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Postoperative delirium (POD) following microvascular head and neck reconstruction negatively impacts patient outcomes, and only a few risk factors have been identified. The aim of this study was to identify additional risk factors for POD after intraoral reconstruction with microvascular free flaps. Data from 377 patients who underwent intraoral microvascular free flap reconstruction between 2011 and 2019 were analysed retrospectively. Preoperative, intraoperative, and postoperative variables were compared between 40 patients with POD and 40 patients without POD who were matched for previously identified risk factors (i.e., sex, age, American Society of Anesthesiologists class, preoperative arterial hypertension, tracheotomy, operation time, and blood transfusion). A multivariable regression analysis was then performed to identify risk factors associated with POD. POD occurred in 50 (13.3%) of the 377 cases studied; the median time of onset was postoperative day 2. Excessive preoperative alcohol consumption (odds ratio 9.22, 95% confidence interval 1.09–77.97; P = 0.041) and postoperative transplant revision (odds ratio 25.72, 95% confidence interval 1.26–525.43; P = 0.035) were identified as risk factors for POD. The identification of patients at high risk of POD based on these two risk factors may allow early adjustment of diagnostic and therapeutic modalities to improve outcomes and reduce healthcare costs. [ABSTRACT FROM AUTHOR]

Microvascular free flaps are frequently used for head and neck reconstruction after prior neck dissection (ND) and neck irradiation (RTX). The aim of this study was to investigate the influence of ND and RTX on flap perfusion as a critical factor for flap success. Overall, 392 patients reconstructed with a microvascular fasciocutaneous flap (FF) or perforator flap (PF) in the head and neck region between 2011 and 2020 were analysed retrospectively. Flap perfusion measured intraoperatively and postoperatively with the O2C tissue oxygen analysis system was compared between patients who had received neither ND nor RTX (controls), patients who had received ND but no RTX (ND group), and patients who had received both ND and RTX (ND+RTX group). Intraoperative and postoperative flap blood flow was decreased in FFs in ND group patients compared to controls (median 66.3 AU vs 86.0 AU, P = 0.023; median 73.5 AU vs 93.8 AU, P = 0.045, respectively). In the multivariable analysis, these differences showed a tendency to persist (P = 0.052 and P = 0.056). Flap success rates were similar in control patients, ND patients, and ND+RTX patients (98.7%, 94.0%, and 97.6%, respectively). Flap perfusion is not reduced in FFs and PFs in patients who have undergone ND or ND and RTX. This indicates that neck dissection and neck irradiation should not be contraindications for microvascular free flap reconstruction. [ABSTRACT FROM AUTHOR]

Surgically assisted rapid palatal expansion (SARPE) is a common treatment to correct transverse maxillary deficiencies. Finite element analysis was simulated for six designs of SARPE based on a computed tomography scan of a human skull: median osteotomy with palatal (type A) or alveolar ridge (type B) bone-borne force, additional lateral osteotomy with palatal (type C) or alveolar ridge (type D) bone-borne force, and additional pterygomaxillary separation with palatal (type E) or alveolar ridge (type F) bone-borne force. The transverse expansion was about 1.0 mm. The distribution of von Mises stress and the displacement were evaluated. The largest stress distribution was after types A and B, followed by types C and D, and finally types E and F. Displacement increased simultaneously. Palatal bone-borne forces (types A, C, and E) led to higher stress distributions in the midface and maxilla, but to a more parallel expansion compared with alveolar ridge-borne forces (types B, D, and F). The largest bony displacements at the midpalatal suture were anterior in all models. Increased weakening of the bony pillar of the facial skeleton and the use of palatal bone-borne forces leads to a decrease in stress distribution in the midface and to a more parallel transverse expansion of the maxilla. [ABSTRACT FROM AUTHOR]

Microvascular free flaps are considered to be the gold standard in reconstructive head and neck surgery. However, reduced postoperative transplant perfusion is one of the serious postoperative complications and calls for close and reliable monitoring. Procalcitonin, C-reactive protein, and leukocytes are closely associated with local and systemic inflammatory reactions and might have prognostic capacity concerning tissue necrosis. This study aimed to evaluate perioperative serum levels of these three biomarkers to assess their potential in postoperative flap monitoring. A total of 100 patients with microvascular head and neck reconstructions were included in the study. Perioperative serum levels of parameters were measured and the clinical data were analyzed and correlated. A total of 13% of all flaps developed reduced postoperative perfusion. Analysis of the parameters revealed statistically significant differences in the overall patient collective over time, irrespective of clinically reduced flap perfusion. Co-factors such as sex and history of tobacco and alcohol abuse showed significant differences. The efficacy of the parameters in free flap monitoring has not been verified, although the role of procalcitonin in postoperative monitoring, with special regard to the early detection of infections, is underlined by the present study results. [ABSTRACT FROM AUTHOR]

Introduction Bacterial resistance against antibiotics has become an increasing challenge in the treatment of cutaneous infections. Consequences can be severe, especially in infected wounds following previous local radiotherapy. Certain endogenous peptide antibiotics, the host defence peptides (HDPs), exhibit broad-spectrum antimicrobial activity and promote wound healing. Their use as supplements to conventional antibiotics is a current topic of discussion; however, knowledge of their quantities in healthy and compromised tissue is a prerequisite for such discussion. To date, no data concerning HDP quantities in irradiated skin are available. Methods Expression profiles of the genes encoding HDPs, namely human beta-defensin-1 (DEFB1, hBD-1), beta-defensin-2 (DEFB4A, hBD-2), beta-defensin-3 (DEFB103, hBD-3) and S100A7, were assessed in samples of non-irradiated and irradiated neck. Results A reduction in the expression of all of the examined genes was observed in irradiated skin when compared with non-irradiated skin (statistically significant in the case of S100A7 , P = 0.013). Immunohistochemistry revealed differences in HDP distribution with respect to the epithelial layers. Conclusion The study demonstrates a significant reduction in HDP gene expression in neck skin as a result of radiotherapy. These findings might represent a starting point for novel treatments of cutaneous infections in irradiated patients, such as topical supplementation of synthetic HDP. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the influence of implant diameter and length on primary stability in artificial bone blocks. In total, 240 implants of various diameters (Ø 3.3, 4.1, and 4.8 mm) and lengths (8 and 12 mm) were inserted in four artificial bone blocks of different densities (D1–D4). The primary stability for each bone block density was measured and compared with the primary stability of a narrow and short implant (Ø 3.3 mm, length 8 mm) in the next higher density block. Analysis was done by three-way ANOVA, and mean differences were determined with the 95% confidence interval. Levels of primary stability achieved by choosing the next higher diameter or length were not comparable to those of the next level of block density. However, equivalent values could be achieved by selecting the largest diameter for short and long implants in the lowest block density D4, as well as for long implants in bone type D2. The diameter of an implant has greater influence on primary stability than length. In particular, in the case of poor bone quality, a variation of implant geometry can lead to significant improvement in primary stability. [ABSTRACT FROM AUTHOR]

Upon nitriding of iron-based alloys, development of misfitting coherent nitride precipitates in a ferrite matrix induces an overall expansion of the ferrite lattice. This lattice expansion was quantitatively determined by X-ray diffraction from the change of the lattice parameter of ferrite of homogenously nitrided Fe Cr and Fe V alloys. Adopting the experimentally verified (by X-ray diffraction and transmission electron microscopy) notion that the misfitting precipitates diffract coherently with the matrix , the extent of this hydrostatic lattice-strain component could be calculated, in general, as function of the precipitate/matrix misfit, the volume fraction of precipitates and the elastic properties of the matrix and precipitates. The experimentally observed and the predicted dependencies of lattice dilatation agree very well for both nitrided Fe Cr and Fe V alloys. This is the first time that this type of lattice expansion was experimentally identified and quantitatively explained. [ABSTRACT FROM AUTHOR]

To identify factors that minimise damage during the drilling of sites for dental implants, we reviewed published papers on the amount of heat that is generated. We systematically searched English language studies published between January 2000 and February 2014 on MEDLINE/PubMed and found 41 articles, of which 27 related to an increase in temperature during preparation of the site. We found only basic research with a low level of evidence. Most of the studies were in vitro, and osteotomies were usually made in non-vital bone from cows or pigs. To measure heat in real time, thermocouples were used in 18 studies and infrared thermographs in 7. Three studies reported the use of immunohistochemical analysis to investigate immediate viability of cells. The highest temperature measured was 64.4 °C and the lowest 28.4 °C. Drill wear was reported after preparation of 50 sites, and there was a significant increase in temperature and a small change in the physiological balance of the proteins in the bone cells. Differences in the study designs meant that meta-analysis was not appropriate. For future work, we recommend the use of standard variables: an axial load of 2 kg, drilling speed of 1500 rpm, irrigation, standard artificial bone blocks, and the use of infrared thermography. [ABSTRACT FROM AUTHOR]

Objectives Fractures of the atrophic edentulous mandible are a rare complication that can become severe after the insertion of dental implants. This in vitro study investigated the effects of different implant settings varying in number, diameter, and length. and the influence of a fixed bar. Materials and methods In biomechanical experiments on artificial mandibles, an unmodified reference group, four implant settings with two different implants, and the effect of adding a fixed bar to these settings were tested. All specimens were loaded with incisal biting forces until failure due to fracture. Results Implants weakened all specimens significantly compared with those in the reference group. Without a fixed bar, four short and thick implants showed the best results, with high significance. With a fixed bar, four long and thin implants withstood the highest loads. The addition of fixed bars reduced the differences between the implant settings. Fixed bars did not show increased stability for all groups; however, these groups showed a higher mean strength. Conclusions Four implants with a short and thick design should be the first choice when implants are placed without a fixed bar in an atrophic mandible. With a fixed bar, four long and thin implants should be used. [ABSTRACT FROM AUTHOR]

Purpose Retrospective clinical evaluation and biomechanical tests were performed to compare the primary stability and the rate of pseudarthrosis formation after irradiation for two types of mandibular split osteotomies: the stairstep osteotomy (SSO) and the straight-line osteotomy (SLO). Methods The postoperative occurrence of pseudarthrosis was retrospectively analysed in 46 non-consecutive clinical cases of SSO and SLO between 2003 and 2013. Biomechanical tests were performed on 12 standardised synthetic mandibles (Synbone) to compare the SSO and SLO approaches. Two 2.0 mm monocortical miniplates (Medartis) were used for osteosynthesis. The artificial mandible specimens were loaded to 300 N on the Mandibulator test bench while interfragmentary motion was measured using the PONTOS optical measurement device. Results The retrospective clinical analysis showed a rate of pseudarthrosis of 19% in the SLO group versus only 5% in the SSO group ( p = 0.17). In the biomechanical investigation, the average interfragmentary movement was 14.3 ± 7.70 for the SLO group and 4.57 ± 2.33 for the SSO group under a maximum load of 300 N, resulting in a statistically significant difference between the two approaches ( p = 0.014). Conclusion To minimise the rate of postoperative pseudarthrosis formation, SSO is superior to SLO for mandibular split procedures, because SSO provides greater resistance to vertical loads and allows less interfragmentary movement. Level of evidence 2C (Outcomes research). [ABSTRACT FROM AUTHOR]

Purpose: Optimal management of hemoglobin (Hb) and red blood cell transfusion (RBCT) in neurologic intensive care unit (NICU) patients has not been determined yet. Here we aimed to investigate the impact of anemia and transfusion activity in patients who had acute ischemic stroke. Materials and Methods: A retrospective analysis of clinical, laboratory, and outcome data of patients with severe acute ischemic stroke treated on our NICU between 2004 and 2011 was performed. Results: Of 109 patients, 97.2% developed anemia and 33% received RBCT. Significant correlations were found between NICU length of stay (NICU LOS) and lowest (nadir) Hb (correlation coefficient, -0.42, P < .001), Hb decrease (0.52, P < .001), nadir hematocrit (Hct; -0.43, P < .001), and Hct decrease (0.51, P < .001). Duration of mechanical ventilation (MV) was strongly associated with both nadir Hb (-0.41, P < .001) and decrease (0.42, P < .001) and nadir Hct (-0.43, P < .001) and decrease (0.40, P < .001). Red blood cell transfusion correlated with NICU LOS (0.33, P < .001) and with duration of MV (0.40, P < .001). None of these hematologic parameters correlated with in-hospital mortality or 90-day outcome. The linear regression model showed number of RBCT (0.29, P = .008), nadir Hb (-0.18, P = .049), Hb decrease (0.33, P < .001), nadir Hct (-0.18, P = .03), and Hct decrease (0.29, P < .001) to be independent predictors of NICU LOS. Duration of MV was also independently predicted by number of RBC transfusions (0.29, P < .001), nadir Hb (-0.20, P=.02), Hb decrease (0.25, P=.002), nadir Hct (-0.21, P=.015), and Hct decrease (0.26, P < .001). Conclusions: Low and further decreasing Hb and Hct levels as well as RBCT activity are associated with prolonged NICU stay and duration of MV but not with mortality or long-term outcome. Our findings do not justify using a more aggressive transfusion practice at present. [ABSTRACT FROM AUTHOR]

We did biomechanical loading tests to compare the quantity and quality of interfragmentary movement in fractured human cadaver mandibles that had been reconstructed with iliac crest using 3 different osteosynthesis systems. Eighteen mandibles from human cadavers with a 4.5cm paramedian L-type defect were reconstructed with bone from the iliac crest using 3 different osteosynthesis systems and continuously loaded on the “Mandibulator” test bench. Six mandibles each had the bones joined together using 2 monocortical non-locking plates, 2 monocortical locking plates, or a single bicortical locking plate/fracture gap. Macroscopic deformation, failure mechanisms, and movement of the fracture gap in all 3 dimensions were assessed and quantified over increasing loading by PONTOS® optical measurement systems. Final mechanisms of failure were excessive deformation of the plate, fracture of the mandibular fragments, and failure of the iliac crest graft. The plate became deformed mainly in the miniplate group. The iliac crest graft failed in all the specimens in which osteosynthesis was performed by a 6-hole TriLock® plate. Interfragmentary movement was minimised in the miniplate group. All three osteosynthesis systems provided sufficient stability for reconstruction when mechanically loaded up to 100N. The miniplate allowed less movement in the gap and gave better stability than the two TriLock® plate systems. The superiority of the miniplate was significant when compared with the 4-hole TriLock® plate. The transplant failed mainly in the 6-hole TriLock® group, which suggests that the iliac crest graft works better with the miniplate as a more malleable osteosynthesis system. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate the impact of endovascular embolisation therapy in men with erectile impotence due to veno-occlusive dysfunction. Methods: We retrospectively evaluated 29 patients with a history of erectile impotence due to veno-oclusive dysfunction confirmed by pharmacocavernosometry and cavernosography. All underwent endovascular embolisation therapy over transfemoral approach. After positioning the catheter system at the target level heights, embolisation with N-butyl-2-cyanoacrylate (Histoacryl®) was performed. Technical and clinical success as well as major and minor complications were evaluated. Results: All procedures were performed without any major or minor events. Complication rate was 0%. Technical success was achieved in 27/29 (93.1%). Two patients failed for anatomical reasons. Overall clinical success was achieved in 24/27 (88.8%) patients with recovering from E1 (poor tumescense/no rigidity) to E4 (good tumescence/intermediate rigidity) in 11/27 (40.7%), E1 to E5 in 8/27 (tumescence/normal rigidity) (29.6%) and E1 to E3 (good tumescence/poor rigidity) in 5/27 (18.5%) respectively. 3/27 (11.1%) received no change in ED severity score. Conclusion: Endovascular embolisation therapy for veno-occlusive dysfunction in erectile impotence is a safe and effective therapeutic option with low complication rate and highly technical and clinical success rates. [Copyright &y& Elsevier]

Abstract: Samples of legume seeds, cereals and cereal by-products (n =113) grown in south-western Germany and originating from different cultivars and harvest years were analyzed for phytase activity, total phosphorus (P) and phytate P. Phytase activities determined by means of a direct incubation method were lowest in legume seeds and oats (262–496U/kg dry matter), intermediate in cereals (except oats) (2323–6016U/kg DM) and highest in cereal by-products (9241–9945U/kg DM). However, the application of an extraction procedure for the determination of phytase activities in legume seeds resulted in values below the detection limit of 50U/kg. On average, about 0.67 of total P in legume seeds, cereals and their by-products is bound to phytate. There was a significant influence (P<0.001) of harvest year (1998–2000) on phytate P contents in wheat. Furthermore, total P and phytate P concentrations differed (P<0.05) between different cultivars of wheat. Moreover, phytase activities differed (P=0.023) between different cultivars of barley. Total P and phytate P concentrations were highly correlated in legume seeds (r =0.95) and cereal by-products (r =0.96) and, to a smaller extent, in cereals (r =0.66). Milling of cereal grains to bran and flour revealed that phytase activity, total P and phytate P are highly concentrated (P<0.001) in the outer grain layers of cereals. The influence of preservation of intact legume seeds with propionic acid over a period of 4, 8 or 12 weeks resulted only in a marginal decrease in phytase activity. Due to high native phytase activities in cereals (except oats) and their by-products these feedstuffs may contribute substantially to the gastrointestinal hydrolysis of phytate in non-ruminant animals, whereas the contribution of native phytases originating from legume seeds in terms of improving the availability of plant P seems to be rather limited. [Copyright &y& Elsevier]

Abstract: Background: Cardiovascular risk in hemodialysis patients is enhanced, resulting in a higher mortality rate compared with the general population, yet the average wait time for renal transplantation in Germany is 5–7 years. The age of wait-listed patients has risen progressively. The aim of this study was to evaluate the prevalence of cardiovascular disease in patients on the waiting list in our center before and after renal transplantation as well as the extent to which invasive treatment was required in these patients. Methods: The study investigated 2 groups: 350 patients on the renal transplantation waiting list at our center in 2008 and 324 patients who underwent renal transplantation at the same center in the years 2003–2007. Results: In 2008, 141 women and 209 men with a mean age of 48.6 years (range 13–71 years) were on the waiting list. In the years 2003–2007, 98 women and 226 men with a mean age of 54.3 years (range 16–78 years) received renal transplants. One hundred six patients on the waiting list for renal transplantation had to undergo coronary angiography. There is no upper age limit for donors or recipients in our program. Mean age at admission on the waiting list was 48.6 years (range 13–71 years). Mean age at transplantation was 54.3 years (range 16–78 years) in our center. Most of these patients were asymptomatic but presented a risk profile that included diabetes mellitus, severe general atherosclerosis, a pathologic ergometric test, or abnormal myocardial scintigraphy. Only in 1 case could coronary heart disease be excluded. Seventy patients (20%) suffered from mild to moderate coronary heart disease without the need for intervention. In 5 patients (1.4%) coronary bypass surgery was necessary due to severe 3-vessel coronary heart disease. In 2 cases (0.6%) replacement of the aortic valve was performed because of aortic valvular stenosis. Coronary angioplasty without implantation of stents was done in 2 patients (0.6%). Twenty-two patients (6.8%) were treated with implantation of bare metal stents and 6 patients (1.7%) with drug-eluting stents. After renal transplantation, 22 patients (6.8%) suffered from peripheral arterial occlusive disease. In 58 patients, coronary heart disease was documented by angiography. 16 patients (4.9%) had 1-vessel disease, 23 patients (7%) 2-vessel disease, and 19 patients (5.8%) 3-vessel disease. Myocardial infarction was documented in 18 patients (5.5%) before and in 5 patients (1.5%) after renal transplantation. Bare metal stent implantation was performed in 6 patients (1.8%) after transplantation. One patient received a drug-eluting stent after renal transplantation. In the years 2003–2007, 22 patients underwent coronary bypass surgery before kidney transplantation. Conclusion: The prevalence of coronary heart disease is high in patients on the waiting list and after renal transplantation. The majority of these patients are clinically asymptomatic. One-third of the patients with coronary heart disease had to be treated invasively. Nevertheless, many diabetic patients are very sick from multiple complications after the waiting time, making theme unsuitable for transplantation. [Copyright &y& Elsevier]

Abstract: We report the case of a severe acute asthma, which required, after optimal medical therapy, helium and sevoflurane CO-administration after tracheal intubation. The Anesthetic Conserving Device® allowed sevoflurane use with intensive care unit''s ventilator. The helium-sevoflurane association was maintained during 9days to decrease the bronchospasm, waiting for the efficiency of an aetiologic treatment. We discuss the suitability of this association to treat severe acute asthma, and its administration modalities. [Copyright &y& Elsevier]

Abstract: In end-stage renal disease patients anemia is known to be an independent risk factor for cardiovascular disease and death. In a monocenter retrospective analysis, we investigated 207 stable patients (68 women/139 men) who underwent a first renal transplantation. Immunosuppressive therapy was performed with either cyclosporine plus mycophenolate mofetil, tacrolimus plus mycophenolate mofetil, or rapamycin plus mycophenolate mofetil; 43.5% of the patients were treated with steroids. Seventy-eight patients (37.7%) displayed anemia, including 8.7% with a severe disorder displaying an average hemoglobin (Hb) level of <6.8 mmo/L in men and <6.2 mmol/L in women. In 8.2% of the cases, we observed moderate anemia (Hb 6.8–7.4 mmol/L in men and 6.2–6.8 mmol/L in women), and in 20.8% (29 men and 14 women), mild anemia (Hb <8.06 mmol/L in men and <7.45 mmol/L in women). Erythropoietin was administered in 55.5% of patients with severe anemia, 53% with moderate anemia, and 11.6% with mild anemia. Serum creatinine level was a significant predictor of anemia (B −0.004; SE 0.001; P < .01). Among patients with creatinine >200 μmol/L, 63% were anemic compared with 22% of those with a serum creatinine level <200 μmol/L (P < .05). No correlation was observed with immunosuppressive medication or treatment with angiotensin-converting enzyme inhibitors/angiotensin-II receptor antagonists. During a 3-year follow-up, both mortality and graft failure rates were significantly greater among anemic patients nonanemic patients (mortality 3.3% vs 0.5%, P < .001; graft failure 4.3% vs 0%, P < .001). We found an unexpectedly high incidence of anemia in patients with well-functioning grafts. Anemia as a risk factor for mortality and graft failure should be treated more intensively among renal transplant patients. [Copyright &y& Elsevier]

Abstract: Approximately 10% to 20% of all annual renal transplantations are retransplantations and up to 20% of patients on waiting lists need a repeat kidney because of previous graft failure. The immunological risk is much greater among retransplanted patients than first-time kidney recipients. It is likely that retransplantation will become even more prevalent in the future. However, clinical studies or retrospective data are rare in this patient population. We retrospectively investigated 50 recipients after second or third renal transplantations in our center since 2001. Immunosuppression was performed with corticosteroids, mycophenolate mofetil (MMF), tacrolimus, and induction therapy with either thymoglobulin (2.5 mg/kg body weight; n = 27) or 20 mg basiliximab on days 0 and 4 (n = 22) after renal transplantation; 1 patient was treated with antithymoglobulin Fresenius after combined liver–kidney transplantation. Acute rejection occurred in 12 recipients (44.4%) after thymoglobulin and in 7 recipients (31.8%) after basiliximab induction therapy (P < .05). In 4 (14.8%) thymoglobulin- and 5 (22.7%) basiliximab-treated recipients, vascular rejections were observed (P = NS). Patients with basiliximab treatment showed improved renal function at 1 year after transplantation: serum creatinine 134.3 μmol/L versus 199.6 μmol/L in the thymoglobulin group (P < .05). Over the observation period the renal function remained stable or improved in both groups if rejection treatment was successful. However, allograft failure was higher in the basiliximab-treated group, namely, 18.1% versus 14.8% in thymoglobulin-treated patients, but the difference did not reach statistical significance. In 3 (11.1%) thymoglobulin- and 4 (18.2%) basiliximab-treated patients cytomegalovirus (CMV) infections complicated the follow-up (P = NS). In the follow-up period of 5 years, no malignant diseases were seen in either group. Three basiliximab-treated recipients died in the first year due to sepsis or cardiovascular complications. Two thymoglobulin-treated patients developed BK virus nephropathy in the follow-up period. In conclusion, we observed a high immunological risk and rejection risk among retransplanted kidney recipients in our center. Particularly, severe vascular rejections with a harmful long-term impact on allograft function were observed in this population. Induction treatment seems to be successful to reduce risk and achieve better results. Single-shot thymoglobulin may be preferable to reduce severe vascular rejection and prevent allograft failure than basiliximab with the same infection rate. [Copyright &y& Elsevier]

Necrotic enteritis (NE) causes significant economic losses in the broiler chicken industry, especially in birds raised without in-feed antibiotics. A standardized blend of plant-derived isoquinoline alkaloids (IQA) derived from Macleaya cordata has shown to have anti-inflammatory potency and promoted animal productivity. This study investigated the effects of IQA supplementation on broiler chickens under NE challenge. A 2 × 2 factorial arrangement of treatments was employed with factors: NE challenge (no or yes), and additives (no additive or IQA at 0.15 g/kg) in starter, grower, and finisher diets. Birds were challenged with Eimeria spp. on d 9 and 108 to 109 Clostridium perfringens on d 14. Each treatment had 7 replicate floor pens with 17 birds each. NE challenge negatively affected growth performance, livability, and carcass traits. Regardless of challenge, IQA increased feed intake and gain on d 24 (P < 0.05) and 35 (P < 0.01) and improved FCR (P < 0.05), flock uniformity (P < 0.01) and breast meat yield (P < 0.001) on d 35. Supplementation of IQA also reduced lesions in the duodenum (P < 0.05), jejunum (P < 0.001), and ileum (P < 0.001). This study suggests that IQA may protect broilers from NE indicating its role as a promising antibiotic alternative. [ABSTRACT FROM AUTHOR]

The article discusses the case of a 43-year-old woman who was admitted to the intensive care unit due to severe sepsis of unknown focus and acute renal failure. Rates of C-reactive protein, procalcitonin, leukocytosis, urea and serum creatinine were shown in laboratory results. Antibiotic treatment was initiated with meropenem and erythromycin.

Purpose/objective(s): The COVID-19 pandemic has direct and indirect impact on patients with cancer. Low- and middle-income regions, especially sub-Saharan Africa, are especially vulnerable to a negative impact on cancer resources and outcomes. We report the initial indirect impact of COVID-19 on cancer care in the sub-Saharan Africa region approximately 14 months into the pandemic.Materials/methods: At the start of the pandemic, we created a consortium of African and North American cancer centers and NGOs for the distribution of factual and timely information and data on COVID-19 and cancer care. A survey was distributed to consortium members and other colleagues from the sub-Saharan Africa region to understand the impact of COVID-19 in cancer care resources. Survey respondents represent cancer experts from 8 centers in Ghana, Nigeria, Kenya, Ethiopia, South Africa, Rwanda, and Zimbabwe.Results: All sites report SARS-COv-2 transmission amongst cancer patients and staff. A total of 48 staff developed COVID-19 infection with one site reporting a single death. Additionally, 62.5% of sites report loss of oncology physician or nursing staff due to redeployment for COVID-19 care resulting in minimal (20%), moderate (60%), or other (20%) impact on cancer care. All 8 sites report a government mandated lockdown with a median duration of 2.3 months (IQR .9-4.2 months). Impact of the lockdown on cancer care was reported as none (12.5%), minimal (12.5%), moderate (50%) and severe (25%). Additionally, we surveyed the impact of COVID-19 on resources in radiation, medical and surgical oncology services. A total of 25% of responders reported decreases in radiation resources while 37.5% reported changes in medical and surgical oncology resources. For radiation oncology, the most common impact was access to CT imaging for 3D-conformal planning (25%), access to brachytherapy (12.5%), and medical physics support (12.5%). For medical oncology, the most frequent impact was access to chemotherapy (37.5%) and blood products (12.5%), and loss of oncology ward space (12.5%). The most frequent impact for surgical oncology was access to operating rooms (37.5%), ventilators (12.5%), anesthesia (25%), blood products (25%), and other supply chain issues (25%). Of centers who reported impact on cancer care, severity of impact was none (50%) and moderate (50%) for radiation oncology; mild (25%) and moderate (75%) for medical oncology; and moderate (75%) and severe (25%) for surgical oncology.Conclusion: Our survey identified diffuse impact of COVID-19 on all facets of cancer care across sub-Saharan Africa. Based on physician assessment of impact, the discipline of surgical oncology may be impacted the greatest. Additional studies measuring the impact of COVID-19 on cancer outcomes are ongoing. [ABSTRACT FROM AUTHOR]

Background: The anaesthetic conserving device, AnaConDa®, allows use of inhaled anaesthetics for sedation in the intensive care unit.We prospectively measured cerebral and cardiopulmonary parameters in patients with acute stroke or subarachnoid haemorrhage during a switch from i.v. to inhalative sedation. Methods: 25 patients were switched from i.v. to an indefinite period of inhaled sedation with sevoflurane. Mean arterial (MAP), intracranial (ICP), and cerebral perfusion pressure (CPP), middle cerebral artery mean flow velocity (MFV) and fractional tissue oxygen extraction (FTOE), systemic cardiopulmonary parameters, and administered drugs were assessed before and after the change (-6 to +12 h). Results: In 8 patients, critically reduced MAP or ICP crisis led to premature termination of sevoflurane sedation. In the other 17 patients, after the first hour, mean ICP increased [2.4 (4.5) mm Hg; P=0.046], MAP decreased [7.8 (14.1) mm Hg; P=0.036] and thus CPP decreased also [-10.2 (15.1)mmHg; P=0.014]. MFV and FTOE did not change. Over a 12 hour post switch observational period, PaCO2 increased slightly [0.3 (0.8) kPa; P=0.104], ICP did not change [0.2 (3.9) mm Hg; P=0.865], but MAP [-6 (6.9) mm Hg; P=0.002] and thus CPP decreased [-6 (8.5) mm Hg; P=0.010]. Conclusion: Sevoflurane led to sufficient sedation, but decreased MAP and CPP in a selected cerebrovascular neurocritical care population. In about a third of these patients, severe adverse reactions, including intolerable ICP increases, were observed. [ABSTRACT FROM AUTHOR]