Bias in the prenatal lung measurements in fetal congenital diaphragmatic hernia with intrauterine growth restriction.

OBJECTIVES: The failure of a fetus to develop to its full potential due to maternal or placental factors is known as intrauterine growth restriction (IUGR). Fetal head growth is usually preserved in that situation producing a potential discordance between head and body size. Our goal is to discover if IUGR has an impact on the prenatal ultrasound measurements taken to assess pulmonary development in congenital diaphragmatic hernia (CDH). METHODS: A retrospective chart review (IRB#2017-6361) was performed on all prenatally diagnosed CDH patients from 2007 to 2016. Patient demographics, fetal and neonatal anthropometric measurements, and fetal lung parameters were the main subjects of the data that were gathered. Fetal growth was assessed by the curves based on US data by Olsen et al. and by Peleg et al. Of 147 CDH patients, 19 (12.9 %) patients were diagnosed with IUGR before the 30th gestational week while there were 20 (13.6 %) patients after the 30th gestational week. RESULTS: Patients with IUGR and the observed-to-expected lung-to-head ratio (O/E LHR) less than 25 % had better survival rates both to discharge and date compared to non IUGR group (p=0.226, OR 2.25 95 % CI 0.60-1.08 and p=0.175, OR 2.40 95 % CI 0.66-1.17, respectively). Moreover, the ECMO need of the patients who had IUGR and O/E LHR less than 25 % was significantly less than the patients without IUGR (38.5 vs. 80.0 %, p=0.005). CONCLUSIONS: This study confirms that the intrauterine measurements to predict pulmonary hypoplasia in CDH patients are misleading in the presence of IUGR and cause an overestimation.

PEGylation of Chrysin Improves Its Water Solubility while Preserving the In Vitro Biological Activity.

Chrysin is a natural flavonoid that despite having numerous biological properties, its therapeutic value is limited due to its very low solubility in aqueous media. In this work, chrysin was conjugated with methoxypolyethylene glycols (mPEGs) of different molecular weights (350, 500, 750, and 2000 g/mol), affording PEGylated chrysins with high yields and excellent purities. In all cases, an increase in the water solubility of the conjugates was observed, which was highest when 500 g/mol of mPEG was used in the PEGylation reaction. Furthermore, in aqueous solution, PEGylated chrysins formed aggregates of ellipsoid shape. Electrochemical studies showed that the redox properties were conserved after PEGylation. While in vitro antibacterial and antifungal studies probed that the intrinsic activity was conserved, in vitro antitumor activities against HepG2 (liver carcinoma cells) and PC3 (prostate cancer cell) showed that PEGylated chrysins retained the cytotoxic activity and the ability of induction of apoptosis for the evaluated human cancer cells.

Prevalence of different LI-RADS v2018 categories in high-risk patients undergoing CT- or MRI-based screening for hepatocellular carcinoma.

PURPOSE: To estimate the prevalence of Liver Imaging Reporting and Data System (LI-RADS, LR) v2018 categories reported on CT or MRI performed for hepatocellular carcinoma (HCC) screening. MATERIALS AND METHODS: This retrospective study included all reports for CT and MRI exams performed for HCC screening patients between 8/2018 and 4/2020. Patients with ultrasound, CT, or MRI of the abdomen within two years of the index exam were excluded. From each radiology report, we extracted number of reported liver observations, and LI-RADS v2018 category for each observation. RESULTS: There were 329 patients (170 [52%] male, mean age 59 years [SD 12]), of whom 177 (54%) had MRI with gadoxetate, 72 (22%) had MRI with extracellular contrast, 7 (2%) had MRI with unspecified contrast, and 73 (22%) had CT. Of 329 patients, 199 (60%) had no reported observations; 130 patients had 166 reported observations: 114 (68.7%) LR-1, 8 (4.8%) LR-2, 21 (12.6%) LR-3, 6 (3.6%) LR-4, 13 (7.8%) LR-5, 3 (1.8%) LR-M, and 1 (0.6%) LR-TIV. Of 114 LR-1 observations, 78 (68%) were cysts, 17 (15%) were hemangiomas, 12 (11%) were vascular shunts, 3 (3%) were focal nodular hyperplasia, 2 (2%) were siderotic nodules, 1 (1%) was a lipoma, and 1 (1%) was biliary hamartoma. There were 23 observations with probably or definitely malignant categories (LR-4, LR-5, LR-M or LR- TIV), reported in 20/329 (6%) of patients. CONCLUSION: In a cohort of at-risk patients undergoing contrast-enhanced CT/MRI for HCC screening, 60% of had no liver observations, and 6 % had probably or definitely malignant observations. IMPLICATIONS FOR PATIENT CARE: The prevalence of LI-RADS v2018 categories on CT or MR exams used for HCC screening can help develop screening criteria and assess cost-effectiveness of surveillance strategies with CT and MRI.

Compound Muscle Action Potential Amplitude as a Predictor of Functional and Patient-Reported Outcomes in Ulnar Neuropathy at the Elbow.

BACKGROUND: Ulnar neuropathy at the elbow (UNE) is a debilitating upper extremity condition that often leaves patients with residual symptoms even after surgical treatment. The role of electrodiagnostic studies in guiding the treatment of UNE is not well established, and conventional electrodiagnostic parameters may not reflect the severity of disease. Compound muscle action potential (CMAP) amplitude is a parameter that corresponds with axonal injury and motor symptoms and may more accurately predict the severity of neurologic injury. METHODS: This prospective multicenter study recruited 78 patients in the Surgery of the Ulnar Nerve project. Patients underwent electrodiagnostic testing and clinical assessment of motor and sensory function, and completed patient-reported outcome questionnaires, including the Michigan Hand Outcome Questionnaire; the Disabilities of the Arm, Shoulder and Hand questionnaire; and the Carpal Tunnel Questionnaire (CTQ). Correlations were measured among each of the electrodiagnostic parameters and outcomes and predictive models for each outcome were subsequently developed. RESULTS: Of all the electrodiagnostic parameters measured, only CMAP amplitude was predictive of scores on the Michigan Hand Outcome Questionnaire; Disabilities of the Arm, Shoulder and Hand questionnaire; CTQ function scale, and motor impairment in grip and pinch strength. None of the parameters were predictive of scores on the CTQ symptom scale or sensory impairments as measured with two-point discrimination or Semmes-Weinstein monofilament testing. CONCLUSIONS: CMAP amplitude, but not other conventional electrodiagnostic parameters, is predictive of functional outcomes in UNE. This electrodiagnostic measurement can alert the clinician to severe cases of UNE and inform surgical decision-making. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Influence of commercial starter culture on fermentation dynamics and quality characteristics of yogurts obtained with different formulations.

BACKGROUND: Four commercial starter cultures containing Streptococcus thermophilus and Lactobacillus delbrueckii subsp. bulgaricus (S1, S2, S3 and S4; S3 also contained Limosilactobacillus fermentum) were compared for fermentation, volatile flavor compounds, physicochemical parameters and microbiology, in yogurt prepared from three milk base formulations with increased protein (B1, B2 and B3). RESULTS: The fermentation patterns differed among starters, with Yoflex Mild 1.0 (S4) and SLB95 (S2) showing the longest fermentation time, depending on the formulation. At 21 days, S. thermophilus counts were similar among starters and higher than 8.52 log CFU mL-1 , for all yogurts. The highest counts (6.86 log CFU mL-1 ) for L. delbrueckii subsp. bulgaricus was found for S2 yogurts made from whey protein hydrolysate (B3). Minor water-holding capacity was detected for YF-L811 (S1) yogurts. Yoflex Harmony 1.0 (S3) starter containing Lim. fermentum produced a distinctive volatile profile characterized by aldehydes with respect to yogurts prepared with S1, S2 and S4, which were characterized by ketones. CONCLUSION: Results indicate the usefulness of carrying out studies similar to the present one to select the most appropriate process conditions depending on the desired product. © 2022 Society of Chemical Industry.

Electrodiagnostic Predictors of Outcomes After In Situ Decompression of the Ulnar Nerve.

PURPOSE: Patients with severe ulnar neuropathy at the elbow frequently experience suboptimal surgical outcomes. Clinical symptoms alone may not accurately represent the severity of underlying nerve injury, calling for objective assessment tools, such as electrodiagnostic studies. The goal of our study was to determine whether specific electrodiagnostic parameters can be used to predict the outcomes after in situ decompression of the ulnar nerve. METHODS: This prospective study enrolled consecutive patients aged ≥18 years diagnosed with ulnar neuropathy at the elbow. Patients completed a baseline battery of motor, sensory, functional, and electrodiagnostic tests before undergoing in situ decompression of the ulnar nerve. They were reassessed at 6 weeks, 3 months, 6 months, and 12 months after surgery. Forty-two patients completed at least 2 follow-up assessments and were included in the study. RESULTS: When controlling for other electrodiagnostic measurements and demographic factors, none of the electrodiagnostic parameters were predictive of outcomes at 12 months after surgery. Patients with decreased compound muscle action potential amplitudes demonstrated slower trends of recovery in grip strength, pinch strength, and overall scores on the Michigan Hand Outcomes Questionnaire as well as its function, work, and activities of daily living subscales, Disabilities of the Arm, Shoulder, and Hand questionnaire, and the Carpal Tunnel Questionnaire. Decreased motor nerve conduction velocity was predictive of slower recovery of 2-point discrimination and pinch strength. CONCLUSIONS: Compound muscle action potential amplitude, but not other conventional electrodiagnostic parameters, was predictive of functional outcomes after in situ decompression of the ulnar nerve. This parameter should play a role in determining the timing and prognosis of treatment for ulnar neuropathy at the elbow. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

An Outcomes Study of Proximal Interphalangeal Joint Silicone Implant Arthroplasty Using the Volar Approach.

BACKGROUND: Arthroplasty is performed at the proximal interphalangeal joint for the management of disabling osteoarthritis. This prospective cohort study evaluated outcomes of the silicone implant for the proximal interphalangeal joint using the volar approach. The authors hypothesize that the volar approach without extensor mechanism disruption will provide improved motion and maintain joint extension. METHODS: Consecutive candidates for proximal interphalangeal joint silicone implant arthroplasty using the volar approach were evaluated. The Michigan Hand Outcomes Questionnaire and functional measurements, including grip/pinch strength and arc of motion, were administered preoperatively and at 6 weeks and 3, 6, and 12 months postoperatively. RESULTS: Twenty-eight patients (35 joints) were included in the study. Eighteen patients (24 joints) were followed to 1 year postoperatively, with an entire cohort average of 10-month follow-up. Nineteen patients were white women, and the mean age was 64 years. The authors' hypothesis was supported by the results showing a mean gain in arc of motion of 7 degrees and a mean 5-degree extension lag improvement at 1 year. The mean postoperative arc of motion was 53 degrees with a 10-degree average extension lag. The median Michigan Hand Outcomes Questionnaire pain score improved from 70 (60 to 80) to 28 (5 to 45); scores also improved for each of the questionnaire domains. Median grip strength was unchanged. CONCLUSIONS: The volar approach to proximal interphalangeal joint arthroplasty is technically challenging but facilitates early aggressive rehabilitation. This is critical for providing improved flexion, especially in the ulnar digits without worsening extension lag. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

'Getting involved in research': a co-created, co-delivered and co-analysed course for those with lived experience of health and social care services.

BACKGROUND: 'Getting Involved in Research' was co-created and delivered by a multi-organisational group to provide an accessible introduction to research for those with lived experience of health and social care services. METHOD: The evaluation of participants' perceptions adopted an exploratory mixed method research design and aimed to gather data to provide an in-depth understanding of the participants' experience of 'Getting Involved in Research' through the co-researchers' analysis of qualitative data using Participatory Theme Elicitation (PTE). PTE was used with the qualitative data to promote co-analysis by the course development group; analyses from an independent academic was also used to further validate the method of PTE. RESULTS: Thirty-five participants in total participated in 'Getting Involved in Research'. Age ranges varied from 19 to 73 years old. Participants were predominately female (n = 24), five males participated (n = 5) and there was one participant who identified as non-binary (n = 1). Six core themes were identified using the PTE approach: (1) A Meaningful Participatory Approach (2) Increasing the Confidence of Participants (3) Interactive Online Format (4) An Ambient Learning Environment (5) A Desire for Future Courses (6) A Balance of Course Content and Discussion. Participants in 'Getting Involved in Research' reported that the content of the training was applicable, relevant, fostered awareness of research methods and anticipated that it would support their involvement in research. CONCLUSION: 'Getting Involved in Research' has contributed innovatively to the evidence base for how to engage with and motivate those who have experience of health and social care to become actively involved in research. This study demonstrates that 'Getting Involved in Research' may be helpful to train those with lived experience and their care partners however, further research following up on the application of the course learning would be required to ascertain effectiveness. FUTURE DIRECTIONS: Future research should explore methods to apply research skills in practice to further develop participants' confidence in using the skills gained through 'Getting Involved in Research'.

The aim of this study was to gather information to help us understand the experience of participants' undertaking a research course called 'Getting Involved in Research'. A group of individuals including those with lived experience of health and social care services, academics, community and voluntary sector workers and a representative from the Department of Health in Northern Ireland worked together to develop a course to encourage and support people to engage with research. The 'Getting Involved in Research', course was designed to provide an understandable introduction to research for those people with lived experience of health and social care. We did this because research in health and social care sector should involve the patients and public who it is intended to help. The evaluation of the course had two distinct phases; we asked course participants to complete a survey before and after the course (pre- and post-course survey) and also asked them to complete a journal reflecting on their experiences after each lecture. This paper gives an overview of the profile of course participants and their responses to the survey questions. The survey answers were analysed using an approach to analysing information which encourages involvement from people with a range of experience of research methods, (known as Participatory Theme Elicitation). Thirty-five participants in total participated in 'Getting Involved in Research'. Age ranges varied from 19 to 73 years old. Participants were predominately female (n = 24), five males participated (n = 5) and there was one participant who identified as non-binary (n = 1). Participants in 'Getting Involved in Research' reported that the content of the course was relevant, encouraged awareness of research methods and encourage their future involvement in research.

Gut Microbiome Characteristics in feral and domesticated horses from different geographic locations.

Domesticated horses live under different conditions compared with their extinct wild ancestors. While housed, medicated and kept on a restricted source of feed, the microbiota of domesticated horses is hypothesized to be altered. We assessed the fecal microbiome of 57 domestic and feral horses from different locations on three continents, observing geographical differences. A higher abundance of eukaryota (p < 0.05) and viruses (p < 0.05) and lower of archaea (p < 0.05) were found in feral animals when compared with domestic ones. The abundance of genes coding for microbe-produced enzymes involved in the metabolism of carbohydrates was significantly higher (p < 0.05) in feral animals regardless of the geographic origin. Differences in the fecal resistomes between both groups of animals were also noted. The domestic/captive horse microbiomes were enriched in genes conferring resistance to tetracycline, likely reflecting the use of this antibiotic in the management of these animals. Our data showed an impoverishment of the fecal microbiome in domestic horses with diet, antibiotic exposure and hygiene being likely drivers. The results offer a view of the intestinal microbiome of horses and the impact of domestication or captivity, which may uncover novel targets for modulating the microbiome of horses to enhance animal health and well-being.

A tele-health intervention to increase physical fitness in people with spinal cord injury and cardiometabolic disease or risk factors: a pilot randomized controlled trial.

STUDY DESIGN: Clinical trial. OBJECTIVES: We used a single-blind parallel-group design to test the feasibility and preliminary efficacy of a telehealth-based physical activity counseling intervention to increase physical fitness in people with SCI. SETTING: Seattle, Washington, United States. METHODS: We recruited under-active, manual wheelchair-using adults at least 1-year post-SCI who had at least two cardiometabolic risk factors/diseases. Participants underwent baseline tests of peak cardiorespiratory fitness; lipids, glucose and insulin; muscle and fat mass; self-reported physical activity, depression, pain and other factors. Participants were assigned 1:1 to treatment vs. usual care (UC) control conditions via concealed computerized randomization. Treatment was delivered via telephone and adapted from the 16-session Diabetes Prevention Program. All baseline tests were repeated at 6 months. Prespecified feasibility goals were to recruit at least nine participants/quarter and retain 85% with complete fitness testing at 6 months. Prespecified efficacy goals were to demonstrate at least a medium treatment effect size (0.50) on fitness, self-reported physical activity, and other outcomes. RESULTS: Seven participants were randomized to treatment, 8 to UC over 15 months. Maximum recruitment was only 5.4 participants/quarter. Thirteen (87%) of participants were retained. The effects of treatment on fitness and most cardiometabolic risk factors did not meet expectations, whereas the effects on self-reported physical activity, depression, and pain did meet expectations. CONCLUSIONS: The study did not meet key efficacy and feasibility objectives, yet there were some promising effects on self-report measures and lessons to be learned for designing future trials.

When primary repair is not enough: a comparison of synthetic patch and muscle flap closure in congenital diaphragmatic hernia?

PURPOSE: Primary closure is often inadequate for large congenital diaphragmatic hernia (CDH) and necessitates repair by prosthetic patch or autologous muscle flap. Our aim was to evaluate outcomes of open patch versus flap repair, specifically diaphragmatic reherniation. METHODS: A retrospective review (IRB #2017-6361) was performed on all CDH patients repaired from 2005 to 2016 at a single academic children's hospital. Patients were excluded from final analysis if they had primary or minimally invasive repair, expired, or were lost to follow-up. RESULTS: Of 171 patients, 151 (88.3%) survived to discharge, 9 expired after discharge and 11 were lost to follow up, leaving 131 (86.8%) long-term survivors. Median follow-up was 5 years. Open repair was performed in 119 (90.8%) of which 28 (23.5%) underwent primary repair, 34 (28.6%) patch repair, and 57 (47.9%) flap repair. Overall, 6/119 (5%) patients reherniated, 1/28 (3.6%) in the primary group, 3/34 (8.8%) in the patch group, and 2/57 (3.5%) in the flap group. Comparing prosthetic patch to muscle flap repair, there was no significant difference in the number of patients who recurred nor time to reherniation (3 vs. 2, p = 0.295; 5.5 ± 0.00 months vs. 53.75 ± 71.06 months, p = 0.288). One patient in the patch group recurred twice. CONCLUSIONS: Both muscle flap and patch repair of large CDH are feasible and durable with a relatively low risk of recurrence.

Risk of preventable hospitalization before and after diagnosis among rheumatoid arthritis patients compared to non-rheumatoid arthritis controls.

OBJECTIVE: The purpose of the study is to investigate the risk of preventable hospitalization among patients with rheumatoid arthritis (RA). METHODS: We identified 11,852 incident RA patients and 59,260 age-, sex-, and index year-matched controls from the Taiwan National Health Insurance Database. Index date was the RA diagnosis date for cases, which was assigned to their matched controls. The odds ratios (OR) of preventable hospitalizations between RA patients and controls were estimated using a mixed effect model adjusted for age, sex, patient characteristics, Elixhauser comorbidity index, medical utilization and regional medical resources. RESULTS: The overall annualized incidence of preventable hospitalization in RA patients and controls was 38.7 vs. 20.9 events per 1,000 person-years (adjusted OR, 1.61; 95% confidence interval [CI], 1.51-1.71). The adjusted OR of preventable hospitalization in RA patients compared to matched controls was 1.17 (1.00-1.37) one year prior to RA diagnosis and remained elevated after RA diagnosis. Adjusted ORs (95% CI) for specific preventable hospitalization categories were 1.93 (1.58-2.36) for chronic obstructive pulmonary disease, 1.64 (1.21-2.21) for asthma, 1.95 (1.78-2.13) for bacterial pneumonia, and 1.59 (1.44-1.75) for urinary tract infection. When assessing the trend of individual preventable hospitalizations before and after diagnosis, bacterial pneumonia and urinary tract infection hospitalizations had a significantly higher OR in RA patients one year before diagnosis and five years afterward (adjusted OR ranges 2.75 to 4.48 and 1.83 to 3.07 respectively, all P-values<0.05) CONCLUSION: RA is independently associated with a higher risk of preventable hospitalization specifically for chronic lung diseases and infections.

In vivo study of the immunomodulatory capacity and the impact of probiotic strains on physicochemical and sensory characteristics: Case of pasta filata soft cheeses.

Nowadays, there is a great interest of food industries on the development of innovative dairy products containing probiotic bacteria. Beyond yoghurt, cheeses could be a suitable matrix for the incorporation of probiotics. This work aimed to study the impact of the addition of two probiotic lactobacilli (L. rhamnosus GG and L. acidophilus LA5), either individually or combined, on the physicochemical and sensory characteristics of pasta filata soft cheeses and to evaluate the immunomodulating capacity of the product using an in vivo model. Four cheese types were produced: CC (control cheese); L-C (added with L. acidophilus LA5); GG-C (added with L. rhamnosus GG) and GGL-C (added with both probiotics). No differences in gross composition were found. An increase in secondary proteolysis was observed in GGL-C cheeses which correlated with a greater bitter and aftertaste. On the contrary, the L-C cheese received the highest overall quality score. The translocation assay was negative. Moreover, the three experimental cheeses were able to modulate the immune system of mice by reducing the secretion of pro-inflammatory cytokines in the intestine, downregulating the levels of interleukin (IL)-10 and increasing the secretion of Secretory Immunoglobulin A (S-IgA). No synergistic effect was detected when both probiotics were added.

Left congenital diaphragmatic hernia-associated musculoskeletal deformities.

AIM: With the advancement in the treatment strategies of congenital diaphragmatic hernia (CDH), there is an increase in the survival rates. This fact leads to an increase in the morbidity and extrapulmonary complications in the long term such as failure to thrive, hernia recurrence, neurodevelopmental delay, gastrointestinal problems, and musculoskeletal anomalies. Herein, we aim to investigate the association between the long-term musculoskeletal complications in CDH patients regarding the defect size, repair type, and perinatal parameters. METHODS: After Institutional Review Board approval was obtained (2017-6361), a retrospective chart review was performed on CDH patients from 2003 to 2016. Patients who were operated due to left-sided isolated congenital diaphragmatic hernia and survived to date were included in the study. Data were collected on demographics, preoperative characteristics, operative interventions, and postoperative outcomes. Statistical analysis was performed with IBM SPSS Statistics 20.0.0 (Chicago, IL). RESULTS: There were 98 patients with left CDH of whom 33 (33.7%) had primary repair, 25 (25.5%) had patch repair, and 40 (40.8%) had muscle flap repair. The median age of the patients was 6.00 ± 3.83 years. 45 patients (45.9%) had large diaphragmatic defects, 28 patients (28.6%) had at least one type of musculoskeletal deformities, 2 of which were pectus carinatum, 16 were pectus excavatum, and 18 were scoliosis. CDH patients who had small diaphragmatic defects and repaired with a patch were less likely develop musculoskeletal deformities while who had primary abdominal closure after ventral hernia significantly have more pectus excavatum. CONCLUSION: Although there was a trend towards an increased risk of the pectus deformity and scoliosis in patients repaired with muscle flap, it did not reach statistical significance. There is a correlation between musculoskeletal deformities and the severity of the CDH.

Effect of storage temperature on the chemical, microbiological, and sensory characteristics of pasta filata soft cheese containing probiotic lactobacilli.

The aim of this study was to manufacture pasta filata cheeses added with two probiotic lactobacilli: Lactobacillus rhamnosus GG and Lactobacillus acidophilus LA5, either individually or combined, and to evaluate the effect of the storage temperature (4 and 12 °C) on their chemical, microbiological, and sensorial characteristics. Three cheese types were made: (i) G: containing L. rhamnosus GG, (ii) L: containing L. acidophilus LA5, and (iii) GL: containing both probiotic strains. Gross composition, pH, microbiological, and sensory characteristics were determined. No differences in gross composition were found among them. pH values remained above 5.2 in cheeses stored at 4 °C. However, a postacidification was observed in cheeses ripened at 12 °C. L. acidophilus LA5 was not able to grow, while L. rhamnosus GG grew 1.5 log10 CFU/g in G and GL cheeses stored at 12 °C, reducing the pH from day 8 onwards. These results emphasize the importance of the storage temperature since the good characteristics of probiotic cheeses are kept if the cold-chain is respected. Thus, the selection of probiotics, together with the food matrix and the starter, should be carefully evaluated.

Congenital diaphragmatic hernia: the good, the bad, and the tough.

OBJECTIVES: We aim to determine factors that are associated with better outcomes of CDH patients. METHODS: A retrospective review was performed on all CDH patients admitted to our institution between 2003 and 2016. This study was performed at a single institution which has a fetal care center. Patients admitted with CDH with at least 1-year follow-up during the analysis were included in the study. RESULTS: Twenty-six (13.8%) patients had a hernia sac, 124 (59%) patients had liver herniation, and 56 (25.1%) patients had an accompanying syndrome. Overall survival to discharge was 73.1% while overall survival to date was 69.5%. The presence of a hernia sac, liver herniation, and accompanying syndromes showed as independent predictors influencing the survival, B 1.968, p = 0.04, OR 7.158, 95% CI 0.907-56.485, B - 1.178, p = 0.01, OR 3.932, 95% CI 1.798-8.602 and B - 1.032, p = 0.05, OR 2.795, 95% CI 0.976-7.764, respectively. CONCLUSION: In our CDH cohort, the presence of a hernia sac was proven to be associated with better outcomes, while thoracic herniation of the liver was associated with worse outcomes. The accompanying syndromes although being more difficult to manage had a little effect on the outcome of the disease itself.

Fetal brain morphometry on prenatal magnetic resonance imaging in congenital diaphragmatic hernia.

BACKGROUND: Many infants with congenital diaphragmatic hernia (CDH) show brain abnormality on postnatal brain MRI related to severity of CDH, degree of lung hypoplasia, intrathoracic liver, right diaphragmatic hernia and large diaphragmatic defect. It is not known whether these factors affect brain growth in utero in CDH. OBJECTIVE: To assess prenatal brain morphometry and abnormalities on fetal MR in congenital diaphragmatic hernia. MATERIALS AND METHODS: We retrospectively reviewed 109 fetal MRIs in 63 fetuses with CDH from 2009 to 2014 (27 died before discharge, 36 survived to discharge). We compared brain injury and gestational-age-corrected z-scores of brain measurements between survivors and non-survivors. We assessed correlations between brain abnormalities and CDH severity. RESULTS: Enlarged extraaxial space was the most common abnormality, frequently seen on fetal MRI at >28 weeks of gestation, similar in survivors versus non-survivors. Anteroposterior cerebellar vermis dimension at >28 weeks of gestation was smaller in non-survivors compared to survivors (P=.02) and positively correlated with observed/expected total fetal lung volume (P=.01). Transverse cerebellar diameter at >28 weeks of gestation was also positively correlated with observed/expected total fetal lung volume (P=.04). We did not identify maturational delay, abnormal parenchymal signal or intracranial hemorrhage on fetal MRI. CONCLUSION: Enlarged extraaxial spaces in the third trimester was the most common abnormality on fetal MRI in congenital diaphragmatic hernia. Cerebellar dimensions on fetal MRI are associated with CDH severity. There was no major brain parenchymal injury on fetal MRI, even in the third trimester, in CDH survivors and non-survivors.

Isolation, Characterization and Performance of Autochthonous Spray Dried Lactic Acid Bacteria in Maize Micro and Bucket-Silos.

The aim of this study was to isolate, identify and characterize lactic acid bacteria (LAB) from spontaneously fermented maize silage, and evaluate their performance as spray-dried (SD) cultures to enhance the fermentation and the aerobic stability of maize micro-silos. Eleven strains of LAB were characterized for growth kinetics, the capability to grow in vegetable-based medium (VBM), production of organic acids and the ability to tolerate heat-stress. Three strains (Lactobacillus plantarum Ls71, Pediococcus acidilactici Ls72, and Lactobacillus buchneri Ls141) were selected and further characterized for the ability to grow as single strain or in co-culture in MRS and VMB medium, to survive at freeze and spray-drying process, for their performance as SD bacteria in micro-silos and for the aerobic stability in bucket silos. L. buchneri Ls141 showed the highest growth capability in VBM and produced the highest amount of acetic acid, while L. plantarum Ls71 produced the highest amounts of lactic acid. P. acidilactici Ls72 was the most heat-resistant strain, with a reduction of 0.2 log10 CFU/mL (15 min at 55°C). The three strains satisfactorily tolerated both spray and freeze-drying. After 4 days of fermentation, all the samples reached a pH value of about 3.7-3.8. A significantly lower cell load of filamentous fungi and yeasts (< 3 log10 CFU/g) and a higher concentration of total LAB (> 8.7 log10 CFU/g) was observed after 30 days of fermentation. A greater amount of acetic acid, crude protein, ash and ammonia nitrogen/total nitrogen was detected in inoculated silages. A significant reduction of filamentous fungi and yeasts was also observed in inoculated bucket silos after 50 d of fermentation. The aerobic stability was significantly improved in inoculated silage since the temperature remained stable after 16 days (384 h). On the contrary, an increase of 5°C was observed in control samples after 1 day. The selected strains have the potential to be produced as SD silage inoculant as they were able to accelerate the fermentation process, to control filamentous fungi and yeasts, to improve some nutritional and chemical parameters of silage and to improve aerobic stability.

Variability in gut mucosal secretory IgA in mice along a working day.

OBJECTIVE: To assess the variability of secretory immunoglobulin A (S-IgA) in the lumen and feces of mice along a working day. RESULTS: Mice were maintained under a 12 h light-dark cycle, light period starting at 8 AM. S-IgA was determined in feces and intestinal content (after one or three washes) at three points along the day: at the beginning, in the middle and at the end of the light period (ELP). Significant reduction in the content of S-IgA in the small intestine fluid and in feces was observed at the end of the light cycle, which coincides with the end of a regular working day (8 PM) in any given animal facility. It was also observed that three washes of the small intestine were more effective than one flush to recover a significant higher amount of S-IgA, with the smallest coefficient of variation observed by the ELP. A smaller CV would imply a reduced number of animals needed to achieve the same meaningful results. The results may be useful when designing animal trials for the selection of probiotic candidates based on their capacity of activating S-IgA, since it would imply a more rational use of experimental animals.