Association between routine cell salvage use for lower segment caesarean section and post-operative iron infusion and anemia.

PURPOSE: Intraoperative cell salvage is central to Patient Blood Management including for lower segment caesarean section. Prior to April 2020, we initiated intraoperative cell salvage during caesarean section based on risk assessment for hemorrhage and patient factors. As the pandemic broadened, we mandated intraoperative cell salvage to prevent peri-partum anemia and potentially reduce blood product usage. We examined the association of routine intraoperative cell salvage on maternal outcomes. METHODS: We conducted a single-center non-overlapping before-after study of obstetric patients undergoing lower segment caesarean section in the 2 months prior to a change in practice ('usual care = selective intraoperative cell salvage', n = 203) and the 2 months following ('mandated intraoperative cell salvage', n = 228). Recovered blood was processed when a minimal autologous reinfusion volume of 100 ml was expected. Post-operative iron infusion and length of stay were modelled using logistic or linear regression, using inverse probability weighting to account for confounding. RESULTS: More emergency lower-segment caesarean sections occurred in the Usual Care group. Compared to the Usual Care group, post-operative hemoglobin was higher and anemia cases fewer in the Mandated intraoperative cell salvage group. Rates of post-partum iron infusion were significantly lower in the Mandated intraoperative cell salvage group (OR = 0.31, 95% CI = 0.12 to 0.80, P = 0.016). No difference was found for length of stay. CONCLUSION: Routine cell salvage provision during lower segment caesarean section was associated with a significant reduction in post-partum iron infusions, increased post-operative hemoglobin and reduced anemia prevalence.

Current state of in situ subsurface remediation by activated carbon-based amendments.

The last decade has seen a growing interest in applying activated carbon (AC)-based amendments for in situ subsurface remediation of organic contaminants such as chlorinated solvents and petroleum hydrocarbons. This remedial technology has been promoted by several major AC-based product vendors on the market. These products involve impregnation or co-application of chemical or biological additives to facilitate various contaminant degradation processes in conjunction with contaminant adsorption. During field applications, rapid contaminant removal and limited rebound after emplacement have often been reported and considered as two major advantages for this remedial technology. Nevertheless, questions remain to be answered regarding its true effectiveness and longevity given the lack of subsequent field characterizations and evidence of the degradation process, especially biodegradation. Additional uncertainties reside in how subsurface heterogeneity may affect the design, implementation and performance monitoring of this technology. In light of these uncertainties, this review presents an independent analysis that focuses on both the scientific and practical aspects of AC-based remedial technology for in situ subsurface remediation by gathering and synthesizing the scientific knowledge and practical lessons from a broad range of contaminant removal processes involving adsorption and/or degradation. The analysis showed that the scientific soundness of combining adsorption and degradation proposed for all the AC-based products is well supported by the literature on ex situ treatment. However, the in situ effectiveness might be affected by additional factors, such as geological heterogeneity, amendment transport and distribution, and total contaminant mass, which require more thorough and quantitative evaluation. Overall, the technology may provide a viable tool in addressing major remediation challenges encountered in current practice, such as mitigation of back diffusion from residual sources in low permeability zones and treatment of low concentration plumes.

Lactase persistence and augmented salivary alpha-amylase gene copy numbers might have been selected by the combined toxic effects of gluten and (food born) pathogens.

Various positively selected adaptations to new nutrients have been identified. Lactase persistence is among the best known, conferring the ability for drinking milk at post weaning age. An augmented number of amylase gene (AMY1) copies, giving rise to higher salivary amylase activity, has been implicated in the consumption of starch-rich foods. Higher AMY1 copy numbers have been demonstrated in populations with recent histories of starchy-rich diets. It is however questionable whether the resulting polymorphisms have exerted positive selection only by providing easily available sources of macro and micronutrients. Humans have explored new environments more than any other animal. Novel environments challenge the host, but especially its immune system with new climatic conditions, food and especially pathogens. With the advent of the agricultural revolution and the concurrent domestication of cattle came new pathogens. We contend that specific new food ingredients (e.g., gluten) and novel pathogens drove selection for lactase persistence and higher AMY gene copy numbers. Both adaptations provide ample glucose for activating the sodium glucose-dependent co-transporter 1 (SGLT1), which is the principal glucose, sodium and water transporter in the gastro-intestinal tract. Their rapid uptake confers protection against potentially lethal dehydration, hyponatremia and ultimately multiple organ failure. Oral rehydration therapy aims at SGLT1 activity and is the current treatment of choice for chronic diarrhoea and vomiting. We hypothesize that lifelong lactase activity and rapid starch digestion should be looked at as the evolutionary covalent of oral rehydration therapy.

The role of multi-disciplinary teams in decision-making for patients with recurrent malignant disease.

BACKGROUND: It is mandatory in many countries for decisions for all new patients with cancer to be made within multi-disciplinary teams (MDTs). Whether patients with disease recurrence should also routinely be discussed by the MDT is unknown. AIM: This study investigated the role of an upper gastro intestinal (UGI) MDT in decision-making for patients with disease recurrence. DESIGN: A retrospective review of prospectively kept MDT records (2010 to 2011) was performed identifying patients discussed with recurrence of oesophagogastric cancer. Information was recorded about: i) why an MDT referral was made, ii) who made the referral and iii) the final MDT recommendation. Implementation of the MDT recommendation was also examined. PARTICIPANTS: All patients discussed with recurrence of cancer at a central UGI cancer MDT were included. RESULTS: During the study 54 MDT meetings included discussions regarding 304 new patients and 29 with disease recurrence. Referrals to the MDT for patients with recurrence came from outpatient clinics (n=19, 65.5%) or following emergency admission (n=10). Most referrals were made by the surgical team (n=25, 86.2%). MDT recommendations were best supportive care (n=11, 37.9%), palliative chemotherapy (n=9, 31.0%), stent (n=5, 17.2%), palliative radiotherapy (n=3, 10.3%) and further surgery (n=1, 3.4%), with 25 (86.2%) of these implemented. CONCLUSION: UGI MDTs focus on new referrals and only a small proportion of patients with recurrent disease are re-discussed. Many patients go on to receive further treatments. Whether such patients are optimally managed within the standard MDT is uncertain, however, and warrants further consideration.

Acute effect of poly-gamma-glutamic acid on calcium absorption in post-menopausal women.

OBJECTIVE: Poly-gamma-glutamic acid (PGA) increases calcium (Ca) solubility in vitro and in vivo, and is associated with reduced bone loss in post-menopausal Japanese women. This study is the first to examine the effect of PGA on Ca absorption in humans. METHODS: A single-blind, randomized, crossover study with a 3-4 week wash-out was performed to determine the effect of PGA (80.6% glutamic acids) on Ca absorption measured by the double stable isotope method. Twenty-four healthy, non-smoking, postmenopausal women (mean age: 56.4 +/- SE 0.9) were given 200 g of orange juice containing 200 mg Ca as Ca-44 enriched CaCO(3), with or without 60 mg of PGA, after an overnight fast. The two tests were separated by 3-4 weeks. An intravenous injection of Ca-42 (CaCl(2) solution) was given 30 min after consuming the drink and a complete urine collection carried out from 24-48 h post-dosing. Ca absorption was calculated from the Ca isotope ratios measured by thermal ionization quadrupole mass spectrometry (TIQMS). RESULTS: Mean Ca absorption with PGA was significantly higher (P < 0.01) than without PGA, 39.1 (SE 1.6) % and 34.6 (SE 1.9) %, respectively. The effect of PGA on increasing Ca absorption was more marked in a sub-group of subjects whose baseline Ca absorption (without PGA) was lower than the population mean value. CONCLUSION: Postmenopausal women who received a single dose of PGA increased their intestinal Ca absorption particularly those individuals with lower basal absorptive capacity.

Absorption of selenium from wheat, garlic, and cod intrinsically labeled with Se-77 and Se-82 stable isotopes.

There is limited information on the absorption of selenium from different foods in humans because of technical difficulties associated with isotopic labeling of dietary selenium. Wheat, garlic, and cod fish were intrinsically labeled with Se-77 or Se-82 stable isotopes. Labeled meals were fed in random order to 14 adults, with a minimum washout period of six weeks between each test meal. Apparent absorption was measured as luminal loss using a fecal monitoring technique over an 8-day period. Plasma appearance of the isotope was measured at 7, 24, and 48 hours post-ingestion. Selenium absorption (+/- SD) was significantly higher (p < 0.001) from wheat (81.0 +/- 3.0%) and garlic (78.4 +/- 13.7%) than from fish (56.1 +/- 4.3%). Lowest plasma concentration was observed after the fish meal at all three time points, with a peak at 24 hours, whereas wheat produced the highest plasma concentration at all three time points and peaked at 7 hours. Selenium absorption from wheat and garlic was higher than from fish, and inter-individual variation was low. Form of selenium and food constituents appear to be key determinants of post-absorptive metabolism.