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Previous reports on the prognostic value of diabetes mellitus for cardiac complications after vascular surgery show divergent results, especially in regards to the role of type 2 diabetes as a cardiac risk factor, which remains unclear. The aim of this study was to assess the impact of type 2 diabetes on 30-day cardiac complications after vascular surgery. Patients undergoing elective vascular surgery between 2002 and 2011 were included in this retrospective cohort study. Previous diagnosis of type 1 and 2 diabetes and use of oral glucose-lowering medications and insulin were recorded. Patients with type 1 diabetes were excluded from the analysis. The main outcome parameter was cardiac complications, a composite of cardiovascular death, non-fatal myocardial infarction, congestive heart failure, severe arrhythmia and asymptomatic troponin release within 30 days of surgery. In multivariate analysis, corrections were made for comorbidities, demographics, medication use and surgical risk. Of 1462 patients, 329 (22.5%) patients had type 2 diabetes. Cardiac complications occurred in 155 (13.7%) patients without diabetes and in 68 (20.7%) with type 2 diabetes. In multivariate analysis, type 2 diabetes was associated with a significantly increased risk of 30-day cardiac complications (odds ratio 1.80; 95% confidence interval 1.25 to 2.60). Results were similar for type 2 diabetes patients managed with (odds ratio 1.84; 95% confidence interval 1.01 to 3.37) and without (odds ratio 1.79; 95% confidence interval 1.19 to 2.70) insulin. Type 2 diabetes is an independent risk factor for cardiac complications after vascular surgery and should be treated as such in preoperative cardiac risk stratification. [ABSTRACT FROM AUTHOR]

BACKGROUND: The use of antibiotics in the livestock sector is increasing to such an extent that it threatens negative consequences for human health, animal health and the environment. Homeopathy might be an alternative to antibiotics. It has therefore been tested in a randomised placebo-controlled trial to prevent Escherichia coli diarrhoea in neonatal piglets. METHOD: On a commercial pig farm 52 sows of different parities, in their last month of gestation, were treated twice a week with either the homeopathic agent Coli 30K or placebo. The 525 piglets born from these sows were scored for occurrence and duration of diarrhoea. RESULTS: Piglets of the homeopathic treated group had significantly less E. coli diarrhoea than piglets in the placebo group (P<.0001). Especially piglets from first parity sows gave a good response to treatment with Coli 30K. The diarrhoea seemed to be less severe in the homeopathically treated litters, there was less transmission and duration appeared shorter. Copyright © 2009. Published by Elsevier Ltd. [ABSTRACT FROM AUTHOR]

The air-Q Intubating Laryngeal Airway (ILA) is a newly introduced extraglottic airway device. In this pilot study, we evaluated its use as a routine airway device during positive pressure ventilation. Ease of endotracheal intubation through the device was also assessed. Fifty-nine ASA I and II patients undergoing elective surgery received an air-Q ILA and an endotracheal tube where indicated. Insertion, ventilation and intubation characteristics were noted, as well as throat morbidity and occurrence of adverse events. An air-Q ILA was successfully inserted in 100% of patients. Mean leak pressure was 19 +/- 5 cmH2O. Endotracheal intubation was indicated in 19 patients and successful in 58% on the first attempt and 74% in total. Ten percent of the study patients were noted to have dysphagia. One patient was diagnosed with bilateral lingual nerve injury but made a complete recovery in four weeks. The air-Q ILA is an adequate extraglottic airway device in terms of insertion and ventilation. However the proposed advantage of ease of endotracheal intubation requires further investigation. [ABSTRACT FROM AUTHOR]

Introduction: Care Sport Connectors (CSCs) have been appointed to create a connection between the primary care and physical activity (PA) sectors to stimulate residents who are inactive to become more physically active to gain health benefits. The objective of this explorative study was to find out whether CSCs achieve these goals by testing the hypothesis that more residents become physically active, and score higher for health-related fitness and health-related quality of life., Method: We conducted a longitudinal study design whereby participants (n = 402) were measured at three time points: at the start of their PA program (T0); after 6 months (T1); and after 1 year (T2). Participants conducted a fitness test to measure their health-related physical fitness and filled in questionnaires to assess PA level (PA-, Fit-, Combi-, and sport norm), health-related quality of life, motivation for PA, and personal information. We used a multi-level analysis to test whether outcomes of participants differ over time. Participants who dropped out and maintainers were compared with a chi-square test and a one-way ANOVA., Results: This study showed that one-third of the participants dropped out (n = 139). Participants who dropped out were, compared with maintainers, less physically active (P = 0.004) and were more often reached in bigger municipalities, by an integral approach. More participants meet the PA norm (P = 0.007) and sport norm (P<0.001) at T2 then at T0. Scores in health-related physical fitness and quality of life were significant but not a meaningful gain in health-related fitness., Conclusion: More residents become physically active and participate in sport because they took part in a PA programs or activity organized by a CSC. Lifestyle interventions should be offered with a higher frequency, intensity, and focus on behavior change. It is necessary to invest in combined lifestyle interventions offered by a collaboration of primary care, welfare, and PA professionals., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Smit et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Newly developed yellow biofortified cassava has been adjudged as a cost-effective solution to vitamin A deficiency in low- and middle-income countries with high cassava intake such as Nigeria. In this study, yellow cassava was developed into a novel pasta enriched with amaranth vegetable and tested among consumers. Attitudes, perception, motives for consumption and perceived barriers were ascertained using focus group discussions and randomised face-to-face interviews, while liking, preference and ranking of the novel food were established through consumer sensory perception., Results: Willingness to consume the new food, low food neophobia (32%), a health-driven consumption pattern, as well as an appreciable acceptance for the developed pasta, was established among the consumers. Ugwu (Telfairia occidentalis) was found to be the most preferred leafy vegetable. The yellow cassava pasta was ranked better than the conventional white cassava., Conclusion: This study shows new avenues to valorise yellow cassava by which nutrition security can be improved in low- and middle-income countries of Africa. © 2021 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2021 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

Bambara groundnut (Vigna subterranea (L.) Verdc.) is an indigenous legume crop, cultivated by subsistence farmers throughout sub-Saharan countries. Research findings indicate that the crop has great nutritional and agronomic potential, but it remains scientifically neglected. A baseline study was conducted in seven districts in semi-arid regions of rural Zimbabwe to gather knowledge on current production and utilization of bambara groundnut, assess its role in providing sustainable food and nutrition security for rural populations and determine priorities for follow-up research. Results revealed a variety of bambara groundnut processing techniques, which included boiling, soaking, roasting and milling across the surveyed districts. Reported constraints to processing and consumption included long cooking time, difficulties with milling and high firewood and water requirements. Fifty to eighty percent of respondents in all districts consumed bambara groundnut once or twice weekly from August to December. Preferred consumer attributes were taste, the satiating effect, nutritional benefits or a combination of these. Current, culturally acceptable processing techniques need improvement to support sustainable bambara groundnut processing while optimising nutrient bio-accessibility. Ultimately, community resilience to food and nutrition insecurity can be promoted by exchange of bambara groundnut processing knowledge amongst the production areas, involving the different stakeholders in the food supply chains., Competing Interests: The authors have declared that no competing interests exist.

Objective: To explore the moderating and mediating role(s) of learning within the relationship between sense of coherence (SOC) and generalized resistance resources., Method: Cross-sectional study (N=481), using a self-administered questionnaire, of employees working in the healthcare sector in the Netherlands in 2017. Four residential healthcare settings and one healthcare-related Facebook group were involved. Multiple linear regression models were used to test for moderating and mediating effects of learning., Results: Social relations, task significance, and job control significantly explained variance in SOC. Conceptual, social, and instrumental learning, combined, moderated the relationship between SOC and task significance. Instrumental learning moderated the relationship between job control and SOC. Social learning also mediated this relationship. Conceptual learning did not show any moderating or mediating effect., Conclusions: The relationship between SOC and the three GRRs seems to be strengthened or explained-to a certain extent-by instrumental and social learning. Healthcare organizations are recommended to promote learning through formal activities as well as through cooperation, feedback, sharing experiences, and job challenges. This requires employee participation and a multilevel interdisciplinary approach., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Small observational studies demonstrate the feasibility of transradial approach for chronic total occlusion (CTO) percutaneous coronary intervention. The aim of the current study is to assess technical success, complication rates, and procedural efficiency in fully transradial approach (fTRA) and transfemoral approach (TFA) in a large prospective European registry adopting the hybrid algorithm for CTO percutaneous coronary intervention (Registry of CrossBoss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom, RECHARGE registry)., Methods and Results: We analyzed 1253 CTO percutaneous coronary intervention procedures performed according to the hybrid protocol in 17 European centers, comparing fTRA (single or biradial access) and TFA (single or bifemoral or combined radial and femoral access). fTRA was applied in 306 (24%) and TFA in 947 (76%) cases. The average Japanese CTO score was 2.1±1.2 in fTRA and 2.3±1.1 in TFA ( P =0.06). Technical success was achieved in 85% in fTRA and 86% in TFA ( P =0.51). Technical success was comparable for fTRA and TFA in different Japanese CTO score subgroups after multivariable analysis and after propensity adjustment. In-hospital major adverse cardiac and cerebral events occurred in 2.0% in fTRA and 2.9% in TFA ( P =0.40). Major access site bleeding occurred in 0.3% in fTRA and 0.5% in TFA ( P =0.66). fTRA compared with TFA had similar procedural duration (80 minutes [54-120 minutes] versus 90 minutes [60-121 minutes]; P =0.07), similar radiation dose (dose area product 89 Gray×cm 2 [52-163 Gray×cm 2 ] versus 101 Gray×cm 2 [59-171 Gray×cm 2 ]; P =0.06), and lower contrast agent use (200 mL [150-310 mL] versus 250 mL [200-350 mL]; P <0.01)., Conclusions: fTRA CTO percutaneous coronary intervention is a valid alternative to TFA with a high rate of success, low complication rates, and no decrease in procedural efficiency., (© 2017 American Heart Association, Inc.)

Background: Significant losses in sorghum biomass and grain yield occur in sub-Saharan Africa owing to infection by the root-parasitic weed Striga hermonthica (Del.) Benth. One strategy to avoid these losses is to adopt resistant crop varieties. For further delineation of the role of germination stimulants in resistance, we conducted a field experiment employing six sorghum genotypes, in eastern Sudan, and in parallel analysed the strigolactone levels in the root exudates of these genotypes under controlled conditions in Wageningen., Results: The root exudates of these genotypes displayed large differences in strigolactone composition and Striga-germination-inducing activity. Korokollow, Fakimustahi and Wadfahel exuded the highest amounts of 5-deoxystrigol. Fakimustahi was by far the highest sorgomol producer, and Wadbaco and SRN39 produced the highest amount of orobanchol. The concentration of 5-deoxystrigol in the root exudate showed a significant positive correlation with in vitro Striga germination and was positively associated with Striga infection in the field experiments, whereas orobanchol was negatively associated with Striga infection in the field experiments., Conclusion: For the first time a close association is reported between strigolactone levels analysed under laboratory conditions and Striga infection in the field in sorghum genotypes. These genotypes may be used for further study of this resistance mechanism and for the introgression of the low germination trait in other sorghum varieties to breed for a strigolactone composition with low stimulant activity. The use of such improved varieties in combination with other Striga management tools could possibly alleviate the current Striga problem on the African continent. © 2016 Society of Chemical Industry., (© 2016 Society of Chemical Industry.)

Background: Receiving adequate support seems to be crucial to the success of self-management. Although different empirical studies separately examined patients' preferences for self-management support (SMS), an overview is lacking., Objective: The aim of this qualitative review was to identify patients' needs with respect to SMS and to explore by whom this support is preferably provided., Search Strategy: Qualitative studies were identified from Embase, MEDLINE OvidSP, Web of science, PubMed publisher, Cochrane central, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO., Inclusion Criteria: Articles needed to meet all of the following criteria: (i) focuses on self-management, (ii) concerns adult patients with rheumatic diseases (rheumatoid arthritis and fibromyalgia), a variant of cancer or chronic kidney disease, (iii) explores support needs from the patients' perspective, (iv) uses qualitative methods and (v) published in English., Data Extraction and Synthesis: A thematic synthesis, developed by Thomas and Harden, was conducted of the 37 included studies., Main Results: Chronic patients need instrumental support, psychosocial support and relational support from health-care professionals, family/friends and fellow patients to manage the chronic condition. Relational support is at the centre of the support needs and fuels all other types of support., Discussion and Conclusions: Patients do not self-manage on their own. Patients expect health-care professionals to fulfil a comprehensive role. Support needs can be knitted together only when patients and professionals work together on the basis of collaborative partnership. Dynamics in support needs make it important to regularly assess patient needs., (© 2015 John Wiley & Sons Ltd.)

Physical inactivity is most commonly found in socially vulnerable groups. Dutch policies target these groups through community-based health-enhancing physical activity (CBHEPA) programs. As robust evidence on the effectiveness of this approach is limited, this study investigated whether CBHEPA programs contribute to an increase in and the maintenance of physical activity in socially vulnerable groups. In four successive cohorts, starting at a six-month interval, 268 participants from 19 groups were monitored for twelve months in seven CBHEPA programs. Data collection was based on repeated questionnaires. Socio-economic indicators, program participation and coping ability were measured at baseline. Physical activity, health-related quality of life and on-going program participation were measured three times. Self-efficacy and enjoyment were measured at baseline and at twelve months. Statistical analyses were based on a quasi-RCT design (independent t-tests), a comparison of participants and dropouts (Mann-Whitney test), and multilevel modelling to assess change in individual physical activity, including group level characteristics. Participants of CBHEPA programs are socially vulnerable in terms of low education (48.6%), low income (52.4%), non-Dutch origin (64.6%) and health-related quality of life outcomes. Physical activity levels were not below the Dutch average. No increase in physical activity levels over time was observed. The multilevel models showed significant positive associations between health-related quality of life, self-efficacy and enjoyment, and leisure-time physical activity over time. Short CBHEPA programs (10-13 weeks) with multiple trainers and gender-homogeneous groups were associated with lower physical activity levels over time. At twelve months, dropouts' leisure-time physical activity levels were significantly lower compared to continuing participants, as were health-related quality of life, self-efficacy and enjoyment outcomes. BMI and care consumption scored significantly higher among dropouts. In conclusion, Dutch CBHEPA programs reach socially vulnerable, but not necessarily inactive, groups in terms of socio-economic and health-related quality of life outcomes. Our findings suggest that CBHEPA programs particularly contribute to physical activity maintenance in socially vulnerable groups, rather than to an increase in physical activity behaviour over time.

Estimates of nutrient bioavailability are required for establishing dietary nutrient requirements and to evaluate the nutritional value of food ingredients or foods that are exposed to processing or extended storage. This study aimed to generate estimates for the bioavailability of dietary CP and AA for adult dogs using existing literature data and to evaluate the accuracy of estimates currently used in 3 authoritative publications. A regression equation was derived relating apparent fecal N outflow to standardized ileal N outflow from a data set containing information on 158 individual diets and their N digestibility when fed to adult dogs. Standardized ileal digestibility (sID) of N (sID) was shown to be nearly perfectly correlated to the sID of the sum of N of AA in 24 diets for which AA digestibility data were available. Regression equations between sID of individual AA and sID were calculated. Bioavailability estimates were subsequently derived from simulated sID values of N and essential and nonessential AA for 10 diets varying in CP content (18 to 42%) and apparent fecal N digestibility (70 and 80%) for an adult dog of 20 kg BW. Calculated bioavailability estimates of the NRC for maintenance dog foods do not lead to realistic nutrient allowance estimates for CP and AA. Estimates used by the Association of American Feed Control Officials and the European Pet Food Industry Federation were closer to calculated values, although the majority were too low, with the exception of CP, Arg, and Lys. Bioavailability estimates for Lys, Met, and Cys as calculated here require further veracity as the chemical form in which these AA are present in commercial pet foods may significantly reduce their bioavailability.

Background: Red blood cell (RBC) transfusions are common in vascular surgery and aim to reduce tissue ischemia. However, the evidence that transfusions are beneficial is contradictory. This study evaluates the impact of perioperative transfusion (transfusion within 3 days of surgery) on 30-day postoperative outcomes in elective vascular surgery patients., Methods: This observational cohort included 1,041 vascular surgery patients between 2002 and 2011 in a tertiary referral center for whom hemoglobin levels were retrospectively available. Patients who received transfusions after 3 days postoperatively were excluded. A propensity score was developed for the likelihood of receiving perioperative transfusion. The study end points were 30-day cardiovascular (CV) events (myocardial infarction, heart failure, arrhythmias, stroke, asymptomatic troponin-T release, and CV death) and all-cause mortality. Multivariable logistic regression analyses, adjusting for relevant confounders and transfusion propensity, were used to determine the associations between perioperative transfusion and the study end points., Results: The final study sample comprised 992 patients; 265 (27%) patients received perioperative transfusions. During the 30-day follow-up, a total of 190 (19%) patients suffered from a 30-day postoperative CV event, of which 116 (44%) occurred in patients who received perioperative RBC transfusions compared with 74 (10%) patients without transfusions (P < 0.01). The end point all-cause mortality was reached in 36 (4%) patients-26 (10%) patients with perioperative RBC transfusion compared with 10 (1%) patients without transfusion (P < 0.01). Perioperative transfusion was associated with an independently increased risk of 30-day CV events (odds ratio 5.0; 95% confidence interval 3.1-8.2) and all-cause mortality (odds ratio 4.4; 95% confidence interval 1.6-12.1)., Conclusion: Perioperative transfusion is associated with a strongly increased risk of both 30-day CV events and mortality in elective vascular surgery patients., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Summary: Stimulating brain areas with transcranial magnetic stimulation (TMS) while concurrently and noninvasively recording brain activity changes through functional MRI enables a new range of investigations about causal interregional interactions in the human brain. However, standard head-coil arrangements for current methods for concurrent TMS-functional MRI somewhat restrict the cortical brain regions that can be targeted with TMS because space in typical MR head coils is limited. Another limitation for concurrent TMS-functional MRI approaches concerns the estimation of the precise stimulation site, which can limit the interpretation of the activity changes induced by TMS and increase the variability of the stimulation effects. Here, we present a novel approach using flexible MR receiver coils, allowing for stimulation of a large part of the cortex including more lateral areas. Furthermore, we present a fast and economical method to determine the precise location of the stimulation coil during scanning. This point-based registration method can accurately compute, during scanning, where TMS pulses are delivered. We validated this approach by stimulating medial (M1) and more lateral (dorsal part of the supramarginal gyrus) brain areas concurrently with functional MRI. Activation close to but not directly at the stimulated location and in distal areas connected to the targeted site was observed. This study provides a proof of concept that TMS of medial and lateral brain areas is feasible without significantly compromising brain coverage and that one can precisely determine the exact coil location inside the bore to verify targeting of brain areas.

Background: Although low preoperative haemoglobin (Hb) concentration is a well known risk factor for adverse outcome, little is known about decreases in Hb and postoperative Hb concentrations., Objectives: The aim of this study was to evaluate the prognostic impact of both pre- and postoperative Hb concentrations (divided into low, intermediate and high tertiles) as well as Hb decrease, defined as preoperative minus postoperative Hb (g dl(-1)), on postoperative cardiovascular events in vascular surgery patients., Design: A retrospective observational cohort study., Setting: Erasmus University Medical Centre, Rotterdam, the Netherlands, from 1 January 2002 to 31 December 2011., Patients: One thousand four hundred and eighty-four patients underwent elective open or endovascular abdominal aortic repair (aneurysm or stenosis), lower extremity arterial repair or carotid surgery. Patients for whom pre or postoperative Hb concentrations were not available were excluded., Main Outcome Measures: The study endpoint was 30-day postoperative cardiovascular events, including myocardial infarction, heart failure, arrhythmias, stroke, asymptomatic troponin-T release and cardiovascular death., Results: In 1041 patients, both pre and postoperative Hb concentrations were available. Thirty-day cardiovascular events occurred in 221 (21%) patients. Multivariable logistic regression analyses, adjusting for age, sex, Revised Cardiac Risk Index (high-risk surgery, coronary heart disease, heart failure, cerebrovascular disease, diabetes mellitus, renal insufficiency), hypertension and hypercholesterolaemia, demonstrated that low preoperative Hb (8.7 to 12.9 g dl(-1)) was associated with 30-day events [odds ratio (OR) 1.7; 95% confidence interval (CI) 1.1 to 2.5]. Intermediate (10.6 to 12.1 g dl(-1)) and low (7.4 to 10.5 g dl(-1)) postoperative Hb and Hb decrease were also associated with an independently increased risk of 30-day events (intermediate Hb: OR 1.7; 95% CI 1.1 to 2.7; low Hb: OR 3.1; 95% CI 2.0 to 4.8; and Hb decrease: OR 1.2; 95% CI 1.1 to 1.3, respectively). Sensitivity analyses excluding patients with transfusions (n=314) demonstrated that only postoperative Hb concentrations remained associated with a high risk of 30-day cardiovascular events (intermediate Hb: OR 1.8; 95% CI 1.0 to 3.3 and low Hb: OR 2.0; 95% CI 1.0 to 4.0)., Conclusion: Pre and postoperative Hb concentrations and Hb decrease are all related to 30-day cardiovascular events in elective vascular surgery patients. Postoperative Hb concentrations are the strongest predictor of 30-day cardiovascular events.

Objective: Patients with aneurysmal and occlusive arterial disease have overlapping cardiovascular risk profiles. The question remains how atherosclerosis is related to the formation of aortic aneurysms. Common carotid artery intima-media thickness (CIMT) is an easily accessible and objective marker of early atherosclerosis. The aim of the current study was to investigate whether there is a difference in atherosclerotic burden as measured by CIMT between patients with aneurysmal and those with occlusive arterial disease., Methods: From 2004 to 2011, the CIMT was measured using B-mode ultrasound scanning in patients undergoing vascular surgery for aortic aneurysmal or occlusive arterial disease at the Erasmus University Medical Center. Cardiovascular risk factors, comorbidities, and medication were recorded. Patients treated for combined aneurysmal and occlusive arterial disease and patients diagnosed with a genetic aneurysm syndrome were excluded. Univariable and multivariable analyses were used to calculate differences in CIMT between aneurysmal and occlusive arterial disease., Results: In total, 904 patients were included in the study: 502 patients with aneurysmal disease (85% male; mean age, 72 years) and 402 patients with occlusive arterial disease (65% male; mean age, 64 years). The mean (standard deviation) CIMT in patients with aneurysmal disease was 0.97 (0.29) mm and was 1.07 (0.38) mm in patients with occlusive arterial disease (P < .001). Adjustment for cardiovascular risk factors, comorbidities, and medication showed a mean difference in CIMT of 0.15 mm (95% confidence interval, 0.10-0.20; P < .001)., Conclusions: The current study shows a lower CIMT in patients with aneurysmal disease than in those with occlusive arterial disease, indicating a lower atherosclerotic burden in patients with aneurysmal disease. These findings endorse the idea that additional pathogenic mechanisms are involved in aortic aneurysm formation. Further studies are needed to clarify the role of atherosclerosis in aortic aneurysm formation., (Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Objectives: Thrombotic complications are common in vascular surgery patients. Non-O blood types are associated with an increased risk of thrombo-embolic diseases. The aim of this study is to assess the prognostic implications of non-O vs. O blood type regarding 30-day cardiovascular events and long-term mortality after vascular surgery., Methods: The population of this retrospective cohort study consisted of 4679 patients undergoing elective major vascular surgery between the years 1990 and 2011. Baseline characteristics, ABO blood type and follow-up were obtained. Multivariable regression analyses, adjusted for age, gender, medical history, medication and smoking were used to evaluate the impact of non-O blood type on 30-day cardiovascular events (cardiovascular death, myocardial infarction and stroke) and long-term mortality., Results: Non-O blood type was present in 2627 (56%) patients. Within 30 days after surgery, 129 (4.9%) non-O and 112 (5.5%) O patients suffered a cardiovascular event (P = 0.42). Non-O blood type was not associated with increased mortality during long-term follow-up (adjusted hazard ratio (aHR) 0.96; 95% confidence interval (CI) 0.88-1.04, with a median follow-up of 4 years). Anti-platelet and anticoagulant drugs did not interact with the relationship between ABO blood type and long-term outcome., Conclusion: Non-O blood type is not associated with either 30-day cardiovascular complications or long-term mortality in vascular surgery patients., (Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

The objective of this study was to obtain insight into the effect of frying instructions on food handlers' control decisions in restaurants and to investigate the impact of control decisions on the variation and concentration of acrylamide in French fries. The concentrations of acrylamide and reducing sugars were analyzed, the frying temperature and time were measured, and thawing practices were observed. The results obtained before and after instructions were provided to the food handlers were compared for restaurants as a group and for each restaurant. Frying instructions supported food handlers' decisions to start frying when the oil temperature reached 175°C; all handlers started frying at the correct temperature. However, the effect of the instructions on the food handlers' decisions for frying time differed; most handlers increased the frying time beyond 240 s to achieve crispier French fries with a final color dictated by their preference. Providing instructions did not result in a significant difference in the mean concentration of acrylamide in French fries for the restaurants as a group. However, data analyzed for each restaurant revealed that when food handlers properly followed the instructions, the mean concentration of acrylamide was significantly lower (169 μg/kg) than that before instructions were provided (1,517 μg/kg). When food handlers did not complying with the frying instructions, mean acrylamide concentrations were even higher than those before instructions were provided. Two different strategies were developed to overcome the noncompliant behavior of food handlers: establishing requirements for the features of commercial fryers and strict monitoring of compliance with instructions.

The objective of this study was to obtain insight into the actual effectiveness of lowering reducing sugars concentration in par-fried potato strips on the concentration and variation of acrylamide in French fries prepared in real-life situations in food service establishments. Acrylamide, frying time, frying temperature, and reducing sugars were measured and characteristics of fryers were recorded. Data showed that the use of par-fried potato strips with lower concentrations of reducing sugars than the commonly used potato strips was an effective measure to reduce acrylamide concentrations in French fries prepared under standardised frying conditions. However, there was still large variation in the acrylamide concentrations in French fries, although the variation in reducing sugars concentrations in low and normal types of par-fried potato strips was very small and the frying conditions were similar. Factors that could affect the temperature-time profile of frying oil were discussed, such as setting a lower frying temperature at the end than at the start of frying, product/oil ratio and thawing practice. These need to be controlled in daily practice to reduce variation in acrylamide., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Defecation problems occur frequently in infants. A clearer insight into the normal defecation pattern is required to gain a better understanding of abnormal defecation., Aim: To describe the defecation pattern of healthy infants in The Netherlands., Methods: From a research population of 1175 healthy Dutch infants, 600 infants without any complaints were selected. The parents recorded details of feeding and defecation at the age of 1, 2 and 3 months using a standardised questionnaire and bowel diary., Results: In breastfed infants, average daily defecation frequency decreased significantly during the first 3 months (from 3.65 to 1.88 times per day), whereas no significant changes were observed in infants fed standard formula or mixed feeding. At every age both the average and the range of defecation frequency of breastfed infants were higher than those of infants receiving formula feeding. Breastfed infants had softer faeces than formula-fed infants and the colour more often was yellow. At the age of 3 months, 50% of stools of formula-fed infants were green coloured. There was no significant difference in quantity between the three types of feeding, but there existed a negative correlation between defecation frequency and quantity., Conclusion: This study gives insight into the defecation patterns of the largest cohort of healthy infants published so far. In the first 3 months of life, breastfed infants have more frequent, softer and more yellow-coloured stools than standard formula-fed infants. Green-coloured stools in standard formula-fed infants should be considered normal.

Vascular surgery patients are at increased risk of adverse cardiovascular events because of silent coronary artery disease and an increased propensity for left ventricular dysfunction. The Revised Cardiac Risk Index is commonly used for preoperative risk stratification. Aortic valve calcium is associated with cardiovascular mortality in the general population. The present study evaluated the prognostic implications of aortic valve calcium on 30-day postoperative and long-term outcomes in vascular surgery patients. Echocardiographic aortic valve evaluation was completed in 1,172 vascular surgery patients. Aortic valve sclerosis was defined by the presence of thickening and/or calcium of ≥1 cusps of a tricuspid aortic valve not inducing stenosis (i.e., with a maximal velocity at continuous Doppler of <2.5 m/s). Stenosis was defined as a maximum velocity of >2.5 m/s. Troponin-T measurements and electrocardiograms were performed routinely after surgery. The study end points were the composite of postoperative cardiovascular events and long-term mortality. Aortic valve sclerosis was present in 416 patients (36%), and aortic valve stenosis was present in 30 patients (3%). After multivariate regression analyses adjusted for age, gender, Revised Cardiac Risk Index, hypertension, hypercholesterolemia, and medication use, aortic valve sclerosis was not associated with either the postoperative or long-term outcomes. In contrast, aortic valve stenosis was associated with a greater postoperative and long-term event rate (odds ratio 3.9, 95% confidence interval 1.7 to 8.7; and hazard ratio 2.1, 95% confidence interval 1.2 to 3.7, respectively). In conclusion, the present study has shown that aortic valve calcium is common in vascular surgery patients. Its presence is associated with negative postoperative and long-term outcomes., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to assess the vitamin D status in patients with occlusive or aneurysmatic arterial disease in relation to clinical cardiovascular risk profiles and markers of atherosclerotic disease., Methods: We included 490 patients with symptomatic peripheral arterial disease (PAD, n = 254) or aortic aneurysm (n = 236). Cardiovascular risk factors and comorbidities carotid intima-media thickness (CIMT), ankle-brachial index (ABI), serum high-sensitive C-reactive protein (hs-CRP) and vitamin D were assessed. Patients were categorised into severely (≤25 nmol l(-1)) or moderately (26-50 nmol l(-1)) vitamin D deficient, vitamin D insufficient (51-75 nmol l(-1)) or vitamin D sufficient (>75 nmol l(-1))., Results: Overall, 45% of patients suffered from moderate or severe vitamin D deficiency. The prevalence of vitamin D deficiency was similar in patients with PAD and those with an aortic aneurysm. Low levels of vitamin D were associated with congestive heart failure and cerebrovascular disease. Adjusting for clinical cardiovascular risk factors, multivariable regression analyses showed that low vitamin D status was associated with higher CIMT (P = 0.001), lower ABI (P < 0.001) and higher hs-CRP (P = 0.022)., Conclusions: The current study shows a strong association between low vitamin D status and arterial disease, independent of traditional cardiovascular risk factors and irrespective of the type of vascular disease, that is, occlusive or aneurysmatic disease., (Copyright © 2012. Published by Elsevier Ltd.)

Objectives: Endovascular aneurysm repair (EVAR) is associated with reduced cardiac stress compared with open repair and is an attractive therapeutic option, especially in cardiac fragile patients. General and locoregional anaesthesia differ regarding the stress response evoked by surgery. The aim of the study is to compare the incidence of cardiac events after EVAR under general or locoregional anaesthesia., Methods: A total of 302 consecutive patients undergoing infrarenal EVAR between 2002 and 2011 were analysed in this retrospective cohort study. Selection of anaesthesia type was at the discretion of the treating physicians. Medical history, medication use, anaesthesia technique and follow-up were obtained. The study end point was 30-day cardiac complications, including cardiac death, non-fatal myocardial infarction, heart failure, ventricular arrhythmia and troponin T release. Multivariable analysis, adjusted for the propensity of receiving a locoregional technique and cardiac risk factors according to the Revised Cardiac Risk Index, was used to assess the association between cardiac events and anaesthesia type., Results: A total of 173 patients underwent general anaesthesia and 129 locoregional anaesthesia. Obesity, aspirin use and therapeutic anticoagulation were more common in patients receiving general anaesthesia. Cardiac events were observed in 13.3% of patients receiving general anaesthesia and in 4.7% of patients receiving locoregional anaesthesia (P = 0.02), or 6.4% versus .8% (P = 0.02) when asymptomatic troponin release is excluded from the end point. In the general anaesthesia group, two cardiac deaths, six non-fatal myocardial infarctions, two cases of non-fatal heart failure, one non-fatal cardiac arrest and 12 cases of troponin T release were observed, compared with one myocardial infarction and five cases of troponin T release in the locoregional anaesthesia group. In multivariable analysis, general anaesthesia was associated with adverse cardiac events (odds ratio (OR) 3.8; 95%-confidence interval (CI) 1.1-12.9). Non-cardiac complications occurred in 11.6% of patients in both groups (P = 1.00)., Conclusion: General anaesthesia was associated with an increased risk of cardiac events in EVAR, compared with locoregional anaesthesia., (Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Acrylamide is a probable human carcinogen, and its presence in a range of fried and oven-cooked foods has raised considerable health concern world-wide. Dietary intake studies observed significant variations in acrylamide concentrations, which complicate risk assessment and the establishment of effective control measures. The objective of this study was to obtain an insight into the actual variation in acrylamide concentrations in French fries prepared under typical conditions in a food service establishment (FSE). Besides acrylamide, frying time, frying temperature, and reducing sugars were measured and the actual practices at receiving, thawing and frying during French fries preparation were observed and recorded. The variation in the actual frying temperature contributed most to the variation in acrylamide concentrations, followed by the variation in actual frying time; no obvious effect of reducing sugars was found. The lack of standardised control of frying temperature and frying time (due to inadequate frying equipment) and the variable practices of food handlers seem to contribute most to the large variation and high acrylamide concentrations in French fries prepared in a restaurant type of FSE as compared to chain fast-food services, and institutional caterers. The obtained insights in this study can be used to develop dedicated control measures in FSE, which may contribute to a sustainable reduction in the acrylamide intake., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Purpose of Review: Cardiac complications after noncardiac surgery cause significant morbidity and mortality. This review will discuss recent developments in risk stratification, monitoring, and risk reduction strategies., Recent Findings: The addition of biomarkers for ischemia, left ventricular function, and atherosclerosis to classic cardiac risk factors improves the prediction of both short-term and long-term outcome after noncardiac surgery. Intraoperative monitoring, using continuous 12-lead ECG assessment and transesophageal echocardiography, may timely identify treatable myocardial ischemia and arrhythmias. A prudent perioperative beta-blocker and statin regimen can reduce cardiac complications and mortality without increasing the risk of stroke in intermediate to high-risk patients. The use of circulatory assist devices might improve outcomes after major surgery in patients with severely reduced left ventricular function., Summary: Systematic preoperative assessment can identify patients at high risk of cardiac complications and guide the application of appropriate risk reduction strategies.

Objectives: This article describes the rationale and design of the DECREASE-XIII trial, which aims to evaluate the potential of esmolol infusion, an ultra-short-acting beta-blocker, during surgery as an add-on to chronic low-dose beta-blocker therapy to maintain perioperative haemodynamic stability during major vascular surgery., Design: A double-blind, placebo-controlled, randomised trial., Materials & Methods: A total of 260 vascular surgery patients will be randomised to esmolol or placebo as an add-on to standard medical care, including chronic low-dose beta-blockers. Esmolol is titrated to maintain a heart rate within a target window of 60-80 beats per minute for 24 h from the induction of anaesthesia. Heart rate and ischaemia are assessed by continuous 12-lead electrocardiographic monitoring for 72 h, starting 1 day prior to surgery. The primary outcome measure is duration of heart rate outside the target window during infusion of the study drug. Secondary outcome measures will be the efficacy parameters of occurrence of cardiac ischaemia, troponin T release, myocardial infarction and cardiac death within 30 days after surgery and safety parameters such as the occurrence of stroke and hypotension., Conclusions: This study will provide data on the efficacy of esmolol titration in chronic beta-blocker users for tight heart-rate control and reduction of ischaemia in patients undergoing vascular surgery as well as data on safety parameters., (Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

In scientific literature, several estrogenic compounds are reported to induce responses in vitro that are significantly higher than that of estradiol (E2). These supramaximal (SPMX) estrogenic effects do not occur consistently and seem to differ depending on the cellular models applied. This study analyzes the possible underlying causes, mechanisms, and drivers for SPMX estrogenic effects in in vitro functional assays reported in the peer-reviewed literature. For the 21 natural and industrial chemicals identified as SPMX inducers, the culture and exposure conditions varied greatly among and between the assays. Detailed information on assay characteristics, however, sometimes lacked. Diethylstilbestrol, genistein, and bisphenol A were selected to build a database. The meta-analysis revealed that the occurrence of SPMX effects could be related to a number of specific assay characteristics: (1) the type of serum used to supplement the exposure medium, (2) the end point used to quantify the estrogenic potency (endogenous or transfected), (3) the number of estrogen response elements, and (4) and the promoter's nature. An SPMX response was not reported for expression of endogenous genes, assays that used African green monkey kidney (COS-1) cell line or with chloramphenicol transferase as the reporter gene. There were no indications that solvent concentration in culture, exposure period, or cell model influenced the occurrence of an SPMX effect. It is important to understand the mechanism behind this phenomenon because in vitro assays for estrogenicity are used extensively to characterize and quantify the estrogenic potency of compounds, mixtures and environmental extracts.

Polyolefin fractions are often end fractions resulting from the recycling of end-of-life consumer products. Polypropylene (PP) and polyethylene (PE) are present in such fractions as a mixture. For instance, the ratio of PP and PE in car scrap is 70:30 on average. However, the grade of the PP and PE should typically be better than 97% to be reused again as a high quality product. Density separation of the different polyolefins can be a solution. A promising separation technique is the inverse magnetic density separator (IMDS). This paper discusses the potential of shredder residue, one of the possible polyolefin's waste stream sources for the IMDS, in detail. Experiments with the separation of polyolefins with an IMDS prototype show both high grade and high recovery. The paper concludes with the economic opportunities of the IMDS in the recycling of polyolefins.

Animal studies show favorable effects of n-3 fatty acids on inflammation and cancer, but results from epidemiologic studies appear to be inconsistent. The authors conducted meta-analyses of prospective cohort studies that evaluated the association between fish consumption or n-3 fatty acids and colorectal cancer incidence or mortality. Random-effects models were used, and heterogeneity between study results was explored through stratified analyses. The pooled relative risks for the highest compared with the lowest fish consumption category were 0.88 (95% confidence interval: 0.78, 1.00) for colorectal cancer incidence (14 studies) and 1.02 (95% confidence interval: 0.90, 1.16) for colorectal cancer mortality (four studies). The pooled relative risks for colorectal cancer incidence were 0.96 (95% confidence interval: 0.92, 1.00) for each extra occurrence of fish consumption per week (seven studies) and 0.97 (95% confidence interval: 0.92, 1.03) for each extra 100 g of fish consumed per week (four studies). Stratified analysis showed that the pooled relative risk for colorectal cancer incidence was more pronounced for women and in studies with a large exposure contrast. In cohort studies, fish consumption was shown to slightly reduce colorectal cancer risk. Existing evidence that n-3 fatty acids inhibit colorectal carcinogenesis is in line with these results, but few data are available addressing this association.

The purpose of this study was to improve the micronutrient quality of indigenous African infant flour using traditional techniques available in the region. Response surface methodology was used to study the effect of duration of soaking, germination, and fermentation on phytate and phenolic compounds (PC), pH, viscosity, and the in vitro solubility (IVS) of iron and zinc in infant sorghum flour. The phytate and the PC concentrations of the flour were significantly modified as a result of the duration of germination and fermentation and their mutual interaction. These modifications were accompanied by a significant increase in % IVS Zn after 24 h of sprouting. Except for the interaction of soaking and fermentation, none of the processing parameters exerted a significant effect on the % IVS Fe. The viscosity of the porridge prepared with the flour decreased significantly with the duration of germination, making it possible to produce a porridge with high energy and nutrient density. The use of germination in combination with fermentation is recommended in the processing of cereals for infant feeding in developing countries.

Behavioural and electrophysiological responses of Anopheles gambiae Giles sensu stricto (Diptera: Culicidae) to human skin emanations collected on glass beads were studied using a dual-port olfactometer and electroantannography. Glass beads to which skin emanations from human hands had been transferred elicited a level of attraction similar to a human hand. The attractiveness of these handled glass beads faded away 4 h after transfer onto the beads. Storage at -20 degrees C for up to 8 weeks showed a decreased but still attractive effect of the beads. In a choice test between one individual and four others, the emanations from the reference individual were significantly more attractive in three out of four cases. The headspace of handled glass beads elicited a dose-dependent EAG response. The substances causing EAG activity could be removed partially by dichloromethane, ethanol and pentane-ether. Glass beads provide a suitable neutral substrate for the transfer of human odour to enable chemical analysis of the human skin emanations for identification of kairomones of anthropophilic mosquitoes.

Epidermal clonogenic cell survival and colony formation following irradiation were investigated and related to radiosensitivity. A rapid in vivo/in vitro assay was developed for the quantification of colonies arising from surviving clonogenic cells in pig epidermis after irradiation. Bromodeoxyuridine (BrdU)-labelled cells in full thickness epidermal sheets were visualized using standard immunohistochemistry. In unirradiated skin, approximately 900 BrdU-positive cells mm(-2) were counted. In a time sequence experiment, BrdU-positive cell numbers increased from an average of 900 cells mm(-2) to approximately 1400 cells mm(-2) after BrdU-labelling for 2-24 h. In irradiated skin, colonies containing >/=16 BrdU-positive cells were seen for the first time at days 14/15 after irradiation. The number of these colonies per cm(2) as a function of skin surface dose yielded a cell survival curve with a D(0)-value (+/-SE) of 3.9+/-0.6 Gy. This relatively high D(0)-value is possibly due to a rapid fall off in depth dose distribution for the iridium-192 source and consequently a substantial contribution of hair follicular epithelium to colony formation. At 14/15 days after irradiation, the ED(50) level of 33.6 Gy for the in vivo response of moist desquamation corresponded with 2.7 colonies cm(-2). Surprisingly, the number of colonies increased with time after irradiation with an estimated doubling time of approximately 4 days, while the D(0)-value remained virtually unchanged. This increase in colony numbers could be due to migration of clonogenic cells, to the recruitment of dormant clonogenic cell survivors by elevated levels of cytokines, or to both. Although frequent biopsying caused increased cytokine levels, which had a systemic effect on unirradiated skin, it had no influence on colony formation in irradiated skin. Smaller colonies, containing 4-8 cells or 9-15 cells, were abundant, particularly after higher doses, which resulted in higher D(0)-values. The majority of these small colonies were abortive and did not progress to larger colonies. There was no statistical evidence for significant variations in the interanimal responses.

An experimental brachytherapy model has been developed to study acute and late normal tissue reactions as a tool to examine the effects of clinically relevant multifractionation schedules. Pig skin was used as a model since its morphology, structure, cell kinetics and radiation-induced responses are similar to human skin. Brachytherapy was performed using a microSelectron high dose rate (HDR) afterloading machine with a single stepping source and a custom-made template. In this study the acute epidermal reactions of erythema and moist desquamation and the late dermal reactions of dusky mauve erythema and necrosis were evaluated after single doses of irradiation over a follow-up period of 16 weeks. The major aims of this work were: (a) to compare the effects of iridium-192 (192Ir) irradiation with effects after X-irradiation; (b) to compare the skin reactions in Yorkshire and Large White pigs; and (c) to standardize the methodology. For 192Ir irradiation with 100% isodose at the skin surface, the 95% isodose was estimated at the basal membrane, while the 80% isodose covered the dermal fat layers. After HDR 192Ir irradiation of Yorkshire pig skin the ED50 values (95% isodose) for moderate/severe erythema and moist desquamation were 24.8 Gy and 31.9 Gy, respectively. The associated mean latent period (+/- SD) was 39 +/- 7 days for both skin reactions. Late skin responses of dusky mauve erythema and dermal necrosis were characterized by ED50 values (80% isodose) of 16.3 Gy and 19.5 Gy, with latent periods of 58 +/- 7 days and 76 +/- 12 days, respectively. After X-irradiation, the incidence of the various skin reactions and their latent periods were similar. Acute and late reactions were well separated in time. The occurrence of skin reactions and the incidence of effects were comparable in Yorkshire and Large White pigs for both X-irradiation and HDR 192Ir brachytherapy. This pig skin model is feasible for future studies on clinically relevant multifractionation schedules in a brachytherapy setting.