de esta terapéutica (AU)

Cirugía de control de daños: análisis fisiopatológico e implicancias / Demage control surgery: phisio-pathologic analysis and involves

Antecedentes: La cirugía "por etapas" o "de control de daños" ha cambiado conceptualmente el manejo de pacientes en estado "in tremis". estos pueden tener una patología de base traumática, ginecoobstétrica o bien de cualquier otro origen que descompese su sistema cardiovascular o metabólico. Si bien es un concepto fisiopatológico moderno, el origen se remonta a los primeros años del siglo XX. Objetivos: Evaluar la experiencia de nuestro hospital en el manejo de pacientes sometidos a la táctica del "control de daño". Diseño: Estudio de evaluación retrospectiva. Población: pacientes que ingresaron con traumatismos en abdomen y que fueron declarados "in extremis" ante el estado metabólico y/o cardiovascular. Método: Se evaluaron 41 pacientes de los cuales veinte eran traumatismos hepáticos, siete traumatismos pelvianos, cinco traumatismos de hipocondrio izquierdo, otros cinco con traumatismos retroperitoneales en zona ll y otros cuatro con traumatismo duodenopancreático. Resultados: Con una mortalidad global de 18 casos (43,9 por ciento), los que presentaron mayor mortalidad grupal fueron los de hipocondrio izquierdo (60 por ciento) y los retroperitoneales (60 por ciento), finalmente los pelvianos con 57,1 por ciento y los duodenopancreáticos con 50 por ciento. Los traumatismos hepáticos presentaron una mortalidad del 30 por ciento. Conclusiones: Es una táctica clinicoquirúrgica para un grupo reducido de pacientes cuyo estado hemodinámico y/o metabólico presenta alta mortalidad. La indicación de la incorporación del paciente a la sistemática del control del daño es del cirujano. Los resultados obtenidos dependen además de la calidad profesional y técnica de los Servicios de Terapia Intensiva, Anestesia y Hemoterapia. El control del daño mantiene elevada aún la mortalidad. El hecho está relacionado con la condición de extrema gravedad de cada uno de los pacientes. Debe tenerse presente que sólo entre un 5 y un 9 por ciento de los traumatizados graves reúne criterios de aplicación de esta terapéutica

Condensed-phase effects on the structural properties of C6H5CN-BF3 and (CH3)3CCN-BF3: IR spectra, crystallography, and computations.

Condensed-phase effects on the structure and bonding of C(6)H(5)CN-BF(3) and (CH(3))(3)CCN-BF(3) are illustrated by a variety of results, and these are compared to analogous data for the closely related complex CH(3)CN-BF(3). For the most part, the structural properties of C(6)H(5)CN-BF(3) and (CH(3))(3)CCN-BF(3) are quite similar, not only in the gas phase but also in the solid state and in argon matrices. However, the structures do change significantly from medium to medium, and these changes are reflected in the data presented below. Specifically, the measured crystallographic structure of C(6)H(5)CN-BF(3) (s) has a B-N distance that is 0.17 A shorter than that in the equilibrium gas-phase structure obtained via B3LYP calculations. Notable differences between calculated gas-phase frequencies and measured solid-state frequencies for both C(6)H(5)CN-BF(3) and (CH(3))(3)CCN-BF(3) were also observed, and in the case of (CH(3))(3)CCN-BF(3), these data implicate a comparable difference between solid-state and gas-phase structure, even in the absence of crystallographic results. Frequencies measured in argon matrices were found to be quite similar for both complexes and also very near those measured previously for CH(3)CN-BF(3), suggesting that all three complexes adopt similar structures in solid argon. For C(6)H(5)CN-BF(3) and (CH(3))(3)CCN-BF(3), matrix IR frequencies differ only slightly from the computed gas-phase values, but do suggest a slight compression of the B-N bond. Ultimately, it appears that the varying degree to which these systems respond to condensed phases stems from subtle differences in the gas-phase species, which are highlighted through an examination of B-N distance potentials from B3LYP calculations. The larger organic substituents appear to stabilize the potential near 1.8 A, so that the structures are more localized in that region prior to any condensed-phase interactions. As a result, the condensed-phase effects on the structural properties of C(6)H(5)CN-BF(3) and (CH(3))(3)CCN-BF(3) are much less pronounced than those for CH(3)CN-BF(3).

Relationship between macroinvertebrate fauna and environmental variables in small streams of the Dominican Republic.

Field assessment methods for freshwater macroinvertebrates and water quality in tropical small-island states were assessed in the Dominican Republic. Macroinvertebrate samples were collected from 26 river sites within the Dominican Republic's Yaque del Norte river catchment. Environmental data on geographical, physical and chemical variables were also collected from each site. The Biological Monitoring Working Party score and total numbers of Ephemeroptera and Trichoptera were calculated for each site. Physico-chemical and biological data sets were ordinated by principal components analysis and non-parametric multi-dimensional scaling, and the biotic and abiotic data sets were correlated to determine the most influential factors determining site similarities. Macroinvertebrate assemblage structure was correlated with declining water quality: however, a high correlation between water quality and altitude confounded an unqualified interpretation of impairment.

Multivariate relationships between groundwater chemistry and toxicity in an urban aquifer.

Multivariate statistical methods were used to investigate the causes of toxicity and controls on groundwater chemistry from 274 boreholes in an urban area (London) of the United Kingdom. The groundwater was alkaline to neutral, and chemistry was dominated by calcium, sodium, and sulfate. Contaminants included fuels, solvents, and organic compounds derived from landfill material. The presence of organic material in the aquifer caused decreases in dissolved oxygen, sulfate and nitrate concentrations, and increases in ferrous iron and ammoniacal nitrogen concentrations. Pearson correlations between toxicity results and the concentration of individual analytes indicated that concentrations of ammoniacal nitrogen, dissolved oxygen, ferrous iron, and hydrocarbons were important where present. However, principal component and regression analysis suggested no significant correlation between toxicity and chemistry over the whole area. Multidimensional scaling was used to investigate differences in sites caused by historical use, landfill gas status, or position within the sample area. Significant differences were observed between sites with different historical land use and those with different gas status. Examination of the principal component matrix revealed that these differences are related to changes in the importance of reduced chemical species.

Tratamiento no operatorio en el traumatismo abdominal cerrado: análisis preliminar / Non operative management for blunt solid organ abdominal trauma

Antecedentes: Es controvertido el tratamiento no operatorio en el traumatismo abdominal cerrado. Establecida la causa mecánica, los cirujanos tuvieron históricamente tendencia a la exploración quirúrgica en los traumatismos moderados y graves. Objetivo: Analizar una secuencia de tratamiento no operatorio en el traumatismo abdominal cerrado tipos I, II y III (de acuerdo a la clasificación AAST). Lugar de aplicación: Departamento de Cirugía General, Complejo Médico-Hospitalario de Fuerzas de Seguridad. Diseño: Estudio prospectivo observacional. Material y métodos: 39 pacientes con traumatismo abdominal cerrado con criterios de inclusión para análisis secuencial de tratamiento no operatorio: 12 hepáticos, 15 renales y 12 esplénicos. Resultados: Se encontró 0 por ciento de mortalidad con 4 fallas terapéuticos (10,2 por ciento) una hepática y 3 esplénicas. No hubo fallas con trauma renal. Internación hospitalaria prolongada en lesiones esplénicas. Conclusiones: Sólo en centros asistenciales con dedicación al trauma con disponibilidad de diagnósticos imagenológicos las 24 hs del día con protocolos de inclusión y exclusión de pacientes pueden realizar tratamiento no operatorio. Deben involucrarse en ésto autoridades y cirujanos actuantes debido al costo de internaciones prolongadas. Desventajas incluyen el retardo en la decisión quirúrgica. La principal ventaja es la disminución de laparotomías innecesarias

Tratamiento no operatorio en el traumatismo abdominal cerrado: análisis preliminar / Non operative management for blunt solid organ abdominal trauma

Antecedentes: Es controvertido el tratamiento no operatorio en el traumatismo abdominal cerrado. Establecida la causa mecánica, los cirujanos tuvieron históricamente tendencia a la exploración quirúrgica en los traumatismos moderados y graves. Objetivo: Analizar una secuencia de tratamiento no operatorio en el traumatismo abdominal cerrado tipos I, II y III (de acuerdo a la clasificación AAST). Lugar de aplicación: Departamento de Cirugía General, Complejo Médico-Hospitalario de Fuerzas de Seguridad. Diseño: Estudio prospectivo observacional. Material y métodos: 39 pacientes con traumatismo abdominal cerrado con criterios de inclusión para análisis secuencial de tratamiento no operatorio: 12 hepáticos, 15 renales y 12 esplénicos. Resultados: Se encontró 0 por ciento de mortalidad con 4 fallas terapéuticos (10,2 por ciento) una hepática y 3 esplénicas. No hubo fallas con trauma renal. Internación hospitalaria prolongada en lesiones esplénicas. Conclusiones: Sólo en centros asistenciales con dedicación al trauma con disponibilidad de diagnósticos imagenológicos las 24 hs del día con protocolos de inclusión y exclusión de pacientes pueden realizar tratamiento no operatorio. Deben involucrarse en ésto autoridades y cirujanos actuantes debido al costo de internaciones prolongadas. Desventajas incluyen el retardo en la decisión quirúrgica. La principal ventaja es la disminución de laparotomías innecesarias (AU)

Estimating the effects of 17alpha-ethinylestradiol on populations of the fathead minnow Pimephales promelas: are conventional toxicological endpoints adequate?

Environmental benchmarks have recently been proposed for several steroids including the synthetic steroid, 17alpha-ethinylestradiol (EE2). These benchmarks are based on extrapolation from studies involving long-term exposure of various fish species to EE2. One of the critical studies was a complete life-cycle experiment performed with the fathead minnow Pimephales promelas over a 289 day exposure period. The lowest observed effect concentration (LOEC) and the no observed effect concentration (NOEC) for gonad histology were 4 and 1 ng L(-1) respectively. This was because no testicular tissue could be found in any fish exposed to 4 ng L(-1). In the present paper, the survival and reproduction data from that study are reanalyzed to determine the effects of EE2 on the intrinsic rate of population growth (r = In (lambda)), a parameter of demographic importance. We estimate critical threshold concentrations with respect to r and compare these with those previously derived from conventional toxicity test summaries. Further, we assess the influence of individual variability on threshold estimates using a combination of bootstrap and regression approaches, together with a suite of perturbation analyses. These yield ErC100 values (the concentration estimated to reduce intrinsic growth rate to zero) of 3.11 ng L(-1) (linear model) and 3.41 ng L(-1) (quadratic model), comparable with a maximum acceptable toxicant concentration (MATC) of 2 ng L(-1) for feminization of exposed fish calculated by Laenge et al. Our results indicate that reduction in population growth rate with increasing concentration occurred more through EE2 acting to reduce fertility than survival rates. The significance of these summary statistics when deriving environmental benchmarks for steroid estrogens is discussed in the context of affording protection to populations following long-term exposure.

Ovarian cyclicity in thyroid-suppressed ewes treated with propylthiouracil immediately before onset of seasonal anestrus.

Two experiments were conducted to determine if propylthiouracil (PTU)-induced thyroid suppression immediately before onset of anestrus would extend the breeding season in mature ewes. In Exp. 1, twice-weekly serum concentrations of progesterone indicated that all ewes were cyclic before initiation of treatment. Beginning on d 0 (January 17), ewes received 0 (n = 4), 20 (n = 5), or 40 (n = 5) mg of PTU x kg(-1) of body weight (BW) x (-1) for 35 d. Blood samples were collected regularly throughout the trial and serum thyroxine and progesterone were quantified. Ewe BW were similar (P > 0.90) among treatments before the experiment began (mean = 78.2 +/- 4.5 kg). Likewise, serum concentrations of thyroxine averaged 86.5 +/- 8.0 ng/mL on d 0. After 11 d of PTU treatment, serum thyroxine was 90.2,75.2, and 44.2 +/- 14.0 ng/mL in ewes receiving 0, 20, and 40 mg of PTU/kg BW, respectively (linear effect, P = 0.04). On d 20, thyroxine values in the three respective groups were 73.0, 51.1, and 16.1 +/- 12.9 ng/mL (linear effect, P < 0.01). Fourteen days after PTU treatment ended, serum thyroxine did not differ (P = 0.53) among the three respective groups (71.4,73.3, and 57.5 +/- 11.8 ng/mL). Ewes receiving PTU tended to weigh less on d 42 (84.2, 78.2, and 71.8 +/- 5.1 kg for ewes treated with 0, 20, and 40 mg PTU/kg, respectively; linear effect, P = 0.10). Day of onset of anestrus was designated as the day on which serum progesterone decreased and remained below 1 ng/mL. Ewes treated with 0, 20, or 40 mg of PTU/kg BW became anestrous on d 16,40, and 81 (+/- 12) of the experiment, respectively (linear effect, P < 0.01). At the time the 35-d treatment period ended, 25, 60, and 100% of ewes receiving 0, 20, or 40 mg of PTU/kg exhibited normal estrous cycles. In Exp. 2, ewes received 0, 20, or 40 mg of PTU/kg BW for 14 d. The dose was then decreased to 0, 10, and 20 mg of PTU/kg BW for the remaining 21 d. Serum thyroxine decreased to concentrations below 20 ng/mL by d 9 after initiation of PTU treatment. Ewe weights did not differ throughout the trial and no BW loss was observed. The average day that each group entered anestrus was similar to those in Exp 1. Large doses of PTU dramatically lower serum thyroxine and this effect appears to inhibit onset of anestrus in ewes.

Serum thyroid hormones and reproductive characteristics of Rambouillet ewe lambs treated with propylthiouracil before puberty.

Twenty-four Rambouillet ewe lambs (average weight=43.7+/-1.2 kg, approximately 6 months of age) were used to examine the effect of thyroid suppression before the onset of puberty on serum thyroid hormones, body weights (BW), and reproductive performance. Beginning in early September, ewe lambs were randomly assigned to three treatments (n=8 lambs/treatment). All animals remained in a single pen (4 x 12 m) with access to salt, water, shade and alfalfa hay (2.5 kg per animal per day) throughout the experiment. Beginning on Day 0 (first day of treatment), all ewe lambs received daily treatments (gavage) for 15 days consisting of 0, 20, or 40 mg 6-N-propyl-2-thiouracil(PTU)/kg BW per day. Beginning on Day 15, the 20 and 40 mg treatments were lowered to 10 and 20 mg PTU/kg BW, respectively. All animals were treated for 28 days. Ovarian cyclicity was determined by twice weekly progesterone (P(4)) analysis. Thyroxine (T(4)) concentrations were similar on Day 0 (61.6, 54.8 and 56.9+/-2.5 ng/ml, P=0.17) in ewe lambs receiving 0, 20 and 40 mg PTU/kg BW, respectively. By Day 7, both PTU-treated groups had T(4) values less than 20 ng/ml (9.0 and 15.4+/-2.5 ng/ml) compared with 78.5 ng/ml in controls (P<0.01). By 7 days after termination of PTU treatment, serum T(4) had risen to 29.1 and 26.9 (+/-2.9)ng/ml in the 20/10 and 40/20 PTU groups, respectively. On Day 66, control ewes had 55.0 ng T(4)/ml compared with 43.1 and 39.0 (+/-2.6 ng/ml) for ewes in the 20/10 and 40/20 groups, respectively (linear, P<0.01). Serum triiodothyronine (T(3)) followed a similar pattern to that observed for T(4). Ewe lamb BW were similar (P>0.50) among groups throughout the treatment period. However, following the treatment, PTU-treated ewes tended (P<0.10) to weigh less than controls. Average Julian day of puberty was also similar (P>0.50) among treatments (286, 288 and 288+/-5 days; control, 20/10 and 40/20, respectively). Control ewes had a pregnancy rate of 75%, while both PTU-treated groups had pregnancy rates of 88% (P>0.20). The administration of PTU resulted in a rapid decline in serum T(4) and T(3) but neither time of puberty nor pregnancy rates were affected by lowered thyroid hormones.

Estimated blood loss and transfusion requirements of radical cystectomy.

PURPOSE: Radical cystectomy has been associated with significant blood loss and/or transfusion requirement. We defined and characterized blood loss and transfusion parameters in this population. MATERIALS AND METHODS: We reviewed the records of 304 consecutive patients who underwent radical cystectomy and urinary diversion between October 1995 and July 2000. Charts were examined, and univariate and multivariate logistic regression analysis was performed to evaluate estimated blood loss and the transfusion requirement. RESULTS: Complete blood loss data were available in 297 cases. Overall 45% of patients had anemia preoperatively. Median estimated blood loss was 600 ml. (range 100 to 3,000). On univariate analysis increased estimated blood loss was related to patient age, American Society of Anesthesiologists score, longer operative time and paralytic ileus. Overall transfusion was done in 88 of 297 cases (30%) with a median requirement of 2 units (range 1 to 10). The transfusion rate in male and female patients was 26% and 40%, respectively (p <0.05). On univariate analysis female gender, ileal conduit diversion and lower preoperative hematocrit correlated with transfusion need (p = 0.04, <0.001 and <0.001, respectively). On multivariate logistic regression analysis lower preoperative hematocrit, increased estimated blood loss, major complications and ileal conduit diversion type correlated with a higher transfusion rate (odds ratio 8.34, 5.88 and 4.60, respectively). CONCLUSIONS: Acute blood loss anemia is common in patients undergoing radical cystectomy, and predicting blood loss and transfusion requirements remains difficult. These data indicate the need for continued refinement in surgical techniques to decrease blood loss as well as for strategies designed to decrease the need for blood transfusion.