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The objective of this study was to investigate the effects of dietary Bacillus subtilis supplementation on growth performance, jejunal lesion scores, oocyst shedding, and cytokine and tight junction protein expression in broiler chickens infected with Eimeria maxima. A total of 196 male day-old Ross 708 broilers were given a nonexperimental diet until 14 D of age. Then, all chickens were randomly assigned to one of seven dietary treatments: 2 basal diets (CON and NC); CON + virginiamycin (AB1); CON + bacitracin methylene disalicylate (BMD; AB2); CON + B. subtilis 1781 (PB1); CON + B. subtilis 747 (PB2); or CON + B. subtilis 1781 + 747 (PB3). At day 21, all chickens except those in the CON group were orally inoculated with E. maxima oocysts. At 7 D after E. maxima infection, the body weight gains of chickens fed PB2 and PB3 increased (P = 0.032) as much as those in chickens fed AB2. The body weight gain and feed efficiency of chickens fed PB2 were significantly increased (P < 0.001), and PB2 chickens showed (P = 0.005) the lowest lesion scores after E. maxima infection. Chickens fed PB2 showed (P < 0.05) lower mRNA expression of IL-1β in infected chicken groups. Chickens in the AB1, AB2, PB1, PB2, and PB3 groups showed (P < 0.05) greater mRNA expression of junctional adhesion molecule 2 in jejunal tissue, whereas occludin expression increased (P < 0.05) in the jejunal tissue of chickens fed AB2 or PB2. Dietary B. subtilis supplementation significantly improved the growth performance of young chickens to a level comparable with that induced by virginiamycin or BMD without E. maxima infection. After infection with E. maxima, dietary virginiamycin and BMD significantly enhanced the epithelial barrier integrity, and the dietary B. subtilis 747 showed significantly enhanced growth performance, intestinal immunity, and epithelial barrier integrity. Together our results indicated that certain strains of B. subtilis provide beneficial effects on the growth of young broiler chickens and have the potential to replace antibiotic growth promoters., (Copyright © 2019. Published by Elsevier Inc.)

To quantify the fine-scale spatial variations and local source impacts of urban ultrafine particle (UFP) concentrations, we conducted 3-6 weeks of continuous measurements of particle number (a proxy for UFP) and other air pollutant (CO, NO 2 , and PM 2.5 ) concentrations at 32 sites in Pittsburgh, Pennsylvania during the winters of 2017 and 2018. Sites were selected to span a range of urban land use attributes, including urban background, near local and arterial roads, traffic intersections, urban street canyon, near-highway, near large industrial source, and restaurant density. The spatial variations in urban particle number concentrations varied by about a factor of three. Particle number concentrations are 2-3 times more spatially heterogeneous than PM 2.5 mass. The observed order of spatial heterogeneity is UFP > NO 2  > CO > PM 2.5 . On average, particle number concentrations near local roads with a cluster of restaurants and near arterial roads are roughly two times higher than the urban background. Particle number concentrations in the urban street canyon, downwind of a major highway, and near large industrial sources are 2-4 times higher than background concentrations. While traffic is known as an important contributor to particle number concentrations, restaurants and industrial emissions also contribute significantly to spatial variations in Pittsburgh. Particle size distribution measurements using a mobile laboratory show that the local spatial variations in particle number concentrations are dictated by concentrations of particles smaller than 50 nm. A large fraction of urban residents (e.g., ~50%) in Pittsburgh live near local sources and are therefore exposed to 50%-300% higher particle number concentrations than urban background location. These locally emitted particles may have greater health effects than background particles., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Positive and negative artifacts of particle-phase organic carbon (p-OC) and the polycyclic aromatic hydrocarbons (PAHs) in gasoline direct injection (GDI) engine exhaust particulate matter (PM) were assessed using an integrated organic gas and particle sampler (IOGAPS). Three configurations (denuder + sorbent impregnated filters (SIFs), upstream Zefluor filter + denuder + SIFs, and standard filter pack + SIFs) were used to collect GDI exhaust samples at cold start and highway cruise operating conditions with no aftertreatment. Approximately 35% of the measured GDI p-OC was attributed to positive artifacts; negative artifacts were not detectable due to low overall SVOC concentrations. GDI engine exhaust PAH concentrations were approximately 10 times higher during cold start than highway cruise. At highway cruise, pyrene and fluoranthene were the dominant PAHs in the undenuded filter pack; downstream of the denuder benzo(a)anthracene was the dominant PAH. From a comparison of our findings to published PAH emission factors we estimate that three-way catalyst conversion efficiencies of PAHs were approximately 80% for 3 of the 15 PAHs measured during highway cruise operation. These conversion efficiencies may be considerably lower during cold start operation when the three-way catalyst has not reached its operating temperature. Our previous work showed that adverse biological responses to GDI engine exhaust exposure may be dominated by the particle phase when measured downstream of a Teflon filter. Understanding the partitioning characteristics of PAHs may help elucidate specific PAHs contributing to this effect., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: The role of obesity as a risk factor for difficult intubation remains controversial. We primarily assessed the association between body mass index (BMI) and difficult tracheal intubation., Methods: We analysed electronic records of more than 67 000 adults having elective non-cardiac surgery requiring tracheal intubation at the Cleveland Clinic between 2011 and 2015. The association between BMI and difficult intubation, defined as more than one intubation attempt, was assessed using multivariable logistic regression adjusting for pre-specified confounders., Results: Amongst 40 183 patients with BMI <30 kg m -2 and 27 519 with BMI ≥30 kg m -2 , 9% required more than one intubation attempt. Increasing BMI up to 30 kg m -2 was significantly associated with increased odds of more than one intubation attempt [odds ratio (OR): 1.03; 97.5% confidence interval (CI): 1.02, 1.04] per unit increase in BMI, P < 0.001. However, the odds of difficult intubation remained unchanged once BMI exceeded 30 kg m -2 (P = 0.08). The results were similar when analysis was restricted to patients without history of airway abnormalities in whom intubation was attempted using a standard direct laryngoscope (OR: 1.03; 99.4% CI: 1.01, 1.04) per kg m -2 increase in BMI <30 kg m -2 )., Conclusions: Increasing BMI was associated with increasing odds of difficult intubation in the lean range. At higher BMI, the odds of difficult intubation remain elevated, but there is no additional increase in odds with further increase in BMI. Obese patients were thus harder to intubate than lean ones, but difficult intubation was no more likely in morbidly obese patients than in those who were only slightly obese., (Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Background: The anti-inflammatory effects of statins have been suggested to relieve postoperative pain. This retrospective study tested the association between the perioperative routine use of statins in therapeutic doses, and opioid requirements and pain scores, after hip replacement surgery., Methods: With IRB approval, data was obtained for adult patients who had elective hip replacement surgery under spinal anaesthesia at Cleveland Clinic between 2005 and 2015. Patients were compared using a joint hypothesis framework. We used the inverse probability of treatment weighting method to control for observed confounding factors (a total of 26)., Results: We included 611 statin users and 780 non-statin users. Pain score during the initial 72 h after surgery was 0.07 higher (95% CI: -0.02, 0.17) in statin users (noninferiority test in both directions P<0.001). The estimated ratio of geometric means in the cumulative i.v. morphine equivalent opioid consumption was 1.01 (95% CI: 0.93, 1.10) for statin vs non-statin users (noninferiority test P=0.001 in the hypothesized direction and<0.001 in the other direction) during the initial 72 h after surgery. The statin and non-statin patients were deemed equivalent on postoperative opioid consumption and pain score., Conclusions: This is the first large retrospective clinical study that investigates the effects of statin use on postoperative pain and opioid consumption. We observed no difference between statin users and non-users during the initial 72 h after hip surgery. Our findings do not support the routine use of statins as part of an analgesic regimen., (© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com)

Gasoline direct injection (GDI) engines are increasingly prevalent in the global vehicle fleet. Particulate matter emissions from GDI engines are elevated compared to conventional gasoline engines. The pulmonary effects of these higher particulate emissions are unclear. This study investigated the pulmonary responses induced by GDI engine exhaust using an ex vivo model. The physiochemical properties of GDI engine exhaust were assessed. Precision cut lung slices were prepared using Balb/c mice to evaluate the pulmonary response induced by one-hour exposure to engine-out exhaust from a laboratory GDI engine operated at conditions equivalent to vehicle highway cruise conditions. Lung slices were exposed at an air-liquid interface using an electrostatic aerosol in vitro exposure system. Particulate and gaseous exhaust was fractionated to contrast mRNA production related to polycyclic aromatic hydrocarbon (PAH) metabolism and oxidative stress. Exposure to GDI engine exhaust upregulated genes involved in PAH metabolism, including Cyp1a1 (2.71, SE=0.22), and Cyp1b1 (3.24, SE=0.12) compared to HEPA filtered air (p<0.05). GDI engine exhaust further increased Cyp1b1 expression compared to filtered GDI engine exhaust (i.e., gas fraction only), suggesting this response was associated with the particulate fraction. Exhaust particulate was dominated by high molecular weight PAHs. Hmox1, an oxidative stress marker, exhibited increased expression after exposure to GDI (1.63, SE=0.03) and filtered GDI (1.55, SE=0.04) engine exhaust compared to HEPA filtered air (p<0.05), likely attributable to a combination of the gas and particulate fractions. Exposure to GDI engine exhaust contributes to upregulation of genes related to the metabolism of PAHs and oxidative stress., (Copyright © 2016 Elsevier B.V. All rights reserved.)

This work is presented as an improvement of a recently introduced method for airborne particulate matter (PM) filter analysis [1]. X-ray standing wave (XSW) and total reflection X-ray fluorescence (TXRF) were performed with a new dedicated laboratory instrumentation. The main advantage of performing both XSW and TXRF, is the possibility to distinguish the nature of the sample: if it is a small droplet dry residue, a thin film like or a bulk sample. Another advantage is related to the possibility to select the angle of total reflection to make TXRF measurements. Finally, the possibility to switch the X-ray source allows to measure with more accuracy lighter and heavier elements (with a change in X-ray anode, for example from Mo to Cu). The aim of the present study is to lay the theoretical foundation of the new proposed method for airborne PM filters quantitative analysis improving the accuracy and efficiency of quantification by means of an external standard. The theoretical model presented and discussed demonstrated that airborne PM filters can be considered as thin layers. A set of reference samples is prepared in laboratory and used to obtain a calibration curve. Our results demonstrate that the proposed method for quantitative analysis of air PM filters is affordable and reliable without the necessity to digest filters to obtain quantitative chemical analysis, and that the use of XSW improve the accuracy of TXRF analysis., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Total Reflection X-ray Fluorescence (TXRF) is a well-established technique for chemical analysis, but it is mainly employed for quality control in the electronics semiconductor industry. The capability to analyze liquid and uniformly thin solid samples makes this technique suitable for other applications, and especially in the very critical field of environmental analysis. Comparison with standard methods like inductively coupled plasma (ICP) and atomic absorption spectroscopy (AAS) shows that TXRF is a practical, accurate, and reliable technique in occupational settings. Due to the greater sensitivity necessary in trace heavy metal detection, TXRF is also suitable for environmental chemical analysis. In this paper we show that based on appropriate standards, TXRF can be considered for non-destructive routine quantitative analysis of environmental matrices such as air filters. This work has been developed in the frame of the EU-FP6 PHIME (Public Health Impact of long-term, low-level Mixed element Exposure in susceptible population strata) Integrated Project (www.phime.org). The aim of this work was to investigate Mn air pollution in the area of Vallecamonica (Italy)., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Four poultry-slaughtering plants (2 turkey, 2 duck) were investigated for airborne concentration of microorganisms, including mesophilic and psychrotrophic bacteria and yeasts and molds. Approximately 40 sites were sampled in each plant during four visits (fall, winter, spring, and summer) by using an Anderson N-6 Air Sampler containing either tryptic soy agar (for mesophilic and psychrotrophic bacteria), or Rose Bengal agar (for yeasts and molds). Sampling sites inside the plants were categorized into the following areas: shackling, picking, evisceration, post chiller, cut-up, portion packaging and whole bird packaging. Areas outside the plant were sampled as controls. Airborne microbial counts in each plant were highest in shackling areas and decreased toward the packaging areas. Bacteria were the most common airborne microorganisms identified. In general, mesophilic bacterial counts ranged from an average high of 6 log CFU/m 3 in shackling to an average low of 2.5 log CFU/m 3 outside the plant. Mean psychrotrophic bacterial levels were usually within 1 log unit (90%) less than mesophilic bacterial levels and ranged from 2.5 to 5 log CFU/m 3 Yeasts and molds typically represented only a small proportion of the microbial population and usually were between 2.5 to 4 log CFU/m 3 Air flow, distribution, temperature, relative humidity, and design of the slaughtering facility were all important factors affecting overall bioaerosol contamination. This study identified the sources and concentrations of bioaerosols that may affect product safety and shelf life. This information is useful for developing appropriate strategies for poultry-slaughtering plant design.

One hundred fifty patients with suspected wrist ligamentous injuries were studied with both triple injection wrist arthrography and arthroscopy. The diagnoses obtained by these two techniques were compared to determine the differences between these two modalities. All the patients in this study had both the clinical diagnosis of ligamentous injuries of the wrist and normal findings on x-ray films. Intercarpal abnormalities were found in 106 patients (71%) at wrist arthrography and in 136 patients (91%) at arthroscopy. There was only 42% agreement (63 patients) between the arthrographic and arthroscopic diagnoses. Eighty-seven patients (58%) had alterations of their arthrographic diagnoses following arthroscopy. For patients with normal arthrographic findings (44 patients), 88% underwent arthroscopy because there was insufficient correlation between the physical examination findings and the arthroscopic findings. Out of the 44 patients with normal arthrographic findings, 35 patients (80% of the subgroup) had injuries found at arthroscopy. Over half of the patients had alterations in their arthrographic diagnoses following arthroscopy. In a patient with suspected ligamentous injury of the wrist, wrist arthroscopy may be the most efficient method in arriving at a definitive diagnosis.

This study reviews the clinical course of 22 patients with chronic renal failure on hemodialysis with ischemic or neurologic problems in the upper extremity distal to an arteriovenous fistula. Two distinct presentations were observed. Twelve patients developed significant motor and/or sensory impairment immediately following surgical construction of the fistula. Ten patients presented with upper extremity ischemia, established or impending tissue loss, or nonhealing wounds distal to a dialysis fistula. Seventeen of the 22 patients were diabetic. Nerve conduction studies, noninvasive vascular studies, and arteriography were used to confirm the diagnosis. Sixteen of the 22 patients had ligation or revision of the fistula. Five patients underwent amputations at the metacarpal or phalangeal level, and one patient underwent below-elbow amputation.

Fourteen patients were surgically treated for ulnar artery occlusion. Digital blood pressure measurements obtained pre- and intraoperatively helped guide the choice between ligation or reconstruction of the ulnar artery following resection of the occluded segment. The digital brachial index (DBI) was derived by calculating the ratio of digital blood pressure to the simultaneous brachial artery pressure. A DBI value of less than or equal to 0.7 was an indication for arterial reconstruction. If the DBI was greater than 0.7, resection of the occluded arterial segment without reconstruction was considered appropriate. Eight patients were treated by arterial reconstruction and six patients were treated with arterial resection. Seven of the eight reconstructed ulnar arteries were patent at follow-up evaluation by Doppler evaluation. DBI measurements obtained at follow-up were compared to preoperative values. In the reconstruction group, DBI change in the small, ring, and index fingers was positive, whereas it was negative in the resection group. Eleven patients indicated improvement from their presurgical status, although over half continued to experience pain on a regular basis. Reports of environmental and contact cold intolerance also showed improvement following surgery. Complaints of pain and cold intolerance were not significantly different between the resection and reconstruction groups at follow-up evaluation.

Four Arabian geldings were used in a randomized, repeated measure design to study the effect of two different diets on plasma free fatty acids at rest and during exercise. On each of four sampling days, two horses were fed one of two isoenergetic diets, either 100% corn or 100% alfalfa, at 22% of their estimated daily energy requirement. Two hours after the consumption of the diet, each horse participated in a submaximal standard exercise test consisting of three consecutive 10-min runs of increasing intensity at heart rates of 132, 140 and 147 beats/min, respectively. There were no significant (P greater than 0.05) differences between the two groups (corn-fed vs. alfalfa-fed) in pre-meal (0.554 +/- 0.031 vs. 0.629 +/- 0.033 mmol/L), post-meal (0.520 +/- 0.027 vs. 0.609 +/- 0.041 mmol/L), and basal (0.392 +/- 0.036 vs. 0.401 +/- 0.052 mmol/L) free fatty acid concentrations. However, free fatty acids were significantly higher in the horses fed alfalfa (0.608 +/- 0.038 mmol/L) rather than corn (0.484 +/- 0.031 mmol/L) during exercise.

Distal interphalangeal joint arthroplasty is effective in alleviating the pain of degenerative arthritis while preserving motion and stability. This procedure was undertaken as an alternative to arthrodesis for 17 women with osteoarthritis and 1 woman with rheumatoid arthritis. Silicone interpositional arthroplasty was performed in 31 digits of patients whose mean age was 58.3 years. The patients were evaluated at an average of 72.2 months (range, 12.6 to 123.1 months) after surgery. All patients reported that their primary preoperative symptom of pain was effectively eliminated by the procedure. At reevaluation, the active range of motion of the distal interphalangeal joint averaged 32.2 degrees and extension lag averaged 12.7 degrees . Lateral stability of the distal joint was present in all but one middle finger implant. Two implants were removed at 3 months postoperatively for wound problems and one at 31 months because of prothesis fracture.

A case of scapholunate dissociation with a dorsal carpal instability pattern is described in a skeletally immature 13-year-old male. The malrotation of the scaphoid was treated by soft tissue reconstruction, with use of a dorsal capsulodesis to provide a dorsal restraint to excessive palmar flexion of the scaphoid. In the skeletally immature carpus, isolated ligamentous injuries are less frequently recognized than epiphyseal injuries. To avoid interference with the successful conclusion of carpal growth, soft tissue reconstruction of deranged carpal relationships is preferable to intercarpal arthrodesis in the skeletally immature patient.

Low viscosity perfluorocarbon liquids were used as an intraoperative tool during vitrectomy for retinal detachment (RD) after penetrating ocular trauma. These liquids are immiscible with water and have specific gravities from 1.8 to 1.9. Intraoperatively, the perfluorocarbon liquids flattened the retina in 14 eyes by displacing the subretinal fluid through peripheral breaks. Posterior retinotomy was not required for internal drainage of subretinal fluid. Pooled subretinal fluid was displaced from the macular area in five patients. The perfluorocarbon bubble mechanically stabilized the retina during epiretinal membrane dissection. The perfluorocarbon liquid was removed and replaced perfluorocarbon gas or silicone oil. In 11 patients followed for more than 6 months after the final surgery, eight (73%) eyes were anatomically successful, with six (54.5%) gaining visual acuity of 20/400 or better.

Twenty-three female patients had silicone interpositional arthroplasty of the distal interphalangeal joint in 38 digits. The operative indications were pain and deformity of the distal interphalangeal joint. The underlying diagnosis was osteoarthritis in all but one patient who had rheumatoid arthritis. The average age at the time of operation was 58.3 years. The implants have been in place for a mean period of 72.2 months (range, 12.6 to 123.1 months). At follow-up, extension lag averaged 12.7 degrees and the range of motion of the distal interphalangeal joint had a mean value of 33.2 degrees. Compared with arthrodesis, silicone interpositional arthroplasty offers the advantage of retained motion while preserving stability.