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• 3D dose reconstruction based on in vivo dosimetry was performed for high-dose-rate prostate BT. • Maximum relative deviation in the clinical target volume D 90% was 5%. • In one fraction a 18% increase in bladder D 2cm 3 was observed and a maximum deviation of 15% in urethra dose. • 3D dose reconstruction can aid in determining the dosimetric impact of geometric variations in BT. In vivo dosimetry (IVD) can be used for source tracking (ST), i.e., estimating source positions, during brachytherapy. The aim of this study was to exploit IVD-based ST to perform 3D dose reconstruction for high-dose-rate prostate brachytherapy and to evaluate the robustness of the treatments against observed geometric variations. Twenty-three fractions of high-dose-rate prostate brachytherapy were analysed. The treatment planning was based on MRI. Time-resolved IVD was performed using a fibre-coupled scintillator. ST was retrospectively performed using the IVD measurements. The ST identified 2D positional shifts of each treatment catheter and thereby inferred updated source positions. For each fraction, the dose was recalculated based on the source-tracked catheter positions and compared with the original plan dose using differences in dose volume histogram indices. Of 352 treatment catheters, 344 had shifts of less than 5 mm. Shifts between 5 and 10 mm were observed for 3 catheters, and shifts greater than 10 mm for 2 catheters. The ST failed for 3 catheters. The maximum relative difference in clinical target volume (prostate + 3 mm isotropic margin) D 90% was 5%. In one fraction, the bladder D 2cm 3 dose increased by 18% (1.4 Gy) due to a single source position being inside the bladder rather than nearby as planned. The max increase in urethra dose was 1.5 Gy (15%). IVD-based 3D dose reconstruction for high-dose-rate prostate brachytherapy is feasible. The dosimetric impact of the observed catheter shifts was limited. Dose reconstruction can therefore aid in determining the dosimetric impact of geometric variations and errors in brachytherapy. [ABSTRACT FROM AUTHOR]

The evaluation of the Fischer-Tropsch experiment with H 2 /CO = 2.13 at 210 °C with changes in CO conversion and water addition. [Display omitted] • Co-based catalyst developed WGS activity at low H 2 /CO ratio. • Water has a positive effect on C 5+ selectivity for all H 2 /CO ratios. • Re-oxidation of cobalt is proposed as the main deactivation mechanism caused by water. Fischer-Tropsch synthesis has been investigated over a commercial type cobalt-based catalyst (20 %Co/0.5 %Re/γ-Al 2 O 3) by varying the H 2 /CO ratio (2.55–1.12), CO conversion (15–75 %), reaction temperature (210 °C, 230 °C), and by adding water to the syngas. The experiments were conducted in a fixed bed reactor with the main purpose of obtaining experimental data to be used in the development and fitting of a mechanistic model. A positive effect of water on the catalyst activity was found for experiments with a H 2 /CO ratio higher than 1.7. Water was found to always increase the C 5+ selectivity regardless of the H 2 /CO ratio. Increasing conversion led to increased C 5+ selectivity. The selectivity to CO 2 was significantly enhanced at higher conversions (high water partial pressure), particularly with the lowest H 2 /CO = 1.12, interpreted as the emergence of water-gas shift activity. Re-oxidation of cobalt, probably limited to small cobalt particles, is proposed as the main deactivation mechanism caused by water while a steeper deactivation curve was found for higher temperature, indicating that sintering also may play a role. [ABSTRACT FROM AUTHOR]

To use quantities measurable during in vivo dosimetry to build unique channel identifiers, that enable detection of brachytherapy errors. Treatment plan of 360 patients with prostate cancer who underwent high-dose-rate brachytherapy (range, 16–25 catheters; mean, 17) were used. A single point virtual dosimeter was placed at multiple positions within the treatment geometry, and the source-dosimeter distance and dwell time were determined for each dwell position in each catheter. These values were compared across all catheters, dwell position by dwell position, simulating a treatment delivery. A catheter was considered uniquely identified if, for a given dwell position, no other catheters had the same measured values. The minimum number of dwell positions needed to identify a specific catheter and the optimal dosimeter location uniquely were determined. The radial (r) and vertical (z) dimensions of the source-dosimeter distance were also examined for their utility in discriminating catheters. Using a virtual dosimeter with no uncertainties, all catheters were identified in 359 of the 360 cases with 9 dwell position measurements. When only the dwell time were measured, all catheters were uniquely identified after 1 dwell position. With a 2-mm spatial accuracy (r,z), all catheters were identified in 94% of the plans. Simultaneous measurement of source-dosimeter distance and dwell time ensured full catheter identification in all plans ranging from 2 to 6 dwell positions. The number of dwell positions needed to uniquely identify all catheters was lower when the distance from the implant center was higher. The most efficient fingerprinting approach involved combining source-dosimeter distance (i.e., source tracking) and dwell time. The further the dosimeter is placed from the center of the implant the better it can uniquely identify catheters. [ABSTRACT FROM AUTHOR]

The potential of using computer vision to estimate the weight of pigs has been demonstrated in several studies. In this paper, we propose a Vision Analysis and Prediction (VAP) system, which consisted of two main parts: (1) computer vision – a vision algorithm was developed to segment the pigs and identify which pig area could be used to estimate the corresponding weight; (2) statistical analysis – a statistical method for predicting pig weight using the area was presented, including BLUP model and linear regression as well as a prediction function. The results showed that our approach has successfully estimated the weight of growing pigs (approximate ranges from 20 to 105 kg) with an accuracy of weight estimation of 97.76% on average for the predicted mean weight at pen level. The proposed system does not require modifications to the building and shows a strong potential to be utilized in pig weight estimation in slaughter pens. • A VAP system has great potential for pig weight estimation in slaughter pens. • The VAP includes two parts: a computer vision algorithm and a predicting model. • The VAP can accurately predict pig weights from 20 to 105 kg in a slaughter pen. • The VAP can help for optimal decision making to improve animal productivity. [ABSTRACT FROM AUTHOR]

The purpose of this project was to exemplify the use of Evolutionary Operation (EVOP) technique at herd level to test the effect of change in the herd's normal management procedure. As pigs are day active animals, it is assumed that an increase in the activity level during the night will indicate that the pigs are forced to change their normal diurnal rhythm to adapt to the conditions. Thus change in the diurnal pattern of drinking was used as a potential indicator of stress/resource limitations in the pen. A three way factorial experiment with 714 crossbred pigs (34.3±4.1 kg) was carried out. The variables were: stocking density (14 or 18 pigs per pen), number of straw allocations (one allocation of 140 g straw per pig/day or four daily allocations of 35 g straw per pig) and allocation of pigs to pens (randomly or by size). The pigs were fed a libitum. Water consumption and temperature at pen level were continually measured during the experimental period (29 days). The day was divided into two 12-h periods: “day” (from 0700 h to 1859 h) and “night” (from 1900 h to 0659 h), and the proportion of the water consumption during the night of the total water consumption was calculated at pen level. Data were analysed using a linear mixed effect model. The average daily water consumption was 4.52±0.24 l per pig per day. On average, 26.0% of the total amount of water was consumed during the night. An increasing stocking density increased the proportion of water consumed during the night by 2.0 percentage points ( P =0.01). A random distribution of the pigs instead of sorting them by size at pen level reduced the proportion of water consumed during the night by 2.3 percentage points ( P =0.03), while no significant effect of the number of straw distributions ( P =0.36) or interactions was found. Looking at the daily water consumption, no effect of stocking density ( P =0.32), straw allocation ( P =0.85) or sorting the pigs (Randomly versus sorted by size, P =0.11) was found. Groups with small pigs had a lower water intake compared with groups with large or randomly sorted pigs ( P <0.01). The results show that the use of an EVOP design at herd level using change in the diurnal rhythm as response variable can be used to give a fast indication of the optimal combination of production factors within the herd. [ABSTRACT FROM AUTHOR]

The long-term prognosis of patients with ST-elevation myocardial infarction (STEMI) aged 45 years or younger and differences according to gender have not been well characterized. Methods We included 16,685 consecutive STEMI patients from 2003 to 2012 (67,992 patient-years follow-up) from the Eastern Danish Heart Registry and the Swedish Coronary Angiography and Angioplasty Registry who were treated with primary percutaneous coronary intervention (PCI). Results We identified 1026 (6.2%) patients up to 45 years of age (mean age: 40.7 vs. 66.3 years, P < 0.001). Patients in the young group were predominantly men (79.7% vs. 71.9%) and smokers (71.2% vs. 44.2%, P < 0.001) but with a lower prevalence of hypertension (17.3% vs. 39.3%), hyperlipidemia (18.0% vs. 23.8%), diabetes (9.0% vs. 12.4%) and previous myocardial infarction (6.9% vs. 12.2%, all P < 0.001) compared with older patients. Young patients had a 0.8% annual mortality. During the follow-up period 6.3% of young patients died vs. 28.5% of older patients ( P < 0.001). Both 30-day-mortality (adjusted hazard ratio [HR] = 0.26, 95% confidence interval [CI]: 0.12–0.54, P < 0.001) and mortality after 30 days and onwards (HR = 0.25, CI: 0.17–0.37, P < 0.001) were significantly lower in the young group. There was no difference in short-term (HR = 0.78, CI: 0.32–1.90, P = 0.59) or long-term (HR = 0.62, CI: 0.33–1.91, P = 0.59) mortality between women and men in the young group (HR = 0.79, CI: 0.21–1.80, P = 0.39). Conclusions STEMI patients, aged 45 years or younger, have an excellent prognosis after treatment with primary PCI. Long-term annual survival is more than 99% in these patients. Young women with STEMI do not have a worse long-term prognosis than young men with STEMI. [ABSTRACT FROM AUTHOR]

Abstract: Background: Recombinant granulocyte-colony stimulating factor (G-CSF) mobilized pluripotent cells from the bone marrow are proposed to have a regenerative potential. Though, a report of excessive instent restenosis, in patients treated with G-CSF before percutaneous coronary intervention (PCI) warrants caution. Methods: Patients (n =59) enrolled in the STEMMI trial, a randomized and double blind study, comparing G-CSF and placebo after large ST-elevation myocardial infarctions, had an intracoronary ultrasound imaging at 6 months follow-up with a quantitative analysis of instent neointimal hyperplasia. Results: During G-CSF treatment leukocyte counts, and CD34+ and CD45−/CD34− cell fractions in peripheral blood increased markedly ( p <0.0001 vs. placebo). At follow-up, there were no differences in intracoronary late lumen loss, expressed as neointima volume per mm of stent (1.6 mm3 ±1.2 [G-CSF group] vs. 1.9 mm3 ±1.3 [placebo group]; p =0.38), and in minimal instent lumen area (5.4 mm2 ±2.4 vs. 5.3 mm2 ±2.6, p =0.90). In the placebo group, plasma concentration of stromal cell-derived factor-1 (SDF-1) increased significantly after STEMI. This SDF-1 response was completely suppressed during G-CSF treatment. A rebound increase of SDF-1 was observed after withdrawal of G-CSF ( p =0.001). Plasma concentration of SDF-1 at the time of stent implantation correlated positively to neointimal hyperplasia ( p =0.025). Conclusions: G-CSF treatment, initiated after PCI, does not lead to excessive instent neointimal hyperplasia or restenosis in patients with STEMI. The timing of G-CSF, in relation to the PCI, might be important, as G-CSF influences SDF-1. [Copyright &y& Elsevier]

Abstract: The aim of the study was to investigate the relationship between the ear skin temperature and the behaviour of pigs. Fifty-four pigs weighing 75±5kg were used in three replications (18 pigs per replication) and housed in pens (six pigs per pen) in a controlled climate facility. The room temperature was changed by 2°C from 18°C down to 10°C and up again to 22°C. The ear skin temperature (EST) was continuously recorded and the activity, lying posture, location and contact with pen mates were scored by 12min scan sampling for 24h at the set point temperatures 18°C, 10°C and 22°C. A diurnal rhythm in the EST, the posture and the lying behaviour was found. The EST was highest at night and lowest in the afternoon. During night the pigs had more physical contact to pen mates than during day time. For all three set point temperatures the predominant lying position during the night was the fully recumbent position. The room temperature affected the lying behaviour and the EST. With decreasing room temperature the pigs increased their contact to pen mates and fewer pigs were observed lying in the fully recumbent position. The EST decreased with decreasing room temperature, and the range in the EST''s at the three set point temperatures was larger during day than night (4°C versus 2°C). The results indicate that pigs adjust their behaviour to a higher EST when resting than when they are active, and they use behavioural adjustment (e.g. increased/decreased contact to pen mates) to bring their skin temperature into a preferred interval. [Copyright &y& Elsevier]

Abstract: Objective: The influence of treatment with granulocyte-colony stimulating factor (G-CSF) on the development of in-stent intimal hyperplasia is not known. We aimed to study this phenomenon in patients who had stents implanted in the course of an acute ST-elevation infarction and successively were treated with G-CSF. Method: We performed angiography and intracoronary ultrasound follow-up after 5 months in 41 consecutive patients in the STEMMI trial, which is a randomized double-blind placebo-controlled study on the effect of G-CSF injections on the myocardial function following acute myocardial infarction in patients treated with primary percutaneous coronary stent implantation. The intracoronary ultrasound images were analyzed by a blinded and independent core laboratory. Results: There were no differences in in-stent neo-intimal hyperplasia determined by intracoronary ultrasound between patients treated with G-CSF compared to patients treated with placebo. Neo-intimal hyperplasia per mm of stent was 1.87 (±1.41) and 1.89 (±1.39), respectively (p =0.97). Angiographic in-segment restenosis (>50% diameter stenosis) was found in 28% of patients (24% in the G-CSF group and 33% in the placebo group; p =0.55). Conclusion: G-CSF treatment following coronary stent implantation in primary PCI treated AMI patients does not increase in-stent restenosis excessively and it does not seem warranted to limit further study of effects of G-CSF for that reason. [Copyright &y& Elsevier]

Abstract: The aim of the present study was to identify characteristics of sow behaviour and parturition related to early piglet mortality in loose-housed farrowing sows. Data from 152 farrowings that originated from three different herds with loose-housed sows during parturition were used. Graphical chain models were used to model the relationships between perinatal behaviour, periparturient individual conditions (time of day of parturition, rectal temperature 1–3 days postpartum) and causes of early piglet mortality. Modelling was based on the correlation between variables within herd and farrowing batch. The analysis showed that different causes of mortality were linked to different behavioural variables during the periparturient period and that they grouped into three independent categories. The first category was associated with stillbirth and death due to other causes. Stillbirth was positively related to the variation of the inter-birth interval and negatively related to the percentage of piglets that suckled during the first 8h after birth of first piglet (BFP). Death due to other causes was negatively related to the suckling activity during the post-partal period (9–24h after BFP). The second category was associated with piglet crushing, which was positively related to much lateral lying the last 4h before BFP. Finally, the third category was associated with death due to lack of colostrums ingestion of colostrum, which was linked to the time of parturition and sow rectal temperature on days 1 and 2 after farrowing. Sows that gave birth during the morning compared to evening/night had more dead piglets due to lack of colostrums ingestion. Death due to lack of colostrums ingestion was also higher in sows with high rectal temperature on the day after BFP. The results further showed that litter size not only influenced mortality but also behavioural variables. High litter size was related to high nest building activity before BFP, low but more variable inter-birth intervals, and much lateral lying after BFP. The study points towards several areas of interest for further research that can help understand early piglet mortality. These include causes of variation in the progress of parturition, causes of individual differences in sow activity and responsiveness to piglets, and early management of farrowing. In addition, the study suggests possible indicators of problematic farrowings rendering liveborn piglets at risk. These include prepartum lateral lying in the sow, low suckling activity and rate of stillbirth. [Copyright &y& Elsevier]

Objectives: In the Euroinject One phase II randomized double-blind trial, therapeutic angiogenesis of percutaneous intramyocardial plasmid gene transfer of vascular endothelial growth factor (phVEGF-A165) on myocardial perfusion, left ventricular function, and clinical symptoms was assessed. Background: Evidence for safety and treatment efficacy have been presented in phase I therapeutic angiogenesis trials. Methods: Eighty “no-option” patients with severe stable ischemic heart disease, Canadian Cardiovascular Society functional class 3 to 4, were assigned randomly to receive, via the NOGA-MyoStar system (Cordis Corp., Miami Lakes, Florida), either 0.5 mg of phVEGF-A165 (n = 40) or placebo plasmid (n = 40) in the myocardial region showing stress-induced myocardial perfusion defects on 99mTc sestamibi/tetrofosmin single-photon emission computed tomography. Results: No differences among the groups were recorded at baseline with respect to clinical, perfusion, and wall motion characteristics. After three months, myocardial stress perfusion defects did not differ significantly between the VEGF gene transfer and placebo groups (38 ± 3% and 44 ± 2%, respectively). Similarly, semiquantitative analysis of the change in perfusion in the treated region of interest did not differ significantly between the two groups. Compared with placebo, VEGF gene transfer improved the local wall motion disturbances, assessed both by NOGA (p = 0.04) and contrast ventriculography (p = 0.03). Canadian Cardiovascular Society functional class classification of angina pectoris improved significantly in both groups but without difference between the groups. No phVEGF-A165-related adverse events were observed; however, NOGA procedure-related adverse events occurred in five patients. Conclusions: The VEGF gene transfer did not significantly improve stress-induced myocardial perfusion abnormalities compared with placebo; however, improved regional wall motion, as assessed both by NOGA and by ventriculography, may indicate a favorable anti-ischemic effect. This result should encourage more studies within the field. Transient VEGF overexpression seems to be safe. [Copyright &y& Elsevier]

Abstract: Latent class analysis to assess the sensitivity and specificity of a diagnostic test can be carried out under different assumptions. An often applied set of assumptions is known as the Hui–Walter paradigm, which essentially states that: (i) the population is divided into two or more populations in which two or more tests are evaluated under assumption that (ii) sensitivity and specificity of the tests are the same in all populations; and (iii) the tests are conditionally independent given the disease status. This study explores the implications of these assumptions. Through simulation studies, it is shown how the size of the difference between disease prevalences within the populations influences the precision of the estimates. It is also illustrated by a simulation study how a difference in a test sensitivity between populations may result in estimates that are biased towards the sensitivity of the test in the population with highest disease prevalence, since that population estimate is supported by most of the data. It is shown that the assumption of conditional independence between tests in general cannot be ignored in latent class models. Failure to impose conditional independence will result in a model that lacks identifiability in a way that cannot be handled by adding more tests or dividing the sample into more populations. [Copyright &y& Elsevier]

The accuracy of clinical observations was estimated using Bayesian latent-class models with two or more independent tests. Four veterinarians carried out systematic independent clinical examinations on 155 pigs in three herds. Based on the results of binary recordings of clinical observations on dullness, poor body condition (PBC), skin lesions, lameness, respiratory disease, and diarrhea, a latent disease state for each clinical disease was estimated using Gibbs sampling.The accuracy of the clinical observations differed for the four observers and for different clinical signs. Population parameters were estimated from a Bayesian hierarchical model, and the accuracy of a random observer was calculated. We concluded that the accuracy of the veterinarians in this study substantiated the need to pursue more-precise definitions of the clinical findings and that larger sample sizes would be needed to provide reasonable variance estimates. Finally, we concluded that the uncertainty in the clinical decision-making process (starting with the clinical examination) needs to be represented fully. [Copyright &y& Elsevier]

The estimation of farm specific parameters is often ignored in studies of decision support systems such as, e.g., sow replacement problems. This study concerns the specification and estimation of farm specific parameters in a model for litter size required by a replacement problem considering culling based on productive performance. This implies a joint distribution of the litter size at the parities under consideration. A non-linear parametric mean curve is used to model the expected litter size at different parities for sows within the same herd. The covariance matrix is modeled using variance components of random effects, serial correlation and measurement error. Data from a total of 43 herds are used to devise a likelihood based inference, using maximum likelihood to obtain initial estimates for maximum posterior estimation of farm specific parameters. The maximum posterior approach is required to obtain reasonable estimates in the cases where on-farm registrations are inadequate. [Copyright &y& Elsevier]

Abstract: Introduction: To investigate the efficacy of implantation of sirolimus-eluting stents (SES) in the ostium of coronary arteries. Methods: We assigned 96 patients with lesions located in ostias of the coronary circulation to receive a SES or a bare-metal stent (BMS). Results: At follow-up the late lumen loss was 0.07mm in the SES versus 1.06mm in the BMS group (p <0.001); −0.04mm versus 0.11mm (p =0.12) in the neighbour ostium. The rate of target lesion revascularisation was 2% with SES and 39% with BMS (p <0.001), and major adverse cardiac events (MACE) 6% versus 41% (p =0.001). Conclusions: In patients with ostial coronary lesions the angiographic outcome is improved and the long-term MACE rate is low after SES compared with BMS implantation. [ABSTRACT FROM AUTHOR]

High piglet mortality is an issue in the pig production. Evidence indicates that if the time of farrowing can be predicted, the mortality can be reduced through planned supervision or improved climate regulation. The aim of the study was to improve the prediction of onset of farrowing by monitoring pre-parturient behaviour of sows using several sensors and by developing an automated system for the prediction of time to farrowing. The resulting prediction model, named as Hidden Phase-type Markov Model (HPMM), assumes that a sow passes through the behavioural states Before Nest-Building , Nest-Building and Resting before reaching the Farrowing state. Each state was further split into phases, to allow a more realistic distribution of sojourn times. As these phases and states are unobservable, HPMM was used to calculate the probability of a sow being in given phase using the automatic sensor measures. Thus time to farrowing could be predicted at each time point. The prediction algorithm was validated on a sensor data set for about 35 sows, each followed from day 105 (day-105) since mating until the farrowing. Sensors include sow activity measured by video recording as well as by a photo-cell grid, and water consumption. The algorithm was evaluated using heuristic warning strategies e.g. that a warning should be generated when the expected time to farrowing was less than 12 h (inspired by the regulation of floor heating systems). The performance of the sensors was evaluated. Different combinations of sensor types outperformed the use of a single sensor type. Using a combination of water and activity sensors the prediction algorithm gave a coherent warning period prior to farrowing (true warning) in 97% of the cases. The duration from start of the warning period to farrowing had a mean 11.5 (SD = 4.6) h. False warning periods ending before farrowing lasted on average only 0.7 h per sow. The use of HPMM thus allowed a direct prediction of the time to farrowing, handling more than one sensor and a compact representation of historical sensor information. [ABSTRACT FROM AUTHOR]

Abstract: Background: The study assessed long-term safety and efficacy of intramyocardial injection of autologous bone-marrow derived mesenchymal stromal cells (BMMSCs) in patients with severe stable coronary artery disease (CAD) and refractory angina. Methods: Thirty-one patients with severe stable CAD and refractory angina were included. Patients had reversible myocardial ischemia and no further revascularization options. Autologous BMMSCs were isolated, culture expanded and stimulated with vascular endothelial growth-factor to facilitate endothelial differentiation. BMMSCs were injected into an ischemic, viable region of the myocardium. Patients were followed for 3years. Results: We found significant clinical improvements in exercise time (p=0.0016), angina class (CCS) (p<0.0001), weekly number of angina attacks (p<0.0001) and use of nitroglycerine from (p=0.0017). In the Seattle Angina Questionnaire there were significant improvements in physical limitation score, angina stability score, angina frequency score and quality of life score (all p<0.0001). When comparing all hospital admissions from 3years before to 3years after treatment, we observed highly reduced admission rates for stable angina (p<0.0001), revascularization (p=0.003) and overall cardiovascular disease (p<0.0001). No early or late side-effects of the treatment were observed. Conclusions: The final 3-year follow-up data after intramyocardial injection of autologous BMMSCs, in patients with severe CAD and refractory angina, demonstrated sustained clinical effects, reduced hospital admissions for cardiovascular disease and excellent long-term safety. The results indicate that autotransplantation of BMMSCs to the heart does not only improve symptoms but also slows down disease progression. [Copyright &y& Elsevier]

Abstract: Twenty-six sows housed in farrowing pens were observed from 5 days prior to until 5 days after parturition. Pens consisted of a resting area with solid concrete floor and an activity area with drained concrete floor. The sows were randomly distributed between two pen types: Pens where the floor of the resting area was heated to 34°C (HEAT sows) and pens where the floor of the resting area was kept neutral (CONTROL sows). The average room temperature was 19.8±0.8°C. The lying position of the sows as well as posture of the sows were observed continuously and scan sampling was carried out every hour recording the position of the piglets. Thirteen sows chose to farrow in the resting area and 13 in the activity area with no significant difference between treatments. Sows that farrowed in the resting area were lying in the resting area for the majority of their lying time during the 5 days after the birth of the first piglet (BFP), whereas sows that farrowed in the activity area tended to lie more and more in the resting area in the days following parturition, the latter being significantly more pronounced for HEAT sows (F 10,177 =1.92, P =0.04). The number of postural changes was higher in CONTROL sows than in HEAT sows (F 1,20 =7.67, P =0.01), in particular on the day of parturition (day 0). In contrast, the duration of time the sows were active (standing/walking) did not differ significantly between HEAT and CONTROL sows on any days. The percentage of the litter resting without contact with the sow in the resting area increased over days for HEAT piglets whereas the percentage remained low for CONTROL piglets (F 4,79 =4.95, P =0.001). In conclusion, the percentage of sows that farrowed on the heated floor was unaffected by treatment. However, after parturition, both the sows and the piglets actively sought the heated floor. [Copyright &y& Elsevier]

Abstract: It has previously been shown that when sows lie down in the open there is a much greater risk of piglet crushing than when they lie down alongside a wall, probably because the wall provides support and/or a piglet escape zone. Therefore, walls in farrowing pens should be attractive to the sow, so that she chooses to use them when lying down. EU-regulations state that farrowing pens must be given “some means of protecting the piglets, such as farrowing rails”. Walls with farrowing rails may, however, not be the most appropriate option as they may be unattractive to the sows. We tested sow preferences for lying down alongside a plain wall, a sloping wall or a wall with a farrowing rail. Beforehand, we tested preferences for three sloping wall designs (plain, curved and multiple bars) in order to use the preferred one in the later choice experiment. In both experiments, 4×6 pregnant second–seventh parity individually housed sows were used over a 3-day training and a 4-day testing period. In both experiments, the three types of walls were balanced on position in the pen. In both tests, the sows predominantly lay down alongside the walls (on average, 80±4 and 86±3% of lying down events, respectively). In the test of the three sloping wall designs, the sows had no significant preferences for wall designs. For practical reasons the plain sloping wall was used in the subsequent test. Here, there was a significant effect of wall type (on average, 16±5% of lying down events alongside the wall with the farrowing rail, 48±8% alongside the plain wall and 36±8% alongside the plain sloping wall (P <0.025)). The sows lay down alongside the wall with the farrowing rail less than alongside the plain or the plain sloping wall (P <0.01), but the preference for the two latter wall types did not differ significantly. Irrespective of the wall type, the sows had a significant preference for the back wall of the pen (P <0.001 in both experiments). In conclusion, walls with farrowing rails appear to be less attractive to lie down against than other wall designs. Although farrowing rails provide piglets with escape zones they may not be optimal for piglet survival because they do not encourage the sow to lie down alongside a wall, rather than in the open. Moreover, they may not be optimal from a sow welfare perspective due to lack of support for the sow when lying down. [Copyright &y& Elsevier]

Abstract: This paper analyzes the problem faced by managers of pig fattening units when the pigs are subject to common epidemic diseases, such as respiratory diseases or Swine Influenza. The problem is defined as a simultaneous optimization of the delivery policy and control strategies for disease control. As some disease controls, such as vaccination, are implemented at the batch level and last through the lifetime of the vaccinated pigs, the problem requires that decisions are addressed at multiple timescales. Using the framework of multi-level hierarchic Markov processes a general framework was defined. The elements defining the framework were the decisions at the tactical (batch) level and the operational (daily) level. Decisions at the strategic level, e.g., decisions lasting longer than the length of a batch, were considered as constraints to the lower levels of the decision problem and not optimized. The major components of the general framework were a stochastic growth model, an epidemic model to handle within-batch spread of disease, a transition model to handle the between-batch spread of disease, and link between the growth model and the disease model and a general set of control measures. The model was illustrated using an example with Swine Influenza in an all-in-all-out production system. Results show that the optimal delivery policy and control strategies for disease interact. This suggests that decision support must adopt an integrated approach to modelling the decision complex in pig production in order to represent the full complexity of the system. [Copyright &y& Elsevier]

Rooting behaviour appears to be an important part of the behavioural repertoire in pigs. It is suggested that it is in fact a behavioural need. The present study investigated whether nose-ringed gilts, which are unable to root, can satisfactorily substitute rooting with other exploratory activities. The behaviour of 24 gilts in groups of three, half of them nose-ringed, was studied on undisturbed days as well as on days of exposure to four different tests: (1) delayed feeding; (2) double feeding; (3) removal to an unknown area; (4) removal to an unknown area supplied with a trough with stones. The gilts’ posture and their behaviour were recorded by 1-min scan samplings, whereas pawing, aggression, and comfort behaviour were recorded by all occurrence sampling. Observations took place for 2.5 h in the morning and 2.5 h in the afternoon. On undisturbed days no significant differences were found between ringed and unringed gilts as regards the percentage of scans in which the gilts were active and foraging or exploring. However, the unringed gilts rooted significantly more than the ringed gilts (P<0.01). The kind of foraging and exploratory behaviours that the ringed gilts chose as substitutes for rooting depended on the replicate in question, maybe due to more or less nutrition in the grass. On an undisturbed day, there was no significant difference as regards the number of times ringed and unringed gilts were observed performing any behaviour that could be considered a sign of frustration. During delayed and double feeding, ringed and unringed gilts reacted similarly. When exposed to an unknown area, ringed gilts increased the levels of alertness and comfort behaviour, which might indicate frustration. We conclude that in a stable environment ringed gilts were able to substitute other exploratory behaviours for rooting in a satisfactory way. However, it was clear that the gilts that were able to root did so for a large part of their active time, indicating that the experience obtained by rooting was rewarding. [Copyright &y& Elsevier]

Objective: We aimed to relate the amount of jeopardized myocardium to mortality in shocked patients presenting to the catheterization laboratory with ST-elevation myocardial infarction (STEMI) and cardiogenic shock.Background: In contrast with historical data and previous professional guidance, contemporary randomized data suggest that multi-vessel revascularization in such patients does not improve survival; mechanistic insight is incomplete.Methods: Clinical databases identified cases of STEMI and shock triaged for primary percutaneous coronary intervention (PPCI) in Eastern Denmark from June 2011 to December 2014 (n = 128). British Cardiovascular Intervention Society (BCIS)-1 jeopardy scores were calculated from angiography. The study endpoint was 30-day mortality.Results: Median lactate values were 6.0 [2.9-10.7] mmol/L. 30-day mortality was 53.9%. 68% of patients had multi-vessel coronary disease. Median pre-PCI BCIS-1 myocardial jeopardy scores were 8 [6-10]. After multiple logistic regression increasing age (p = 0.008; odds ratio [OR] 1.06), lactate values (p = 0.017; OR 1.02), mechanical ventilation (p = 0.011; OR 1.25) and a systolic blood pressure ≤ 90 mmHg at end-case (p = 0.005; OR 1.26) were predictive of 30-day mortality. Post-PPCI culprit vessel TIMI 3 flow was associated with reduced mortality (p < 0.001; OR 0.66). There was no association between pre-PCI jeopardy scores and the primary endpoint.Conclusions: In patients with STEMI and shock, myocardial jeopardy scores do not relate to patient outcomes. Jeopardy scores may be applied to existing datasets in order to understand why multi-vessel revascularization does not lead to the anticipated clinical benefits in cardiogenic shock. [ABSTRACT FROM AUTHOR]

• SuPAR was a strong prognostic biomarker of non-cardiac mortality after STEMI. • The suPAR level was independent of sampling time < 12 h after revascularization. • SuPAR may identify patients in risk of non-cardiac mortality prior to discharge. Identification of patients at high risk of non-cardiac mortality following ST-segment elevation myocardial infarction (STEMI) could guide clinicians to identify patients who require attention due to serious non-cardiac conditions after the acute phase of STEMI. The purpose of this study was to evaluate if the non-specific and prognostic biomarker of inflammation and comorbidity, soluble urokinase receptor (suPAR), could predict non-cardiac mortality in a cohort of STEMI patients. SuPAR was measured in 1,190 STEMI patients who underwent primary percutaneous coronary intervention (pPCI). The primary endpoint was non-cardiac mortality, secondary endpoints were cardiac mortality, all-cause mortality, reinfarction and periprocedural acute kidney injury. Backwards elimination of potential confounders significantly associated with the respective outcome was used to adjust associations. Patients were followed for a median of 3.0 years (interquartile range 2.5– 3.6 years). Multivariate cox regression revealed that a plasma suPAR level above 3.70 ng mL−1 was associated with non-cardiac and cardiac mortality at hazard ratios 3.33 (95% confidence interval 1.67–6.63, p = 0.001, adjusted for age) and 0.99 (0.18–5.30, p = 0.98, adjusted for previous myocardial infarction and left ventricular ejection fraction), respectively. In patients with pPCI treated STEMI, suPAR was an independent prognostic biomarker of non-cardiac but not cardiac mortality and may identify patients with high risk of non-cardiac mortality. [ABSTRACT FROM AUTHOR]

To predict irreversible reduction in left ventricular ejection fraction (LVEF) during admission for ST-segment elevation myocardial infarction (STEMI) using cardiac magnetic resonance (CMR) in addition to classical clinical parameters. Irreversible reduction in LVEF is an important prognostic factor after STEMI which necessitates medical therapy and implantation of prophylactic implantable cardioverter defibrillator (ICD). A post-hoc analysis of DANAMI-3 trial program (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) which recruited 649 patients who had CMR performed during index hospitalization and after 3 months. Patients were divided into two groups according to CMR-LVEF at 3 months: Group 1 with LVEF≤35% and Group 2 with LVEF>35%. Group 1 included 15 patients (2.3%) while Group 2 included 634 patients (97.7%). A multivariate analysis showed that: Killip class >1 (OR 7.39; CI:1.47–36.21, P = 0.01), symptom onset-to-wire ≥6 h (OR 7.19; CI 1.07–50.91, P = 0.04), LVEF≤35% using index echocardiography (OR 7.11; CI: 1.27–47.43, P = 0.03), and infarct size ≥40% of LV on index CMR (OR 42.62; CI:7.83–328.29, P < 0.001) independently correlated with a final LVEF≤35%. Clinical models consisted of these parameters could identify 7 out of 15 patients in Group 1 with 100% positive predictive value. Together with other clinical measurements, the assessment of infarct size using late Gadolinium enhancement by CMR during hospitalization is a strong predictor of irreversible reduction in CMR_LVEF ≤35. That could potentially, after validation with future research, aids the selection and treatment of high-risk patients after STEMI, including implantation of prophylactic ICD during index hospitalization. • Irreversible damage to the myocardium after STEMI can be predicted in 47% of the patients. • ICD implantation can be considered in these patients with irreversible damage to the myocardium. • Cardiac MRI during admission for STEMI can help directing the future treatment in selected patients. • 77% of STEMI patients with LVEF <35% will experience increase in their LVEF to >35% within three months. [ABSTRACT FROM AUTHOR]

To assess the impact of sampling bias due to reported as well as unreported exclusion of the target population in a multi-center randomized controlled trial (RCT) of ST-elevation myocardial infarction (STEMI). We compared clinical characteristics and mortality between participants in the DANAMI-3 trial to contemporary non-participants with STEMI using unselected registries. A total of 179 DANAMI-3 participants (8%) and 617 contemporary non-participants (22%) had died (Log-Rank: P < 0.001) after a median follow-up of 1333 days (range: 1–2021 days). In an unadjusted Cox regression model all groups of non-participants had a higher hazard ratio to predict mortality compared to participants: eligible excluded (n = 144) (hazard ratio: 3.41 (95% CI: (2.69–4.32)), ineligible excluded (n = 472) (hazard ratio: 3.42 (95% CI: (2.44–4.80), eligible non-screened (n = 154) (hazard ratio: 3.37 (95% CI: (2.36–4.82)), ineligible non-screened (n = 154) (hazard ratio: 6.48 (95% CI: (4.77–8.80). Sampling bias had occurred due to both reported and unreported exclusion of eligible patients and the difference in mortality between participants and non-participants could not be explained only by the trial exclusion criteria. Thus, screening logs may not be suited to address the risks of sampling bias. • Participants in the DANAMI-3 trial were not representative to the background population with STEMI. • Participants in the DANAMI-3 trial were not representative to the per protocol target population. • Sampling bias and unreported screening had occurred. • Screening logs may not be suitable for addressing issues of external validity. [ABSTRACT FROM AUTHOR]

Background: Although some studies found improved coronary flow and myocardial salvage when stent implantation was deferred, the DANAMI-3-DEFER (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) did not show any improvement in clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) and deferred stenting.Objectives: This study sought to evaluate the effect of deferred stent implantation on infarct size, myocardial salvage, and microvascular obstruction (MVO) in patients with STEMI.Methods: In the present DANAMI-3 substudy, a total of 510 patients with STEMI were randomized to PCI with deferred versus immediate stent implantation. The patients underwent a cardiac magnetic resonance examination before discharge after the index procedure and again 3 months later. The primary endpoint was final infarct size.Results: Deferred stenting did not reduce final infarct size (9% left ventricle [LV]; interquartile range [IQR]: 3% to 18% vs. 10% LV; IQR: 3% to 18%; p = 0.67). Similarly, deferred stenting was not associated with myocardial salvage index (66%; IQR: 50% to 89% vs. 67%; IQR: 49% to 88%; p = 0.80) or presence of MVO (43% vs. 42%; p = 0.78). In a post hoc analysis, stent length was the only subgroup of 7 that had an effect on outcome. In patients with a stent length ≥24 mm, deferred stenting reduced the final infarct size (6% LV; IQR: 2% to 18% vs. 13% LV; IQR: 7% to 23%; p = 0.006; and p for interaction = 0.005).Conclusions: In the DANAMI-3-DEFER cardiac magnetic resonance substudy, routine deferred stenting did not reduce infarct size or MVO and did not increase myocardial salvage. These results do not support the use of routine deferred stenting in STEMI patients treated with primary PCI. (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [DANAMI-3]; NCT01435408). [ABSTRACT FROM AUTHOR]

We aimed to assess the risk factors and outcome of ventricular fibrillation (VF) before and during primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction. From 1999 to 2012, we consecutively enrolled 5,373 patients with ST-segment elevation myocardial infarction. In total, 410 of the patients had VF before and 88 had VF during PPCI. During a mean follow-up of 4.2 years, 1,196 subjects died. A logistic regression model identified younger age, anterior infarct, Killip class >I at admission, and a preprocedural Thrombolysis In Myocardial Infarction flow grade of 0 to I to be significantly associated with VF before PPCI, whereas inferior infarct, a preprocedural Thrombolysis In Myocardial Infarction flow grade of 0 to I, and Killip class >I at admission were significantly associated with VF during PPCI. All-cause mortality was evaluated using the Cox regression model. Compared with the patients without VF, those with VF before or during PPCI had a significantly increased 30-day mortality, with an adjusted hazard ratio = 3.40 (95% confidence interval 1.70 to 6.70) and 4.20 (95% confidence interval 1.30 to 13.30), respectively. Importantly, there was no tendency of 30-day mortality difference between VF before and during PPCI (p = 0.170). In patients with VF before or during PPCI who survived for at least 30 days, there was no increase in the long-term mortality. In conclusion, our data suggest that 30-day mortality is the same for patients with VF before PPCI compared with VF during PPCI, and the occurrence of VF before or during PPCI was associated with increased 30-day mortality but not with long-term mortality. [ABSTRACT FROM AUTHOR]

Previous studies have shown a poor correlation between angiographic assessment of stenosis grade (%) and its functional assessment by fractional flow reserve (FFR). This study aimed to investigate whether a more comprehensive evaluation of the coronary angiogram may contribute to a better identification of flow-limiting stenoses. Coronary angiograms of 1,350 patients (1,883 lesions) were retrospectively analyzed for stenosis grade (eyeballing, %) and matched with FFR values. Angiography-derived optimal cut-off values and intervals delineating the [90% sensitivity--90% specificity] range were 50.8% [42.5-- 65.0%] for the left main (LM), 62.2% [50.0--72.5%] for the proximal (prox)/mid left anterior descending (LAD) artery, 66.3% [57.5--77.5%] for the prox/mid right coronary artery (RCA), 70.5% [60.0--80.0%] for the prox left circumflex/first obtuse marginal (LCX/OM1), and 71.4% [62.5--82.5%] for the more distal segments. In patients with intermediate LAD lesions, 5 angiographic parameters were identified as independent predictors of flow limitation: (1) a 30--50% lesion prox to the lesion of interest, (2) lesion length >20 mm, (3) distal take-off of all diagonal branches ≥2 mm diameter, (4) "apical wrap" of LAD, and (5) collaterals to an occluded LCX/RCA. Based on these results, a risk score (P20-DAC2) for prediction of flow limitation in intermediate LAD lesions was derived. In conclusion, a comprehensive evaluation of the coronary angiogram--in which besides stenosis grade also other lesion/vessel characteristics are evaluated--can lead to a more accurate identification of functionally significant coronary stenoses. [ABSTRACT FROM AUTHOR]

Background Short-term mortality has been studied thoroughly in patients undergoing primary percutaneous coronary intervention (PCI), whereas long-term cause of death in patients with ST-segment elevation myocardial infarction (STEMI) remains unknown. Objectives The goal of this study was to describe the association between time and cause of death in patients with STEMI undergoing primary PCI. Methods A centralized civil registration system, patient files, and public disease and death cause registries with an accurate record linkage were used to trace time and cause of death in 2,804 consecutive patients with STEMI (age 63 ± 13 years, 72% males) treated with primary PCI. Results Patients were followed up for a median of 4.7 years. During a total of 13,447 patient-years, 717 patients died. Main causes of death within the first 30 days were cardiogenic shock and anoxic brain injury after cardiac arrest. Age, culprit vessel size and flow, and the presence of heart failure and diabetes were independent predictors of mortality. After 30 days, the annual cardiac mortality rate was <1.5%. Causes of death beyond 30 days were noncardiac in 65% of cases (mainly malignancies and pulmonary diseases). The 30-day, 1-year, and 5-year all-cause (and cardiac) mortality rates were 7.9% (7.3%), 11.4% (8.4%), and 23.3% (13.8%), respectively. Conclusions Patients who survive the first month after an STEMI treated with primary PCI have an excellent prognosis, with a <1.5% annual risk of successive cardiac death. Noncardiac causes are responsible for the majority of later deaths in these patients. [ABSTRACT FROM AUTHOR]

Abstract: The purpose was to elucidate the mechanism of action of sodium dodecyl sulphate (SDS) on drug dissolution from discs under physiologically relevant conditions. The effect of incorporating SDS (4–30%, w/w) and drug into discs on the dissolution constant and solubility were evaluated for the poorly soluble drugs griseofulvin and felodipine in a biorelevant dissolution medium (BDM). Dissolution constants from dissolution profiles of drug discs with and without SDS were measured using miniaturized rotating disc dissolution. Solid state changes were investigated by X-ray diffraction. Solubility was determined using HPLC-UV. The interaction between micelles in BDM and SDS was investigated by isothermal titration calorimetry and dynamic light scattering. Isothermal titration calorimetry showed that SDS formed mixed micelles with bile salt:phospholipid (BS:PC) micelles in BDM. Dynamic light scattering showed that the addition of SDS made the BS:PC micelles grow up to 2.5 times in volume. As a function of SDS addition, the dissolution constant showed an apparent exponential increase, while drug solubility showed a weak linear dependence. The pronounced effect on dissolution constant with SDS in the discs is not caused by an increased surface area as SDS dissolves, micelles in the bulk medium or changes in the solid state properties of the drugs. The proposed mechanism involves a high local concentration of SDS at the solid–liquid interface as SDS dissolves and this solubilizes the drug. The improved solubility at the solid–liquid interface provided a much steeper concentration gradient resulted in a faster dissolution. The total amount of SDS in the discs only gave a minor increase in total surfactant concentration in the dissolution medium and did therefore not to any large extent affect the drug solubility in the bulk. [Copyright &y& Elsevier]

Abstract: Background: Coronary in-stent restenosis (ISR) continues to be a therapeutic challenge especially after drug eluting stent (DES) implantation. We studied patients with ISR to investigate safety and efficacy of a novel drug coated balloon (DCB) incorporating paclitaxel into a microcrystalline structure by applying the inert excipient butyryltri-n-hexyl citrate (BTHC) in a prospective First-in-Man trial. Methods and Materials: Eighty-one patients were enrolled at 9 European sites, thereof 43 (53.1%) presenting with bare metal stent (BMS)-ISR and 38 (46.9%) with DES-ISR. The primary study endpoint was in-stent late lumen loss (LLL) independently assessed by a quantitative coronary angiography laboratory at 6 months. A secondary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, non-fatal myocardial infarction, clinically driven target vessel revascularization after 6 and 12 months. Results: At 6 months, overall LLL was 0.07±0.31 mm showing differences in BMS-ISR and DES-ISR treatment (−0.05±0.28 mm vs. 0.19±0.29 mm, respectively, P=.001). Overall MACE rates at 6 and 12 months were 6.5% and 11.8%. At the 12-month follow-up, one myocardial infarction, and no cardiac death nor stent thrombosis had occurred. Conclusion: Application of a novel paclitaxel coated balloon using BTHC as an excipient in patients with ISR is safe and results in very low LLL, revascularization- and MACE-rates at follow-up. (ClinicalTrials.gov:NCT00961181). [Copyright &y& Elsevier]

It is unknown whether high-sensitivity C-reactive protein (hs-CRP) predicts outcome depending on implanted stent type. We investigated the prognostic value of hs-CRP in relation to type of stent implanted in patients with ST-segment elevation myocardial infarction (STEMI). Immediately before primary percutaneous coronary intervention (pPCI), 301 patients had blood drawn. Patients were categorized according to hs-CRP levels and combination of hs-CRP (≤2 vs >2 mg/L) and stent type (bare metal stent [BMS] vs drug-eluting stent [DES]). Hs-CRP >2 mg/L (median, hazard ratio 2.7, 95% confidence interval 1.3 to 5.6, p = 0.007) and the combined variable of hs-CRP >2 mg/L and BMS (hazard ratio 2.4, 95% confidence interval 1.2 to 4.5, p = 0.006) independently predicted the composite end point of death and MI at 36-month follow-up. There was a significant interaction (p = 0.006) for hs-CRP and stent type. Survival analysis demonstrated significant differences for occurrence of death and MI: 4.8% in BMS + CRP ≤2 mg/L, 11.9% in DES + CRP ≤2 mg/L, 17.6% in DES + CRP >2 mg/L, and 27.9% in BMS + CRP >2 mg/L. None of the 14 stent thromboses occurred in patients with BMS + CRP ≤2 mg/L. In conclusion, preprocedure hs-CRP predicts outcome after pPCI in patients with STEMI. Our hypothesis-generating data indicate that BMS implantation should be preferred when hs-CRP is ≤2 mg/L and DES when hs-CRP is >2 mg/L to decrease long-term adverse outcomes including stent thrombosis in patients with STEMI treated with pPCI. These findings need confirmation in larger randomized clinical trials. [ABSTRACT FROM AUTHOR]

Abstract: In semi-natural environments sows often select a protected nest site at farrowing. Investigations of nest site selection under indoor conditions are scarce but suggest that sows prefer to nest and farrow under a covered area. Since feed-back from a functional nest may improve maternal behaviour and thus piglet survival we investigated if access to a covered area and ad libitum access to straw would improve maternal behaviour of importance for piglet survival. We used forty-four primiparous sows housed in large individual pens from approximately 2 weeks prior to expected parturition. The sows were randomly distributed to four treatment groups of +/− ad libitum access to straw combined with +/− access to a covered area in the pen. The sows’ position in the pen (left or right side) was observed from 24h prior to birth of the first piglet until 24h after using 10-min interval scan sampling and the temporal pattern of sow position in relation to position of the cover (left or right side of the pen) was studied. Furthermore, postural and nest-building behaviours were observed, as well as situations where the piglets were either at risk of being crushed or were crushed. The results showed no significant influence of cover on sow position. Odds-ratio for choosing the covered farrowing position was 1.4 (95% creditability interval (0.4–5.1)). The temporal pattern of sow position showed that the probability of observing the sows in the part of the pen classified as the farrowing position increased from close to 0.5 to 1 as parturition approached and stayed high during the 24h observation period after birth of the first piglet, except for a small drop around 12h after birth of the first piglet. However, the tendency to stay in the nest during farrowing was not increased neither by cover nor by ad libitum access to straw. Access to cover significantly increased prepartum nest-building behaviour (F 1,29 =4.27, P =0.05) whereas there was no significant influence of access to straw. However, it should be taken into account that all sows had access to sawdust on the floor, which may also serve as a nesting material. The number of crushing and near crushing situations within 24h after birth of first piglet (BFP) was significantly decreased in pens with access to straw (F 1,25 =4.50, P =0.04), whereas there was no significant influence of cover on this variable. Neither the number of scan intervals with lateral lying nor the number of postural changes were significantly influenced by cover or straw. In conclusion, the sows did select a specific nest site within the farrowing pen, but neither the choice of nest site nor the temporal consistency of staying in the nest were significantly affected by cover or ad libitum access to straw. Access to a covered area increased the occurrence of nest-building behaviour whereas access to straw reduced the number of near crushing situations. [Copyright &y& Elsevier]

Objectives: The purpose of this study was to compare long-term clinical outcomes after implantation of drug-eluting stents (DES) and bare-metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI). Background: The evidence of long-term efficacy and safety after implantation of DES in patients with complex lesions is scarce. Methods: We randomly assigned 626 patients with STEMI referred within 12 h to have a DES or a BMS implanted in the infarct-related lesion with or without distal protection during primary percutaneous coronary intervention. Results: At 3 years, target lesion revascularization was 6.1% in the DES group compared with 16.3% in the BMS group (p < 0.001), and the rate of major adverse cardiac events was 11.5% versus 18.2%, respectively (p = 0.02). Whereas all-cause mortality did not differ significantly, the rate of cardiac death was higher in the DES group, 6.1% versus 1.9% for the BMS group (p = 0.01). The occurrence of reinfarction, stroke, and stent thrombosis was similar. Conclusions: Implantation of DES in patients with STEMI reduces the long-term rate of major adverse cardiac events compared with BMS, but patients with DES had a higher risk of cardiac death not attributed to myocardial infarction or stent thrombosis. (Drug Elution and Distal Protection During Percutaneous Coronary Intervention in ST Elevation Myocardial Infarction [DEDICATION]; NCT00192868) [ABSTRACT FROM AUTHOR]

Abstract: Background: Granulocyte-colony stimulating factor (G-CSF) therapy after ST-elevation myocardial infarction (STEMI) have not demonstrated impact on systolic recovery compared to placebo. However, recent studies suggest that timing of G-CSF therapy is crucial. Methods: Timing of G-CSF treatment was analyzed in the STEMMI MRI subpopulation including 54 patients with STEMI treated with primary percutaneous coronary intervention (PCI) <12 h after symptom onset. Patients were randomized to double blind treatment with G-CSF (10 µg/kg/day) or placebo. Treatment was initiated from 17 to 65 h (mean 30) after PCI. Left ventricular ejection fraction (LVEF) was evaluated with MRI. Results: Recovery of LVEF from baseline to 6 months was not associated with time from PCI to G-CSF. An identical improvement in LVEF was found in the placebo group and the G-CSF group (p =0.8). There was no correlation between time from PCI to G-CSF and maximum plasma concentration of CD34+ cells (r =−0.3, p =0.1). Similar results were found from data on recovery of the infarction size and change in the systolic wall thickening. Conclusions: In the time window from 17 to 65 h after STEMI treated with PCI, the timing of G-CSF treatment does not seem to affect the recovery of LVEF. It remains to be determined if very early, or very late G-CSF treatment might be effective. [Copyright &y& Elsevier]

The selective thrombin inhibitor bivalirudin with a provisional glycoprotein IIb/IIIa inhibitor (GPI) has been shown to be comparable to heparin plus GPI in the rates of ischemic events but to significantly reduce the risk of bleeding complications in patients with acute coronary syndromes. The aim of this preliminary study was to describe the feasibility and safety of a switch from prehospital administration of unfractionated heparin to bivalirudin in ST-elevation acute myocardial infarction (STEMI) patients referred for primary percutaneous coronary intervention. Patients with STEMI treated with a 1-mg/kg bivalirudin bolus in the ambulance followed by infusion during angiography/primary percutaneous coronary intervention were compared with a STEMI control group (from the preceding year) treated with 10,000 U unfractionated heparin in the ambulance followed by in-hospital treatment with a GPI. A total of 102 patients (59%) receiving bivalirudin and 72 receiving heparin were followed during hospitalization. The baseline characteristics and prehospital treatment times were comparable between the 2 groups. The thrombolysis in myocardial infarction flow before and after primary percutaneous coronary intervention was similar. Stents were used significantly more often in the heparin-treated patients (90% versus 76%; p = 0.04), with bailout GPI for those receiving bivalirudin occurring in 30% compared with 83% of those receiving heparin (p <0.001). Significant bleeding complications were seen in <10% of all patients undergoing angiography with no difference between groups. Bivalirudin was easy to administer in the prehospital setting and did not affect the prehospital run times. In conclusion, the results suggest that prehospital bivalirudin administration is as safe and effective as heparin in the treatment of patients with STEMI. Prehospital administration seemed to reduce the need for GPI. [Copyright &y& Elsevier]

Abstract: The aim of this experiment was to investigate pigs’ preferences for rooting materials. Eighteen materials were allocated to six categories each of which consisted of three similar materials based on characteristics such as structure, size of particles, complexity, destructibility and digestibility. Twelve pairs of pigs chose among the three materials of each of the six categories in a balanced design. Within each category each pair was given four instantaneous choices among the three materials in a three-armed maze. ‘No choice’ was scored if the pigs did not enter one of the maze-arms within 90s. Thus there were four options in each choice situation. The results were analysed using a random utility model incorporating random intercepts to account for the repeated testing of the same animals. The pigs expressed clear preferences within the category EARTH, where compost and peat were preferred to wood-shavings and no choice. In the category CHIP the most probable rank-order was spruce chip, willow chip, fir chip and no choice, while in the category ROUGH the most probable rank-order was maize-silage, grass silage, sugar beets and no choice. However, in these two categories none of the probabilities were sufficiently large to signify a preference for any of the three materials although the probabilities of the ‘no choice’ option were low. The pigs expressed no preferences among any of the four options including ‘no choice’ in the categories TOY (sisal robe, Bite-Rite, wooden beam), HAY (alfalfa hay mixed with straw, seed grass hay, barley straw with under-seed), and STRAW (long straw, chopped straw and straw pellets). [Copyright &y& Elsevier]

Objectives: Our purpose was to evaluate the long-term use of sirolimus-eluting stents (SES) and bare-metal stents (BMS) in patients with complex coronary artery lesions. Background: Although the use of SES has proved to be effective in patients with simple coronary artery lesions, there are limited data of the long-term outcome of patients with complex coronary artery lesions. Methods: We randomly assigned 322 patients with total coronary occlusions or lesions located in bifurcations, ostial, or angulated segments of the coronary arteries to have SES or BMS implanted. Results: At 3 years, major adverse cardiac events had occurred in 20 patients (12%) in the SES group and in 59 patients (38%) in the BMS group (p < 0.001). Four versus 2 patients suffered a cardiac death (p = NS), and 5 versus 1 died of a noncardiac disease (p = NS) in the SES versus the BMS group. Six patients in the SES group versus 15 patients in the BMS group suffered a myocardial infarction (p < 0.05) during the 3-year observation period, and target lesion revascularization was performed in 8 patients (4.9%) versus 53 patients (33.8%), respectively (p < 0.001); of these, 4 in the SES versus 7 in the BMS group were performed between 1 and 3 years after the index treatment (p = NS). According to revised definitions, stent thrombosis occurred in 5 patients (3.1%) in the SES group and in 7 patients (4.4%) in the BMS group (p = NS); very late stent thrombosis was observed in 4 versus 1 patient. Conclusions: A continued benefit was observed up to 3 years after implantation of SES in patients with complex coronary artery lesions. The rate of late adverse events was similar in the 2 groups, and stent thromboses occurred rarely after 1 year. (Sirolimus Eluting Stents in Complex Coronary Lesions [SCANDSTENT]; NCT00151658) [Copyright &y& Elsevier]

Objectives: The purpose of this study was to evaluate the use of distal protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in native coronary vessels. Background: Embolization of material from the infarct-related lesion during PCI may result in impaired myocardial perfusion and worsen the prognosis. Previous attempts to protect the microcirculation during primary PCI have had conflicting results. Methods: We randomly assigned 626 patients with STEMI referred within 12 h to have PCI performed with (n = 312) or without (n = 314) distal protection. The primary end point was complete (≥70%) ST-segment resolution detected by continuous ST-segment monitoring. Blood levels of troponin-T and creatine kinase-MB were monitored before and after the procedure, and echocardiographic determination of the left ventricular wall motion index (WMI) was performed before discharge. Results: Patients were well matched in terms of demographic and angiographic baseline characteristics. There was no significant difference in the occurrence of the primary end point (76% vs. 72%, p = 0.29), no difference in maximum troponin-T (4.8 μg/l and 5.0 μg/l, p = 0.87) or maximum creatine kinase-MB (185 μg/l and 184 μg/l, p = 0.99), and no difference in median WMI (1.70 vs. 1.70, p = 0.35). The rate of major adverse cardiac and cerebral events (MACCE) 1 month after PCI was 5.4% with distal protection and 3.2% with conventional treatment (p = 0.17). Conclusions: The routine use of distal protection by a filterwire system during primary PCI does not seem to improve microvascular perfusion, limit infarct size, or reduce the occurrence of MACCE (Drug Elution and Distal Protection During Percutaneous Coronary Intervention in ST Elevation Myocardial Infarction; NCT00192868). [Copyright &y& Elsevier]

Abstract: Background: Angiogenic growth factors and stem cell therapies have demonstrated varying results in patients with chronic coronary artery disease. A reason could be that these mechanisms are already up-regulated due to reduced blood supply to the myocardium. The objective of this study was to examine if plasma concentrations of circulating stem cells and angiogenic cytokines in patients with severe stable chronic coronary artery disease were correlated to the clinical severity of the disease. Methods: Fifty-four patients with severe coronary artery disease and reversible ischemia at stress myocardial perfusion scintigraphy were prospectively included. The severity of the disease was quantified by an exercise tolerance test, Canadian Cardiovascular Society angina classification, and Seattle Angina Pectoris Questionnaire. Fifteen persons without coronary artery disease served as control subjects. Results: Plasma concentration of VEGF-A, FGF-2, SDF-1, and circulating CD34+ and CD34−/CD45−cells were similar in the two groups, but early stem cell markers (CD105, CD73, CD166) and endothelial markers (CD31, CD144, VEGFR2) were significantly different between patients and control subjects (p <0.005−0.001). Diabetic patients had higher concentration of SDF-1 (2528 vs. 2150 pg/ml, p =0.004). We found significant correlations between both VEGF-A, FGF-2, and CD34+ to disease severity, including degree of reversible ischemia, angina stability score, and exertional dyspnoea. Conclusions: Plasma concentrations of circulating stem cells and angiogenic cytokines have large inter-individual variations, which probably exclude them from being useful as indicators of myocardial ischemic burden. [Copyright &y& Elsevier]

Abstract: The most critical period for the survival of piglets is during the first 2 days of life. Causes of early piglet mortality include reduced vitality due to hypoxia during parturition, hypothermia and lack of adequate colostrum intake. Besides, low vitality piglets may run a larger risk of being crushed by the sow. In the light of the thermoregulatory challenges facing newborn piglets and the possible sow-piglet interactions under loose housing, we investigated whether floor heating around parturition affected early piglet vitality and behaviour related to survival. Twenty-three Landrace×Yorkshire sows of 2nd parity were housed individually in 7.5m2 pens in a climate controlled facility. HEAT sows (n =12) were exposed to pen floor heating (33.5°C) from 12h after onset of nest building and until 48h after birth of 1st piglet, whereas CONT sows (n =11) received no floor heating (21.2°C). The concentration of lactate in umbilical cord blood at birth—an indicator of hypoxia—increased with the birth duration (P <0.001) and with declining piglet weight (P <0.001), with no significant effect of floor heating. After the initial drop in body temperature at birth, floor heating resulted in an earlier recovery of piglet temperatures (P <0.001), i.e. the piglet''s period for experiencing hypothermia after birth was reduced. HEAT piglets also suckled sooner than CONT piglets after the 1st hour post partum (with ratios between HEAT/CONT hazard functions being 2.9–6.4 for latency to suckle in the period 1–3h after birth). Moreover, fewer live-born piglets died during the first 3 days (P =0.047), as well as during the first week in the floor heated litters (mean (S.E.) HEAT 8.7 (2.8)% versus CONT 15.5 (5.2)%, P =0.014). We did not find any effect of floor heating on duration of parturition, inter-birth intervals, litter size, early piglet weight gains, blood glucose and lactate concentrations at birth, heart rate at birth, piglet activity from birth to first suckling or amount of parvovirus antibodies transferred from sow to piglets. In conclusion, floor heating around parturition had no evident effect on the innate piglet vitality, but it had favourable effects on the early recovery of piglet body temperature, latency to first suckle and survival of piglets in the loose house system. [Copyright &y& Elsevier]

Objectives: The purpose of the SCANDSTENT study was to evaluate the use of sirolimus-eluting stents (SES) in complex coronary lesions. Background: The use of SES improves angiographic and clinical outcomes compared with bare-metal stents (BMS) in simple coronary artery lesions, but there is limited evidence of their safety and efficacy when implanted in complex lesions. Methods: We randomly assigned 322 patients with symptomatic complex coronary artery disease to receive either SES or BMS. The lesions were occluded (36%), bifurcational (34%), ostial (22%), or angulated (8%) in morphology. The primary end point was the difference in minimal lumen diameter six months after stent implantation. Results: The patients were well matched in terms of demographic and angiographic baseline characteristics; 18% had diabetes. The reference vessel diameter was 2.86 mm in mean, and the lesion length 18.0 mm. At follow-up, patients who received SES had a minimal lumen diameter of 2.48 mm compared with 1.65 mm in those who received BMS (p < 0.001), a diameter stenosis of 19.3% versus 43.8% (p < 0.001), and 2.0% versus 31.9% developed restenosis (p < 0.001). The rate of major adverse cardiac events was 4.3% with SES versus 29.3% with BMS (p < 0.001), and stent thrombosis was observed in 0.6% in the SES group versus 3.1% in the BMS group (p = 0.15). Conclusions: The use of SES markedly reduced restenosis and the occurrence of major adverse cardiac events in patients with complex coronary artery lesions without increasing the risk of stent thrombosis. [Copyright &y& Elsevier]

Abstract: The aim of the present experiment was to measure pigs’ preferences for four different rooting materials using a set-up where pigs were given the opportunity to consider the relative attractiveness of two different materials simultaneously. Ten pigs had access to work for 50min daily in an operant conditioning experiment using concurrent schedules of reinforcement. During the 50min two different rooting materials were available after completing a fixed number of presses on two different operant panels inside a test pen. Long straw was always used as reinforcement on one panel, while one of four alternative rooting materials (chopped straw, fir branches, peat or long straw) was used as reinforcement on the other panel. The cost of access to the resources varied on both panels according to five pairs of Fixed Ratio schedules (FR8/FR40, FR16/FR32, FR24/FR24, FR32/FR16, FR40/FR8). For each material all pigs went through three test runs of the five FR pairs. Measures of preferences were based both on the generalized matching law (bias) and on the cross-points between the demand curves for the reference material and for the alternative material. Both the bias and the cross-point was significantly affected by type of alternative material in that the cross-point for peat (FR9.0) was significantly lower (P &#60;0.05) and bias (−0.34) significantly higher (P &#60;0.05) than for all other alternative materials (cross-point: branches FR18.3, chopped straw FR23.8, long straw FR29.2; log(bias): branches −0.27, chopped straw −0.01, long straw 0.40). The intercept of the demand curves for the alternative materials were significantly affected (P &#60;0.05) by type of material in that it was higher for peat (1.73±0.14)(lsmeans±std. err.) than for all other materials. The intercept for branches (1.31±0.14) was higher than for chopped straw (0.92±0.14) and long straw (0.54±0.17). The slopes of the alternative demand curves were unaffected by type of material as were the intercepts and slopes of the reference curves. The number of times of pressing the alternative panel in succession before shifting to the reference panel was significantly higher (P &#60;0.001) across all FR''s for peat (11±0.7 at FR24) and branches (9.4±0.7 at FR24) than for chopped straw (8.2±0.6 at FR24) and long straw (7.0±0.6 at FR24). The pigs achieved a new reward sooner following delivery of the previous one (P &#60;0.05) when the alternative material was either peat (1.3±0.13min) or branches (1.3±0.13min) compared to long straw (1.8±0.19min) and chopped straw (1.7±0.13min). All three alternatives were able to substitute completely for long straw, in that the slope of the demand curve of the reference material was not influenced by type of alternative material. In conclusion, both measures of cross-points and bias indicated a preference for peat and branches over chopped straw and long straw. [Copyright &y& Elsevier]

Abstract: Objectives: A phase I safety and efficacy study with granulocyte colony stimulating factor (G-CSF) mobilization of bone marrow stem cells to induce vasculogenesis in patients with severe ischemic heart disease (IHD) was conducted. Design, patients and results: 29 patients with IHD participated in the study. Thirteen patients were treated with G-CSF for 6 days and 16 patients served as controls. G-CSF treatment was without any serious adverse events. Four patients were “poor mobilizers” with a maximal increase in CD34+ cells to 5,000±700/mL blood (mean±S.D.) compared to 28,900±5,100/mL blood in “mobilizers”. At the follow-up, G-CSF treated had improved in CCS classification, NTG consumption and angina attacks, but the controls only in CCS classification. No difference was seen between the two groups. The decline in NTG consumption tended to be significant in “mobilizers” compared to controls. Myocardial perfusion was unchanged at adenosine stress single photon emission computerized tomography (SPECT) or magnetic resonance images (MRI). Left ventricular ejection fraction decreased from 57% to 52% (p<0.01, MRI) and from 48% to 44% (p=0.07, SPECT) in G-CSF treated, but was unchanged measured with echocardiography. Conclusions: Treatment by G-CSF improved symptoms but not signs of myocardial ischemia in patients with severe IHD. The effects seemed related to mobilization of stem cells. An adverse effect on ejection fraction could not be excluded. [Copyright &y& Elsevier]

Objectives: In the Euroinject One phase II randomized double-blind trial, therapeutic angiogenesis of percutaneous intramyocardial plasmid gene transfer of vascular endothelial growth factor (phVEGF-A(165)) on myocardial perfusion, left ventricular function, and clinical symptoms was assessed. Background: Evidence for safety and treatment efficacy have been presented in phase I therapeutic angiogenesis trials. Methods: Eighty "no-option" patients with severe stable ischemic heart disease, Canadian Cardiovascular Society functional class 3 to 4, were assigned randomly to receive, via the NOGA-MyoStar system (Cordis Corp., Miami Lakes, Florida), either 0.5 mg of phVEGF-A(165) (n = 40) or placebo plasmid (n = 40) in the myocardial region showing stress-induced myocardial perfusion defects on (99m)Tc sestamibi/tetrofosmin single-photon emission computed tomography. Results: No differences among the groups were recorded at baseline with respect to clinical, perfusion, and wall motion characteristics. After three months, myocardial stress perfusion defects did not differ significantly between the VEGF gene transfer and placebo groups (38 +/- 3% and 44 +/- 2%, respectively). Similarly, semiquantitative analysis of the change in perfusion in the treated region of interest did not differ significantly between the two groups. Compared with placebo, VEGF gene transfer improved the local wall motion disturbances, assessed both by NOGA (p = 0.04) and contrast ventriculography (p = 0.03). Canadian Cardiovascular Society functional class classification of angina pectoris improved significantly in both groups but without difference between the groups. No phVEGF-A(165)-related adverse events were observed; however, NOGA procedure-related adverse events occurred in five patients. Conclusions: The VEGF gene transfer did not significantly improve stress-induced myocardial perfusion abnormalities compared with placebo; however, improved regional wall motion, as assessed both by NOGA and by ventriculography, may indicate a favorable anti-ischemic effect. This result should encourage more studies within the field. Transient VEGF overexpression seems to be safe. [ABSTRACT FROM AUTHOR]