Filtenborgmichael3374

In the majority of patients undergoing transcatheter aortic valve implantation, the transfemoral access is the suggested approach due to its less invasive nature and feasibility in patients with suitable vascular anatomy. The complications of the transfemoral access site are generally vascular; however, we herein present a rare case of colon perforation following the transfemoral procedure owing to prior abdominal surgery. A transfemoral aortic valve was inserted on account of severe aortic stenosis and a high probability of surgical mortality. The patient developed acute abdomen following the procedure. Hemicolectomy was performed because of colonic perforation caused by femoral catheterization. The patient was well at 3 months' follow-up.Apixaban was introduced in clinical use for nonvalvular atrial fibrillation as an alternative to warfarin. There is a dearth of information regarding apixaban use in patients suffering from atrial fibrillation with intracardiac foreign bodies such as pacemaker leads. In this report, we describe a 72-year-old female patient with a complaint of weakness in both legs of a few days' duration. She was detected to have a thrombus over the pacemaker lead and inside the left atrial appendage during apixaban treatment. After the discontinuation of apixaban and the commencement of warfarin, the thrombus was resolved. Our case is the first report to show that apixaban treatment (5 mg, twice daily) may not prevent the development of pacemaker lead thrombosis in patients with atrial fibrillation.Background Ischemic postconditioning is a novel strategy for attaining cardioprotection. Remarkable evidence from various in vitro and in vivo animal and human studies have shown significant opioid-induced cardioprotection against myocardial ischemia/reperfusion (I/R) injury. The purpose of this study was to assess the cardioprotective effect of sufentanil against I/R injury after on-pump coronary artery bypass grafting (CABG). Methods Between June 2016 and July 2017, 80 consecutive patients with triple-vessel disease undergoing on-pump CABG were enrolled in this prospective randomized study. The patients assigned to the sufentanil group received a single dose of sufentanil (0.2 μg/kg diluted with 50 cc of saline) 5 minutes before the removal of the aorta cross-clamp, with the sufentanil injected via a cardioplegia needle into the aortic root. In the control group, the same volume of normal saline was injected as a placebo. Cardiac enzymes, the inotrope score, and the outcome data were compared between the 2 groups. Results The mean age of the patients was 60.48±7.50 years (range=41-69 y), and men comprised 65.0% of the study population. The levels of CK-MB and cardiac troponin I were significantly lower in the sufentanil group (P less then 0.001). The amount of inotrope use (P less then 0.001), the incidence of atrial fibrillation (P=0.014), electrical shock (P=0.007), and the mechanical ventilation time (P less then 0.001) decreased in the sufentanil group compared with the control group. However, the use of intra-aortic balloon pumps (P=0.247) and the ICU length of stay (P=0.867) were not significantly different between the 2 groups. Conclusion The injection of a single dose of sufentanil into the aortic root prior to aorta cross-clamp removal diminished cardiac injury during on-pump CABG in our patients.Background The aim of this study was to investigate the ability of a new index, namely the left ventricular internal dimension at end-diastole/mitral valve E-point septal separation (LVIDd/EPSS), to predict the left ventricular (LV) systolic function and to compare its performance with that of the EPSS index and to investigate the correlation between the LVIDd/EPSS and the left ventricular ejection fraction (LVEF). Methods The current study recruited 142 patients who presented to the Cardiology Clinic of Sakarya University Education and Research Hospital and were followed for heart failure (HF).M-mode measurements of the EPSS and the LVIDd were recorded in the parasternal long-axis view. Results Totally, 142 HF patients with midrange ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF) were enrolled in the study. There was a significantly correlation both between the EF and the EPSS and between the EF and the LVIDd/EPSS (P0.05). The receiver operating characteristic curve analysis showed that the LVIDd/EPSS predicted advanced HF with 87% sensitivity and 72% specificity, using a cutoff value of 3.35,and it predicted the HFrEF (EF less then 40%) with 84% sensitivity and 81% specificity, using a cutoff value of 3.75. Conclusion The LVIDd/EPSS may allow certain clinicians, especially beginners and emergency department physicians, to assess the LVEF when other methods are not available or questionable.Background Orthostatic hypotension (OH) in the elderly is an important health challenge that poses a significant burden. We sought to determine the prevalence and correlates of OH in an elderly population-based study. Methods This study was conducted within the framework of the Amirkola Health and Ageing Project (AHAP) on 1,588 elderly individuals aged ≥60 years. The baseline measurement was performed from April 2011 to July 2012. The relationships between OH (dependent variable) and age, sex, diabetes, hypertension, and cognitive status (independent variables) were investigated by logistic regression. Results The mean age of the participants was 69.37±7.42 years (men 69.96±7.68 y, women 68.66±7.02 y). The prevalence of OH was 10.7% 8.4% in the male and 13.7% in the female patients. In the final model, hypertension (OR=2.4, 95% CI 1.6-3.7), diabetes (OR=1.3, 95% CI 1.0-1.9), age (OR=2.9, 95% CI 1.7-4.8), and female sex (female [OR=1.6, 95% CI 1.1-2.3]) were significantly correlated with OH. Conclusion The prevalence of OH in our elderly subjects increased with age. Additionally, the older participants with diabetes and hypertension had a higher likelihood of having this OH.Background Although serum paraoxonase-1 (PON-1) and arylesterase (ARE) activities are linked to the presence of stable coronary arterial disease, their correlation with SYNTAX Score I (SS1) and SYNTAX Score II (SS2) has not been known well. Our aim was to determine the association between PON-1 and ARE activities, together with the genetic polymorphism of PON-1, and both SS1 and SS2 in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods Consecutive patients with acute STEMI (n=102 78 male, 24 female; mean age=61.14±12.25 y) admitted to the Emergency Department of Kırşehir Ahi Evran University Hospital between August 2018 and December 2018 were enrolled. PON-1 and ARE activities were determined on hospital admission. The SS1 and SS2 scores were calculated by using the angiographic and clinical data. Subsequently, the relationships between the activities of the enzymes, together with the genetic polymorphism of PON-1, and both SS1 and SS2 were interrogated. Results The mean SS1 and the mean SS2 were 19.8±9.7 and 32.3±11.5, respectively. The phenotype distributions of PON-1 were Q192Q (n=60), R192Q (n=35), and R192R (n=7). The respective PON-1 (U/L) and ARE (kU/L) activities were 514.85±29.34 and 216.82±36.72 in the low SS1 category; 527.60±56.31 and 203.95±55.97 in the intermediate SS1 category; and, 690.10±11.07 and 238.48±45.65 in the high SS1 category.PON-1 and ARE activities did not correlate with the SS1 categories, and varying SS2 scores. The distribution of the Q192R polymorphism was homogenous among the different SS1 and SS2 scores. The localization of acute STEMI also did not associate with the activities of either enzyme. Conclusion Admission serum PON-1 and ARE activities, together with the PON-1 Q192R genetic polymorphism, showed association neither with SS1 and SS2 nor with the localization of infarction in our acute STEMI patients.Background Studies on the association between the prothrombin G20210A variant and coronary artery disease (CAD) risk are inconclusive. This study aimed to investigate the possible association between the G20210A variant in the prothrombin gene and documented CAD and its severity. Methods This study enrolled 1460 patients who were consecutively admitted for elective coronary angiography. Via the standard angiographic techniques, coronary angiographies were done and the presence and severity of CAD were determined through the clinical vessel score and the Gensini score. Prothrombin G20210A genotypes were identified using PCR-RFLP. Results This cross-sectional study was performed on 953 men and 507 women at a mean age of 58.21±10.33 years. The median and the interquartile range for the Gensini score were not statistically significantly different between the wild (GG) and mutant (AA+GA) genotypes (P=0.440). The association between the G20210A polymorphism and the severity of CAD with respect to the vessel score also showed no significant linear trend of higher numbers of diseased vessels (P= 0.765 for the Mantel-Haenszel test of linear trend) in the AA+GA genotype as compared with the GG genotype. Conclusion Our data failed to confirm the hypothesis that the G20210A variant mutation may be a significant determinant of CAD risk or its severity.We describe simulations using an updated version of the Community Multiscale Air Quality model version 5.3 (CMAQ v5.3) to investigate the contribution of intermediate-volatility organic compounds (IVOCs) to secondary organic aerosol (SOA) formation in southern California during the CalNex study. We first derive a model-ready parameterization for SOA formation from IVOC emissions from mobile sources. To account for SOA formation from both diesel and gasoline sources, the parameterization has six lumped precursor species that resolve both volatility and molecular structure (aromatic versus aliphatic). We also implement new mobile-source emission profiles that quantify all IVOCs based on direct measurements. The profiles have been released in SPECIATE 5.0. By incorporating both comprehensive mobile-source emission profiles for semivolatile organic compounds (SVOCs) and IVOCs and experimentally constrained SOA yields, this CMAQ configuration best represents the contribution of mobile sources to urban and regionalas volatile chemical products.Little is known about dental practice patterns of caries prevention in adults among Brazilian dentists. Objective To quantify procedures used for caries prevention for adult patients among dentists from a Brazilian community. Methods Dentists (n=197) who reported that at least 10% of their patients are more than 18 years old participated in the first Brazilian study that used a translated version of the "Assessment of Caries Diagnosis and Caries Treatment" from the U.S. National Dental Practice-Based Research Network. A questionnaire about characteristics of their practice and patient population were also completed by the dentists. Generalized linear regression models and a hierarchal clustering procedure were used (p less then 0.05). Results In-office fluoride application was the preventive method most often reported. The main predictors for recommending some preventive agent were female dentist (dental sealant; in-office fluoride; non-prescription fluoride) and percentage of patients interested in caries prevention (dental sealant; in-office fluoride; non-prescription fluoride). Other predictors included private practice (dental sealant), percentage of patients 65 years or older (in-office fluoride), graduation from a private dental school (non-prescription fluoride), years since dental school graduation (chlorhexidine rinse) and using a preventive method (recommending sealant/fluoride/chlorhexidine rinse/sugarless, xylitol gum). Cluster analysis showed that dentists in the largest subgroup seldom used any of the preventive agents. Conclusion Dentists most often reported in-office fluoride as a method for caries prevention in adults. Some practitioner, practice and patients' characteristics were positively associated with more-frequent use of a preventive agent.Pharmacokinetic data regarding ceftaroline fosamil (CPT) penetration into cerebrospinal fluid (CSF) are limited to a rabbit model (15% inflamed) and adult case reports. We describe serum and CSF CPT concentrations in a 21-year-old, 34.8 kg female, medically complex patient presented with a 4-day history of fevers (Tmax 39.2°C), tachypnea, tachycardia, fatigue, and a 1-week history of pus and blood draining from the ventriculopleural (VPL) shunt. A head CT and an ultrasound of the neck revealed septated complex fluid collection surrounding the shunt. Therapy was initiated with vancomycin and ceftriaxone. Blood and CSF cultures from hospital day (HD) 1 were positive for methicillin-resistant Staphylococcus aureus with a CPT MIC of 0.5 mg/L and a vancomycin MIC range of 0.5 to 1 mg/L. On HD 3, CPT was added. On HD 7, simultaneous serum (69.4, 44, and 30.2 mg/L) and CSF (1.7, 2.3, and 2.3 mg/L) concentrations were obtained at 0.25, 1.5, and 4.75 hours from the end of an infusion. Based on these concentrations, CPT CSF penetration ratio ranged from 2.4% to 7.6%. After addition of CPT, the blood and CSF cultures remained negative on a regimen of vancomycin plus CPT. On HD 14, a new left-sided VPL shunt was placed. The patient continued on CPT for a period of 7 days after the new VPL shunt placement. This case demonstrated CPT CSF penetration in a range of 2.4% to 7.6%, approximately half of the rabbit model. This allowed for CSF concentrations at least 50% free time > 4 to 6× MIC of the dosing interval with a dosing regimen of 600 mg IV every 8 hours in a 34.8 kg chronic patient and resulted in a successful clinical outcome with no identified adverse outcomes.Sleep disturbance is a crucial issue in pediatric palliative care, with a dramatic impact on the quality of life of children and families. Dexmedetomidine (DEX) is a selective α-2 agonist, with anxiolytic, hypnotic, and analgesic properties, that could play a role in the management of refractory sleep disturbances. We describe the use of intranasal DEX as a sleep inductor in a 10-year-old female with dystrophic epidermolysis bullosa and a severe sleep disorder. After treatment with melatonin, benzodiazepines, and niaprazine had failed, she was admitted to the hospital where 3 mcg/kg/day of intranasal DEX was administered before bedtime. She received 0.7 mL of the IV formulation at a concentration of 100 mcg/mL with half the dose given in each nostril via a Mucosal Atomization Device. During this time, she was also monitored for potential side effects (e.g., bradycardia, blood pressure derangements). After 2 weeks of hospitalization, she was discharged with ready-to-use doses of DEX for home treatment. The child's heart rate and blood oxygen saturation were monitored at home. There was a definite improvement in sleep quality and duration, daytime alertness, pain control, and quality of life. No side effects were reported and the drug retained its effect over time (the patient is currently taking the drug). Intranasal DEX could be a safe and effective strategy to manage refractory sleep disturbances in children in pediatric palliative care.Administration of intrathecal chemotherapy for leukemia is a common procedure in pediatric oncology. The direct delivery of drug into the cerebral spinal fluid requires that no preservative be used. Preserved drugs administered in error can result in significant neurotoxicity. A case series is described where preservative-containing methotrexate was incidentally administered intrathecally. All patients were treated at Children's Hospitals and Clinics of Minnesota. Medical records of the patients affected were reviewed and abstracted for this report. Four children with acute lymphoblastic leukemia received 1 dose of intrathecal methotrexate that contained 0.07% benzyl alcohol in January 2019. Overall, minimal to no symptoms were seen after dosing. The error was traced to a drug shortage in which benzyl alcohol-containing methotrexate was obtained and incorrectly stocked. A novel replacement drug procurement process was developed within our institution. The process includes sequestered queues where a drug awaits evaluation and independent double check of entry accuracy in the electronic health record and pharmacy parenteral dose preparation software prior to release and use. In contrast to IV administration, intrathecal benzyl alcohol at concentrations ≥ 0.9% can cause significant neurotoxicity. Although minimal, if any, neurotoxicity was seen in patients who received a 10-fold lower concentration of benzyl alcohol than previously associated with complications, all institutions should recognize the potential for this error and implement similar safety precautions to ensure that this type of error will not occur.We describe an 11-year-old female who presented with severe hypersomnolence after receiving 1 week of modest doses of clobazam (CLB). In reviewing the above case, we considered that the hypersomnolence could be related to a pharmacodynamic, pharmacokinetic, or pharmacogenomic issue associated with CLB or to a combination of these factors. Although serum concentrations of CLB and its active metabolite are sensitive to factors that affect cytochrome-dependent metabolism, drug-drug interactions were omitted as a cause of the hypersomnolence. Subsequent DNA analysis of the cytochrome P450 2C19 gene revealed the patient as *2/*2 genotype with poor metabolizer enzyme activity. Because genetic testing of all patients treated with CLB is currently not practical, CLB dose/concentration ratios and pharmacokinetic drug-drug interaction impact models may be indicated. Genetic testing should be considered when an adverse effect suggests the possibility of a polymorphism important to drug metabolism.Objective Our objective was to compare doses of intravenous magnesium sulfate and their association with escalations in therapy in children and adolescents presenting to the emergency department with an asthma exacerbation. Methods This was a retrospective cohort study among children who received both magnesium sulfate and standard of care therapy for asthma exacerbations. A classification and regression tree (CART) analysis was performed to identify a breakpoint in dose in which a difference in the primary outcome was present. The primary endpoint was need for escalation in therapy within 24 hours of initial magnesium sulfate dose, defined as need for invasive or non-invasive mechanical ventilation or need for adjunctive therapy, that is, epinephrine, terbutaline, aminophylline, theophylline, ketamine, heliox, or additional doses of magnesium sulfate. Results A total of 210 patients were included in the study. A CART analysis identified that a breakpoint of 27 mg/kg of magnesium was associated with a difference in the primary outcome of escalation in therapy in patients 27 mg/kg had a higher incidence of the primary outcome of escalation in therapy, 15 patients (18.3%) versus 3 patients (4.5%) in the ≤27-mg/kg/dose group (p = 0.011). Conclusions Our results demonstrate larger doses of magnesium sulfate are associated with an increased need for invasive or non-invasive mechanical ventilation or need for adjunctive therapy(ies). Our findings are limited by confounding factors that may have influenced this outcome in our population.Objectives Fluorescence imaging using indocyanine green (ICG) allows for the intraoperative mapping of the vascular supply of various tissue beds. Although generally safe and effective, rare adverse effects have been reported including anaphylactoid reactions. The current study retrospectively reviewed our experience the intraoperative administration of ICG to pediatric patients. Methods The anesthetic records of patients who received ICG over a 2-year time period were retrospectively reviewed and demographic, surgical, and medication data retrieved. Objective intraoperative data before and after the administration of ICG were also recorded. These included heart rate, systolic and diastolic blood pressures, oxygen saturation, and peak inflating pressure. Results The study cohort included 100 patients with a median age of 12 years (9.5 ± 7.4 years) and the median weight being 44.5 kg (45.9 ± 36.9 kg). ICG was administered intravenously to all patients. In all cases, 2.5 mg/mL ICG solution was used, with a median dose of 1.1 mL (1.79 ± 1.8 mL). Eight patients received more than 1 dose of ICG, with no adverse respiratory or hemodynamic effects related to its use. Conclusions ICG fluorescence is an important imaging modality that can be safely used as an intraoperative adjunct to various surgical procedures in the pediatric population.Objective Postoperative nausea and vomiting (PONV) is an extremely common side effect of general anesthesia that is difficult to manage. We tested a hypothesis that an aggressive prophylactic intervention with additional antiemetic drugs will reduce the incidence of PONV in a high-risk pediatric population undergoing adenotonsillectomy. Methods In this retrospective study, pediatric patients undergoing adenotonsillectomy were screened for their risk factors for PONV. Patients who had 3 or more risk factors were identified as high risk and received either scopolamine patch preoperatively (for patients over 40 kg body weight) or diphenhydramine immediately postextubation in addition to ondansetron and dexamethasone, which are given routinely. Incidences of PONV within the first 60 minutes of a postanesthesia care unit (PACU) stay were collected and analyzed. Results Overall postoperative vomiting rates during the first hour of a PACU stay were 4.3% for the group that was treated with dexamethasone and ondansetron only and 3.9% for the group that was treated with additional antiemetic drugs. Aggressive prophylactic management of PONV did reduce the rate of nausea and vomiting in a group of high-risk patients (p less then 0.0001). The postoperative antiemetic drug usage was also decreased during the first 60 minutes of a PACU stay. However, the approach did not reduce the overall rate of PONV for the entire study population (p = 0.1612 for nausea and p = 0.0678 for vomiting). Conclusion Aggressive intraoperative management of PONV with additional antiemetic drugs are beneficial in high-risk pediatric population. Intraoperative diphenhydramine usage decreased the rate of PONV. However, preoperative scopolamine patch prevention did not improve PONV, which may be related to the drug's longer onset of action. Our result suggests that current clinical practice is undertreating PONV in pediatric patients receiving general anesthesia.Objectives To identify differences in the incidence and severity of adverse drug events (ADEs) due to CNS depressant drugs among pediatric patients with and without surgery. Methods The Japan Adverse Drug Events Study was a cohort study enrolling pediatric inpatients. Potential ADEs were identified by onsite review of medical charts, incident reports, and prescription queries. Two independent physicians classified ADEs and severity. We compared the incidence and characteristics of ADEs between pediatric patients with surgery (surgery group) and without surgery (non-surgery group). We evaluated severity of ADEs due to CNS depressant drugs among both groups. Results We enrolled 944 patients, 234 in surgery group and 710 in non-surgery group. A total of 480 ADEs due to any drugs occurred in 225 patients. Among 81 ADEs due to CNS depressant drugs, 42 ADEs were in surgery group, whereas 39 were in non-surgery group. The risk of fatal or life-threatening ADEs due to CNS depressant drugs was significantly higher than other drugs (12% vs. 2%, p less then 0.001). In the surgery group, anesthetics led to 2 fatal or life-threatening, 8 serious, and 30 significant ADEs, whereas in the non-surgery group anesthetics led to 2 fatal or life-threatening, 5 serious, and 4 significant ADEs. Anesthetics were higher risk in the non-surgery group (p = 0.049). Conclusions The risks of fatal and life-threatening ADEs were significantly higher with CNS depressant drugs than other drugs. Pediatric patients without surgery have higher risks of fatal or life-threatening ADEs due to anesthetics than those with surgery.Objectives Treatment outcome in children with acute myeloid leukemia (AML) has improved in the developed world but remains poor in developing countries. We assessed the role of etoposide in induction chemotherapy in pediatric AML. Methods This analysis retrospectively compared 2 induction chemotherapy regimens consisting of daunorubicin and cytarabine with etoposide (ADE) and without etoposide (AD). All newly diagnosed cases of AML younger than 18 years from January 1, 2012, onwards who completed their treatment before January 31, 2019, were included. Data of 186 cases, including 117 males (62.9%) and 69 females (37.1%), were analyzed. Demographic, initial presentation blood counts, and AML subtypes were almost identical in both groups. Results Complete remission rates were almost identical for the ADE versus the AD group (78.8% vs 80.0%, p = 0.980). Treatment-related mortality was higher, albeit not significantly, in the ADE (25 of 105; 23.8%) versus the AD (16 of 81; 19.8%) group (p = 0.508). Overall survival was 32 of 105 (30.5%) in the ADE and 43 of 81 (53.1%) in the AD group (p = 0.079), and disease-free survival was 29 of 105 (27.6%) and 39 of 81 (48.1%) in ADE and AD groups (p = 0.056), respectively. Conclusions Etoposide in induction treatment of pediatric AML is associated with increased episodes of bacterial and fungal infections and high treatment-related mortality. Moreover, it does not offer any survival benefit. In low- and middle-income countries like Pakistan, it should not be used in the induction treatment protocol.Objectives This study describes our experience with a clonidine transition protocol to prevent dexmedetomidine (DEX) withdrawal in critically ill pediatric patients. Methods Retrospective review of electronic medical records of patients in the pediatric intensive care unit of a single tertiary children's hospital. All patients up to 19 years of age, who received concomitant DEX infusion and enteral clonidine between June 1, 2016, and May 31, 2018, were included. Results Two of 24 encounters had DEX restarted for withdrawal (8.3%). Five of 14 encounters who were transitioned to clonidine 2 mcg/kg every 6 hours required an increased dose, and 1 of 10 encounters transitioned to clonidine 4 mcg/kg every 6 hours required an increased dose (36% vs 10%, p = 0.21). For encounters with clonidine dose increases, 5 of 6 had improvements in Withdrawal Assessment Tool-1 (WAT-1) scores. Of these 5 encounters, 4 had decreasing or stable opioid and sedative requirements and 1 was transitioned to methadone. No encounters required discontinuation of clonidine owing to adverse events. Two of 24 encounters met our safety endpoint. One received a fluid bolus during the clonidine transition with no change in clonidine dosing, while the other had clonidine dose decreased for asymptomatic bradycardia. Conclusions The 24 encounters in our retrospective study add to the limited literature available to describe dosing, initiation time, and duration of clonidine to prevent withdrawal from DEX in critically ill pediatric patients. Further research is needed to clarify the optimal dosing and duration of clonidine to prevent DEX withdrawal in pediatric patients.Students interested in pediatric pharmacy may face difficulty choosing a postgraduate year 1 (PGY1) Pharmacy residency program. These students can complete their PGY1 Pharmacy residency in a traditional PGY1 Pharmacy program, a program with less than 50% of pediatric rotation experiences, or a pediatric-focused PGY1 Pharmacy program, a program with at least 50% of pediatric rotation experiences. These programs differ in rotational experiences, types of projects available, service commitment, and preceptor backgrounds. This article provides potential advantages and disadvantages that students may consider when selecting between these 2 different PGY1 Pharmacy residency programs. In addition, the article includes advice for students to consider when evaluating the best fit for themselves, and many of the recommendations were developed following a presentation that was given to students at the Pediatric Pharmacy Association's Annual Meeting in April 2019. Ultimately, the best residency program fit for a student interested in pediatrics should be based on each student's priorities, preferences, and career goals.Since the 1940s, anthropogenic nitrogen (N) inputs have grown to dominate global N cycles, particularly in fluvial systems. Negative impacts of this enrichment on downstream estuaries are well documented. Efforts at N reductions are increasingly successful but evaluating ecosystem response trajectories is difficult because of a lack of knowledge of historic conditions. To document continental-scale coastal food web N-dynamics prior to large increases in human N-loads, we sampled 208 fish from an archival collection, taken from coastal waters across the continental U.S., with a median collection year of 1904. The archival fish were compared with 526 samples collected in 2015 from 126 estuaries also along the U.S. coastline. We used stable isotopes of N (δ15N) and carbon (δ13C) as a proxy for human inputs and organic matter sources. Watershed attributes from 1910 and 2012, census data, fish life histories, and basic estuarine geography were used to develop random forest models that determined which variables were the best predictors of isotope values. State, latitude, and fish trophic level were consistently the most important predictors, while human impacts played a lesser role. When the fish were collected (~1914 vs 2015) was not an important predictor, rather where the fish was collected was the best predictor of N source. The model results illustrate the important role that geography plays in coastal food web dynamics and underscore the importance of offshore N-sources to coastal food webs.While fine particulate matters are decreasing in the Pearl River Delta (PRD) region, the regional ozone (O3) shows an increasing trend that affects human health, leading to an urgent need for scientific understanding of source-receptor relationship between O3 and its precursor emissions given the changing background composition. We advanced and applied an adjoint air quality model to map contributions of individual O3 precursor emission sources [nitrogen oxides (NOx) and volatile organic compound (VOC)] at each location to annual regional O3 concentrations and to identify the possible dominant influential pathways of emission sources to O3 at different spatiotemporal scales. Additionally, we introduced the novel adjoint sensitivity approach to assess the relationship between precursor emissions and O3-induced premature mortality. Adjoint results show that Shenzhen was a major source contributor to regional O3 throughout all seasons, of which 49.4% (3.8%) were from its NOx (VOC) emissions. Local emissions (within PRD) contributed to 83% of the regional O3 whereas only ~54% of the estimated ~4000 regional O3-induced premature mortalities. The discrepancy between these two contributions was because O3-induced mortalities are dependent on not only O3 concentration, but incident rate and population density. We also found that a city with low O3-induced mortalities could have significant emission contributions to health impact in the region since the transport pathways could be through transport of local O3 or through transport of O3 precursors that form regional O3 thereafter. It is therefore necessary to formulate emission control policies from both air quality and public health perspectives, and it is also critical to have better understanding of influential pathways of emission sources to O3.The United States (US) Environmental Protection Agency (EPA)'s SPECIATE database contains speciated particulate matter (PM) and volatile organic compound (VOC) emissions profiles. Emissions profiles from anthropogenic combustion, industry, wildfires, and agricultural sources among others are key inputs for creating chemically-resolved emissions inventories for air quality modeling. While the database and its use for air quality modeling are routinely updated and evaluated, this work sets out to systematically prioritize future improvements and communicate speciation data needs to the research community. We first identify the most prominent profiles (PM and VOC) used in the EPA's 2014 emissions modeling platform based on PM mass and VOC mass and reactivity. It is important to note that the on-road profiles were excluded from this analysis since speciation for these profiles is computed internally in the MOVES model. We then investigate these profiles further for quality and to determine whether they were being appropriate source categories. In addition, we conclude that new source emissions testing would be especially beneficial for residential wood combustion, nonroad gasoline exhaust and nonroad diesel equipment.A study was conducted to determine the effect of transportation distance and crating density on meat quality traits during winter. ROSS-308 broilers aged 35 days were divided into 10 treatment groups based on three transportation distances (80, 160, and 240 km) with three crating densities (10, 12, and 15 birds per crate) along with birds slaughtered on farm without crating as a control group. Each treatment was replicated 10 times and placed at various locations in the truck. The birds were transported in plastic crates of 0.91 m×0.55 m×0.30 m at ambient temperature and relative humidity of 3.6-9.5°C and 63.3-78.8%, respectively. The breast meat quality parameters including pH, color, drip loss, shear force, marinade uptake and retention, cooking losses, and yield were determined. The results showed significantly higher pH 15 min post-slaughter (PS), drip loss, lightness, marinade uptake, raw meat cooking yield, and shear force in birds slaughtered on farm without any transportation. The birds transported for 240 km had significantly higher pH at 2 hours (h) PS, marinade retention, and cooking yield. Whereas, pH at 24 h PS, meat redness, yellowness, chroma, and marinated meat cooking yield were significantly higher in all transported treatments compared to the control group. Among different crating densities, the birds transported with 10 birds per crate showed significantly higher meat redness, marinade retention, and cooking yield. The crating density of 15 birds per crate had significantly higher lightness, hue, cooking loss, and shear force. However, no effect of crating density was observed on meat pH, drip loss, and marinade uptake. It can be concluded that an increase in transportation distance and low crating density during winter can negatively affect physical quality of meat with significant improvement in marination and cooking characteristics.The aim of this study was to investigate the effect of starch granules enriched with carvacrol and mixed with straw pellets (as poultry litter) on the mortality of larvae and adults of the lesser mealworm, Alphitobius diaperinus Panzer, a cosmopolitan pest inhabiting chicken houses in vast numbers worldwide. Additionally, the effect of starch granules on the growth parameters and survival of broiler chickens exposed to treated litter was examined. In this study, granules containing 3, 5, and 10% carvacrol was used. In a simulated chicken house bioassay, this material was mixed with pellets in three different proportions 30/70%, 40/60%, and 50/50% (granules/pellets, respectively). On this medium, young larvae (approximately 10 days old), older larvae (last stage before pupa), and unsexed 7-10 days old adults of the lesser mealworm, with access to food, were colonized. Experiments were performed at 29°C in the dark. The study shows that poultry litter with the addition of starch granules enriched with 10% of carvacrol in the proportion of 4060% (granulespellets) appears to be the optimal medium applicable to broiler houses for A. diaperinus control. In this environment, all larvae and adults died within 3-4 days and the overall development of the experimental chickens was similar to that of the control. However, the feed conversion rate was slightly higher in the treated group (1.72) than in the control group (1.56). The average final body weight in the treated group was 100 g lower than that in the control group (the differences were not statistically significant).Adjuvants are common vaccine components. Novel adjuvants may improve the protective immunity conferred by vaccines against poultry diseases. Here, a less-hemolytic saponin, platycodin D (PD), isolated from the root of Platycodon grandiflorum was investigated as a potential alternative adjuvant. PD was tested as an adjuvant in the infectious bronchitis (IB) vaccine, because the existing IB vaccine has often failed to induce effective immune responses. The adjuvant activity of PD in conjunction with IB vaccine was evaluated in this study. Compared to control treatment, PD treatment significantly increased the proliferation of chicken peripheral blood mononuclear cells, concentration of interferon-γ in culture supernatants, and anti-IB antibody titer. In chickens pre-challenged with the Mass 41 infectious bronchitis virus (IBV), PD administration resulted in fewer and less severe clinical signs, lower mortality rate, and higher protection compared to control treatment. Histopathological examination showed that the lungs and kidneys of PD-treated chickens displayed fewer pathological lesions than those of control chickens. Our results also demonstrated that this new vaccine adjuvant improved chicken humoral and cellular immune responses without any side effects. Hence, our findings suggest that PD might serve as an effective adjuvant in IBV vaccines.Salmonella Typhimurium (ST) infection in chickens inhibits their growth and can lead to food-borne diseases in humans. Probiotics are expected to enhance the function of host intestinal barrier against pathogen infection. The aim of our study was to determine the effect of viable Lactobacillus reuteri (LR) on the response of the mucosal barrier function to antigen stimulation in broiler chicks. Day-old male (n=8) and female (n=4) broiler chicks were orally administered either 1 × 108 LR or a water-only control, every day for 7 days. After 7 days, either 1 × 108 heat-killed ST (k-ST), or a buffer-only control, was administered via intra-cardiac injection. The ileum and cecum were collected 3 h post-injection, and paraffin sections were prepared for either mRNA extraction (males), or gut permeability tests (females). Villus and crypt lengths were determined via histological analysis. Real-time PCR was used to calculate expression levels of Toll-like receptors (TLRs), pro-inflammatory cytokines, anti-inflammatory cytokines, avian β-defensins, and tight-junction-associated molecules. Gut permeability was assessed using the inverted intestine method. We found that (1) expression of TLR2-1, TLR21, TGF-β2 and TGF-β3 were reduced following k-ST stimulation, but were unaffected by LR-treatment; (2) oral administration of LR led to increased Claudin1, Claudin5, ZO2, and JAM2 expression following k-ST stimulation; (3) cecal permeability was reduced by co-treatment with LR and k-ST, but not by treatment with LR or k-ST alone. These results suggest that LR, as used in this study, may enhance the intestinal mucosal physical barrier function, but not the expression of other immune-related factors in newly hatched chicks.This study aimed to modify the feed mixtures of laying hens to enrich the consumer eggs with n-3 polyunsaturated fatty acids (PUFA) α-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). One hundred and twenty Tetra-SL laying hens used in the study were divided into three groups of 40 laying hens arranged in five repetitions C, control with 5% soybean oil; E1, 0.5% fish oil + 0.5% microalgae Schizochytrium limacinum; and E2, 0.75% fish oil + 0.75% microalgae. The composition of the mixtures was balanced at the level of 17.5% raw protein and 11.81 MJ/kg metabolic energy (ME). Feed and water were provided ad libitum, and the experiment lasted for 21 days. In this study, the different physical and chemical properties of eggs, the fatty acid profile and lipid oxidation of fat in egg yolks were analyzed. The results of the study showed that the weight of the egg yolk and that of the shell depended on the feeding treatments (P=0.014 and P less then 0.001), and the weight of eggs and basic parts, as well as the thickness of the shell depended on the storage duration (P less then 0.001). The storage time affected the pH of egg yolks and albumen and the reduction in Haugh units and albumen height (P less then 0.001). Significant differences were observed in the content of ALA, DHA, ∑n-3 PUFA (mg/100 g) and the n-6/n-3 PUFA ratio between the C and E1/E2 egg groups (P less then 0.001). The results of the study indicate that it is sufficient to use a lower level of fish oil and the microalgae Schizochytrium limacinum in hens' feed to achieve a satisfactory increase in n-3 PUFA in eggs, while maintaining optimal values of egg quality and freshness indicators.Broiler chickens grow rapidly within a short period; in this regard, our group had previously reported a decrease in the active transport of glucose in the intestines of broiler chickens with their growth. Therefore, in this study, we compared the active transport process of amino acids in the intestines between 1- and 5-week-old broilers using everted sac, Ussing chamber techniques, and real-time quantitative polymerase chain reaction (RT-PCR). The everted sac experiment showed that amino acids were absorbed from all segments of the small intestine in both age groups. There were no significant differences in the serosal to mucosal ratio between 1- and 5-week-old broilers. The Ussing chamber experiment showed that amino acid-induced short-circuit current (ΔIsc) in the ileal epithelium was significantly greater in the 5-week-old chickens than in the 1-week-old chicks (P=0.035). Membrane conductance, an indicator of ion permeability, showed no significant difference between the two groups. Moreover, the mRNA expression levels of amino acid transporters (ASCT1, EAAT3, B0AT1, and y+LAT1) were significantly elevated in the distal ileum of the 5-week-old broilers compared to those in the 1-week-old broilers (P less then 0.05), while no significant differences were observed in the mRNA levels of ATB0'+, B0/+AT, rBAT, CAT1, and CAT2 in both groups. Our study provides clear evidence that age-dependent increase in the active transport of amino acid across the ileal epithelium is caused by the high expression of Na+-dependent amino acid transporters in broiler chickens.1α-Hydroxycholecalciferol (1α-OH-D3) is an active vitamin D derivative. In this study, three experiments were conducted to evaluate the optimal dietary levels of 1α-OH-D3 in broiler chickens from 1 to 42 days of age. 1α-OH-D3 levels used were 0, 1.25, 2.5, 5, and 10 µg/kg in experiment 1, 0.625, 1.25, 2.5, 5, 7.5, and 10 µg/kg in experiment 2, and 2, 2.5, 3, 3.5, 4, 4.5, and 5 µg/kg in experiment 3. In experiment 1, the addition of 0 to 10 µg/kg of 1α-OH-D3 quadratically improved growth performance, tibia development, and mRNA expression levels of nuclear vitamin D receptor (nVDR), membrane vitamin D receptor (mVDR), and type IIb sodium-phosphate cotransporter (NaPi-IIb) in the duodenum of broiler chickens from 1 to 12 days of age. Body weight gain (BWG), the weight and ash weight of the tibia, and mRNA expression levels of mVDR and NaPi-IIb of broilers fed with 0 and 10 µg/kg of 1α-OH-D3 were lower than those of birds fed with 2.5 µg/kg of 1α-OH-D3. In experiment 2, 1α-OH-D3 levels were quadratically related to BWG and to weight and ash weight of the femur and the tibia of broiler chickens at 42 days of age. The highest values of growth performance and bone mineralization were recorded in broilers fed with 2.5 to 5 µg/kg of 1α-OH-D3. In experiment 3, there was no difference observed in BWG and the weight and ash weight of the femur and the tibia of the 42-day-old broilers fed with 2 to 5 µg/kg of 1α-OH-D3. These data suggest that the optimal dietary levels of 1α-OH-D3 were 2 to 5 µg/kg for broiler chickens from 1 to 42 days of age.The objective of this study was to examine the effect of Gynura divaricata (Jakr-Na-Rai, JNR) on the growth performance, hematology, and carcass fat deposition of broilers. A total of 240 male Cobb-500 birds, 22 d old, were randomly allocated into five treatment groups of six replicates. Each group was raised at a high stocking density of 28 kg of bodyweight/m2 until day 43. The treatments consisted of (i) a basal diet, or the basal diet supplemented with (ii) 2.5 mg/kg avilamycin (T2), (iii) JNR crude ethanol extract at a flavonoid level of 1.3 g/kg (T3), and (iv and v) JNR powder at a flavonoid level of 1.3 (T4) or 2.6 g/kg (T5). Dietary supplementation with JNR powder at both flavonoid levels decreased the heterophil/lymphocyte ratio compared to the other groups (P less then 0.001). Birds in the T5 group presented decreased blood glucose (P less then 0.005) and cholesterol (P less then 0.002) levels and a numerically (P=0.056) decreased triglyceride level. The total bile acid concentration increased (P less then 0.001) in all the JNR-fed groups, but there was no significant effect on the digestibility of ileal protein or fat. At 1.3 g/kg of diet, JNR increased the final bodyweight and feed intake (P less then 0.05), but the average daily gain and feed conversion ratio were not different among groups. The carcass and abdominal fat percentages were lowest in chicks fed on the diets supplemented with 2.6 g/kg JNR powder (P less then 0.007 and P less then 0.025, respectively). Drip loss and malondialdehyde concentrations in the breast meat did not change. In conclusion, JNR powder improved several hematological parameters, increased total bile acid concentrations, and decreased the percentage of abdominal fat. The powder form of JNR elicited better results than the ethanol extract form at the same flavonoid inclusion level.A significant association was reported between a single nucleotide polymorphism (SNP; AB604331, g.420 C>A) in the cholecystokinin type A receptor gene and growth traits in some Japanese slow-growing chickens. Demonstration tests of the genetic improvement effect by comparing the superior allele-A fixed chickens with conventional ones were carried out considering the effect of different seasons on growth traits in other slow-growing chickens. Meat-type Okumino-kojidori chickens from Gifu Prefecture are a three-way cross of Gifu-jidori improved, White Plymouth Rock, and Rhode Island Red breeds. We used a total of 468 meat-type Okumino-kojidori 264 individuals from a private hatchery as conventional chickens and 204 A-allele fixed individuals from the Gifu Prefectural Livestock Research Institute as improved chickens. We performed fattening experiments over two seasons summer and winter. In each season, experimental birds of both sexes were hatched on the same day, raised in the same chicken house, and fed the same diet ad libitum for 12 weeks. Body weight was recorded at 3, 6, 9, and 12 weeks of age. SNP genotypes were determined using the mismatch amplification mutation assay. Association between the SNP and growth traits was analyzed using generalized linear models built on sex-based, seasonal, additive, and dominance genetic effects. The observed AA, AC, and CC genotype frequencies in the conventional chickens were 0.158, 0.479, and 0.363, respectively; body weight at 12 weeks and average daily gain from 3 to 12 weeks was superior for the A allele compared to the C allele. The improved chickens were heavier than the conventional ones at 12 weeks. Body weight at 12 weeks in allele-A fixed chickens increased by 3.2% compared to the conventional chickens. We concluded that g.420 C>A is a good selective marker that increases slaughter weight in the meat-type Okumino-kojidori chickens.We have previously reported a significant association between the single-nucleotide polymorphism (SNP; g.420 C>A) in the cholecystokinin type A receptor gene (CCKAR) and the growth traits of Hinai-dori, a breed of chicken that is indigenous to Japan. Moreover, we have demonstrated that the minor allele of this SNP improved the growth rate in a low-growth line of the Hinai-dori breed. Hence, in the present study, we verified the association between this SNP and the growth traits of the Hinai-jidori chicken a cross between a Hinai-dori sire and Rhode Island Red dam. In addition, we verified whether the growth rate was improved in Hinai-jidori chickens produced from the parent stocks in which the SNP A/A genotype was fixed by selection (improved Hinai-jidori chickens). The Hinai-jidori female chicks at 4 weeks of age, were subdivided into three genotypic groups (A/A, A/C, and C/C), with 20 chicks in each group, and reared in an open-sided poultry shed until 23 weeks of age. The results showed that the body weight at 23 weeks of age and the average daily gain after 14 weeks of age were significantly higher in group A/A than in group C/C. Subsequently, the improved and the conventional Hinai-jidori chickens were reared until they reached 22 weeks of age to verify the effects on their growth traits. The body weight of the improved Hinai-jidori chickens at 22 weeks was significantly greater than the conventional Hinai-jidori chickens. Moreover, the association between the SNP and body weights of Hinai-jidori chickens at market age (24 weeks) on the production farms showed that the A allele was significantly superior to the C allele. In conclusion, the CCKAR g.420 C>A SNP improves the growth rate of commercial Hinai-jidori chickens and could be a candidate marker for improving the growth performance in selective breeding of Hinai-jidori chickens.Metabolic syndrome represents one of the major health, social and economic issues nowadays, and affects more than 25% people worldwide. Being a multifactorial health problem, metabolic syndrome clusters various features, such as obesity, dyslipidemia, hyperglycemia and hypertension. Each of these disturbances represents a risk factor for developing cardiovascular disease. Moreover, patients with metabolic syndrome are more likely to suffer from depression, thus treatment with antidepressants (e.g. venlafaxine) is often neccessary. However, many of the antidepressants themselves may contribute to worsening or even development of the metabolic syndrome, thus creating a "vicious circle". The aim of this work was to investigate on the animal model of metabolic syndrome, i.e. on hypertriacylglycerolemic rats fed high-fat-fructose diet (HFFD) 1) the effect of a change in diet from HFFD to a standard diet (SD) and the effect of venlafaxine treatment, 2) during HFFD, 3) as well as during a changed diet to SD. We focused on biometric parameters, blood pressure and selected ECG parameters.