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Background: Blood volume (BV) profiles vary markedly in patients with heart failure (HF), but how HF phenotypes and patient sex impact volume profiles remain to be explored. The aim of the study was to differentiate BV, plasma volume, and red blood cell mass profiles by phenotypes of preserved and reduced left ventricular ejection fractions and assess the impact of patient sex on profile heterogeneity., Methods: Retrospective analysis of clinical and BV data was undertaken in patients with chronic New York Heart Association II-III heart failure. BV was quantitated using the nuclear medicine indicator-dilution methodology., Results: A total of 530 BV analyses (360 HF with reduced ejection fraction and 170 HF with preserved ejection fraction) were identified in 395 unique patients. Absolute BV was greater in HF with reduced ejection fraction (6.7±1.8 versus 5.9±1.6 liters: P <0.001); however, large variability in frequency distribution of volume profiles was observed in both phenotypes (-22% deficit to +109% excess relative to normal volumes). HF with reduced ejection fraction was characterized by a higher prevalence of BV expansion ≥+25% of normal (39% versus 26%; P =0.003), and HF with preserved ejection fraction was characterized a by more frequent normal BV (42% versus 24%; P <0.001). Male sex in both phenotypes was associated with a larger absolute BV (7.0±1.6 versus 5.1±1.3 liters; P <0.001) and higher frequency of large BV and plasma volume expansions above normal (both P <0.001), while females in both phenotypes demonstrated a higher prevalence of normal BV and plasma volume (both P <0.001)., Conclusions: Findings support significant differences in BV, plasma volume, and red blood cell mass profile distributions between heart failure phenotypes, driven in large part by sex-specific factors. This underscores the importance of identifying and distinguishing individual patient volume profiles to help guide volume management strategies., Competing Interests: Disclosures None.

Aims: To identify different red blood cell mass (RBCM) profiles, separate from haemoglobin concentrations, and their impact on blood volume expansion and clinical outcomes in chronic heart failure., Methods and Results: RBCM was measured at hospital discharge using standardized nuclear medicine indicator-dilution methodology in patients following diuretic treatment for clinical congestion. Individual RBCM phenotypes were prospectively identified and analysed for heart failure-related mortality or first rehospitalization over 1 year. Of 132 patients, 42 (32%) demonstrated normal RBCM, 36 (27%) RBCM deficit (true anaemia), and 54 (41%) RBCM excess (erythrocythemia). Dilutional 'anaemia' defined by haemoglobin <12 g/dL with normal or an excess in RBCM with plasma volume expansion was identified in 37 (28%) patients. There were 61 composite outcome events, which included 38 deaths (29% of cohort) occurring over the 1 year follow-up period [14/36 (39%) in RBCM deficit, 12/42 (29%) in normal RBCM, and 12/54 (22%) in RBCM excess subgroups]. By Kaplan-Meier and multivariate analyses, RBCM excess was independently associated with the best event-free survival while RBCM deficit (true anaemia) the poorest outcomes; both compared with normal RBCM (P < 0.001). Dilutional 'anaemia' demonstrated a lower risk compared with true anaemia (P = 0.03)., Conclusions: Markedly different RBCM profiles are identifiable among comparably compensated heart failure patients, and this variability carries significant implications for post-hospital outcomes. Novel to this analysis and in contrast to RBCM deficit is the independent association of RBCM excess with better event-free survival compared with normal RBCM. The distinction of RBCM profiles to guide risk stratification and individualized patient management strategies warrants further study., (© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Different cereal types, in combination with different protein sources, are fed to pigs after weaning, but their interactions and possible implications are not well researched. In this study, 84 male weaned piglets were used in a 21-day feeding trial to investigate the effects of feeding either medium-grain or long-grain extruded rice or wheat, in a factorial combination with protein sources of either vegetable or animal origin, on postweaning performance, shedding of β-haemolytic Escherichia coli , and the coefficient of total tract apparent digestibility (CTTAD). Pigs fed either rice type performed the same ( p > 0.05) as wheat-fed pigs after weaning. The use of vegetable protein sources reduced growth rate ( p < 0.001) and feed intake ( p = 0.007) and deteriorated the feed conversion ratio ( p = 0.028) in weeks two and three compared to pigs fed animal protein sources. The number of antibiotic treatments given for clinical diarrhoea was similar (p > 0.05). However, the faecal E. coli score showed a trend for the main effect of protein source, with pigs fed animal proteins showing a higher E. coli score than pigs fed vegetable proteins (0.63 vs. 0.43, p = 0.057). There was also a tendency for an interaction ( p = 0.069) between cereal type and protein source ( p = 0.069), with this difference being associated with a greater faecal score in pigs fed diets with long-grain rice plus animal proteins and wheat plus animal proteins. Significant interactions occurred for the CTTAD when assessed in week three. In general, pigs fed diets with medium-grain rice or long-grain rice with animal proteins had a higher ( p < 0.001) CTTAD for dietary components than pigs fed all other diets, and vegetable proteins depressed ( p < 0.001) CTTAD compared to animal proteins (main effect of protein: p < 0.001). In summary, pigs tolerated the extruded rice-based diets well and performed equivalently to pigs fed wheat as the sole cereal, and the use of vegetable proteins decreased the E. coli score.

Intravascular volume is largely regulated by the kidneys but how differences in intravascular volume profiles interact with chronic kidney disease (CKD) to influence outcomes in chronic heart failure (HF) has not been explored. Our hypothesis was that a greater degree of volume expansion (VE) would moderate the impact of CKD on HF-related clinical outcomes. Quantitative blood volume (BV) data were available in 137 patients at the time of hospital discharge using a nuclear medicine radiolabeled albumin indicator-dilution technique. The study patients were stratified by the cohort median glomerular filtration rate (GFR, 44 ml/min/1.73 m 2 ). An a priori cut-point of ≥+25% above normal BV was then used to further stratify the two GFR subgroups and prospectively analyzed for 1-year HF-related mortality or 1st re-hospitalization. Persistent BV expansions ≥+25% were present in 51% of the cohort. In the subgroup with GFR above the median (N = 68) greater or lesser BV expansion from +25% did not differentiate outcomes. However, in the subgroup with GFR below the median (N = 69), BV expansion-stratified risk (log-rank p = 0.022) with <+25% VE associated with poorer outcomes, while VE ≥ + 25% was associated with lower risk and comparable to GFR above the median. In patients with chronic HF, significant intravascular VE and CKD are common co-existing conditions. The presence of larger VE, however, appears to be a factor mitigating the impact of declining renal function on clinical outcomes, and as an element of volume pathophysiology warrants further study., (© 2022 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Expansion in blood volume (BV) is a well-recognized response to arterial underfilling secondary to impaired cardiac output in heart failure (HF). However, the effectiveness of this response in terms of outcomes remains inadequately understood. Prospective analysis was undertaken in 110 patients with HF hospitalized and treated for fluid overload. BVs were measured in a compensated state at the hospital discharge using the indicator-dilution methodology. Data were analyzed for composite 1-year HF-related mortality/first rehospitalization. Despite uniform standard of care, marked heterogeneity in BVs was identified across the cohort. The cohort was stratified by BV expansion greater than or equal to +25% above normal (51% of cohort), mild-moderate expansion (22%), and normal BV (27%). Kaplan-Meier (K-M) survival estimates and regression analyses revealed BV expansion (greater than or equal to +25%) to be associated with better event-free survival relative to normal BV ( P = 0.038). Increased red blood cell mass (RBCm; RBC polycythemia) was identified in 43% of the overall cohort and 70% in BV expansion greater than or equal to +25%. K-M analysis demonstrated polycythemia to be associated with better outcomes compared with normal RBCm ( P < 0.002). Persistent BV expansion to include RBC polycythemia is common and, importantly, associated with better clinical outcomes compared with normal total BV or normal RBCm in patients with chronic HF. However, compensatory BV expansion is not a uniform physiological response to the insult of HF with marked variability in BV profiles despite uniform standard of care diuretic therapy. Therefore, recognizing the variability in volume regulation pathophysiology has implications not only for impact on clinical outcomes and risk stratification but also potential for informing individualized volume management strategies. NEW & NOTEWORTHY The novel findings of this study demonstrate that intravascular volume profiles among the patients with chronic heart failure (HF) vary substantially even with similar clinical compensation. Importantly, a profile of blood volume (BV) expansion (compared with a normal BV) is associated with lower HF mortality/morbidity. Furthermore, RBC polycythemia is common and independently associated with improved outcomes. These observations support BV expansion with RBC polycythemia as a compensatory mechanism in chronic HF.

Background: Findings from heart failure (HF) studies linking diuresis-related weight loss to clinical decongestion and outcomes are mixed. Differential responses of interstitial and intravascular volume compartments to diuretic therapy and heterogeneity in volume profiles may confound the clinical interpretation of weight loss in patients with HF., Methods and Results: Data were prospectively collected in hospitalized patients requiring diuresis. Plasma volume (PV) was measured using I-131-labelled albumin indicator-dilution methodology. The cohort was stratified by tertiles of weight loss and analyzed for interstitial fluid loss relative to changes in PV and HF-related morality or first rehospitalization. Among 92 patients, the admission PV was expanded +42% (4.7 ± 1.2 L) above normal with significant variability (14% normal PV, 18% mild-moderate expansion, and 68% with large PV expansion [>+25% above normal]). With diuresis there were proportional decreases in interstitial volume (-6.5 ± 4.4%) and PV (-7.5 ± 11%); however, absolute decreases in the PV (-254 mL, interquartile range -11 to -583 mL) were less than 10% of interstitial volume loss (-5040 mL, interquartile range -2800 to -7989 mL); greater interstitial fluid loss did not translate into better outcomes (log-rank P = .430)., Conclusions: Diuresis-related decreases in weight reflect fluid loss from the interstitial compartment with only minor changes in the PV and without an impact on outcomes. Further, the degree of PV expansion at hospital admission does not drive the magnitude of the diuresis response, even with a wide spectrum of body weights; interstitial fluid overload is preferentially targeted and PV relatively preserved. Therefore, greater interstitial fluid loss reflects clinical decongestion, but not better outcomes, and a limited association with intravascular volume profiles potentially confounding weight loss as a prognostic metric in HF., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The role of coronary microvascular disease and its impact on functional and energetic reserve in heart failure with preserved ejection fraction (HFpEF) remains unclear. We hypothesized that in response to submaximal pharmacologic stress (dobutamine), patients with HFpEF have impairment in left ventricular (LV) myocardial mechanical (external work [EW]), energetic (myocardial O 2 consumption [MVO 2 ]), and myocardial blood flow (MBF) reserve. We further assessed whether coupling of MBF to EW is impaired in HFpEF and associated with compensatory increases or pathological decreases in myocardial O 2 extraction. Lastly, we assessed whether coupling of MVO 2 to EW (mechanical efficiency) was impaired in HFpEF., Methods and Results: In prospectively enrolled patients with HFpEF (n=19) and age/sex-matched healthy controls (n=19), we performed 11 C-acetate positron emission tomography assessing MVO 2 and MBF at rest and during dobutamine infusion. EW was calculated as stroke volume (echo)×end-systolic pressure×heart rate. At rest, compared with controls, patients with HFpEF had higher LV EW, MVO 2 , and MBF. With dobutamine, LV EW, MVO 2 , and MBF increased in both HFpEF and controls; however, the magnitude of increases was significantly smaller in HFpEF. In both groups, MBF increased in relation to EW, but in HFpEF, the slope of the relationship was significantly smaller than in controls. Myocardial O 2 extraction was increased in HFpEF. Mechanical efficiency was similar in HFpEF and controls. In a post hoc analysis, HFpEF patients with LV hypertrophy (n=10) had significant reductions in LV mechanical efficiency relative to controls., Conclusions: In HFpEF during submaximal dobutamine stress, there is myocardial mechanical-, energetic- and flow-reserve dysfunction with impaired coupling of blood flow to demand and slight increases in myocardial O 2 extraction. These findings provide evidence that coronary microvascular dysfunction is present in HFpEF, limits O 2 supply relative to demand, and is associated with reserve dysfunction.

Background: Although volume overload is a commonly described clinical feature of advanced heart failure (HF), less is known regarding volume profiles of patients with less severe class I and II HF., Methods: Intravascular volume was quantitated by radiolabeled-albumin indicator-dilution technique in clinic outpatients., Results: Forty-six patients (age 61 ± 13years, left ventricular ejection fraction 30 ± 8%) were prospectively evaluated with 28 undergoing repeat evaluations at 1 year. There was no difference in averaged total blood volume (TBV) at baseline between class I (N = 26) and II (N = 20) patients (5.6 ± 1.6vs 6.0 ± 1.3 L, P = .368) and at 1-year of follow-up. However, there was marked heterogeneity in plasma volume (-13% to +69% of normal) and red cell mass (RBCM -31% to +50%) profiles with TBV expansion identified in 46% of the cohort, whereas only 48% had a normal TBV. RBCM deficit (true anemia) was common (39%), but a low hemoglobin concentration was accurate in identifying anemia in only 11% of the cohort. RBCM excess (polycythemia) also was identified in 20% of the cohort., Conclusions: Marked heterogeneity in plasma volume and RBCM volume profiles is present even in mild HF, and identifying volume overload, which was common in early HF, has the potential to help guide therapy in the reduction of HF progression. Intravascular volume as a modifiable risk factor in early HF warrants further study., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background and Purpose: SISCOM and STATISCOM were clinically proved to be effective for ictal/inter-ictal single-photon emission computed tomography (SPECT) analysis coregistered with magnetic resonance imaging (MRI) for seizure localization. Recently, a software package also became available for this analysis. This study aimed to investigate and compare the performance of these analysis methods for seizure localization., Methods: A total of 378 patients who underwent 99m Tc-ethyl cysteinate dimer (ECD) SPECT scans were retrospectively reviewed and 28 remained after applying exclusion criteria. Their SPECT and MRI images were analyzed with SISCOM (with z-score of 1.5 and 2), STATISCOM, and MIMneuro, resulting in a total of 112 image data sets. Two experienced radiologists participated in the blind review process using a custom tool and they can mark up to two hyper- and/or hypoperfusion regions. Their review results were analyzed using the Jackknife Free Response Receiver-Operating Characteristics (JAFROC) test and the JAFROC figure-of-merit (FoM) was reported for each method. The interobserver agreement was also assessed using Cohen's kappa test., Results: Based on the readers' two choices, averaged FoM was 85.7%, 83.9%, 66.1%, and 51.8% for STATISCOM, MIMneuro, SISCOM (z-score = 2), and SISCOM (z-score = 1.5), respectively. The average confidence rating was 2.5, 2.3, 1.6, and 1.1 for STATISCOM, MIMneuro, SISCOM (z-score = 2), and SISCOM (z-score = 1.5), respectively. For interobserver agreement, kappa was .742 for STATISCOM, .816 for MIMneuro, .517 for SISCOM (z-score = 2), and .441 for SISCOM (z-score = 1.5; all P < .001)., Conclusion: Our study demonstrated that STATISCOM showed the best performance for seizure localization, which was closely followed by MIMneuro. In addition, MIMneuro was not inferior to SISCOM with either z-score., (Copyright © 2018 by the American Society of Neuroimaging.)

Objective: The purpose of this study is to determine the efficacy of 11 C-choline PET/CT for the detection of parathyroid adenomas by retrospectively reviewing a large patient population., Materials and Methods: In this single-institution retrospective study, 7088 11 C-choline PET/CT scans performed of 2933 men with prostate cancer from January 2005 through February 2016 were evaluated. Patients with suspected parathyroid adenomas were identified through a review of the electronic medical record and relevant imaging. Patient demographics, laboratory results, and lesion characteristics were noted. Pathologically proven parathyroid adenomas and lesions in patients with imaging or laboratory findings consistent with the diagnosis were considered positive., Results: Thirteen men (mean [± SD] age, 72 ± 7 years) with pathologically or laboratory-proven parathyroid adenomas were identified. All had abnormally elevated serum calcium and parathyroid hormone levels. All adenomas were tracer avid on 11 C-choline PET/CT (maximum standardized uptake value, 5.6 ± 3.0), with activity averaging 4.2 times that of the blood pool and 2.1 times that of the adjacent thyroid. One case of an ectopic adenoma was identified. Of the six pathologically confirmed cases, none displayed high-grade features such as capsular, vascular, or adjacent tissue invasion. Three additional patients with possible parathyroid adenomas at 11 C-choline PET/CT were ultimately found to have thyroid lesions on the basis of tissue diagnosis; however, none of these patients had abnormal calcium or parathyroid hormone levels., Conclusion: In our patient population, 11 C-choline PET/CT identified parathyroid adenomas with high specificity. Prospective investigation is warranted to validate this result and delineate the utility of 11 C-choline PET/CT relative to other modalities.

The objective of this experiment was to compare the pork quality of entire male pigs and pigs immunized against GnRF (IC males) at both light (64.8kg) and heavy (106kg) liveweights and two feeding regimes (restricted at 2.5 times maintenance and ad libitum). There was no difference in objective measurements (P>0.05) or eating pork quality (P>0.1) between entire male and IC males. Fail rates were reduced by 9.1% and 12% for pork from IC males for quality grade (P=0.007) and re-purchase intention (P=0.001), respectively, compared to pork from entire males. Skatole (P=0.001) and androstenone (P<0.001) levels in belly fat were higher in entire male than IC male pigs. In addition, 37.5% of the light entire male pigs fed ad libitum showed skatole levels that exceeded the sensory threshold of 0.2μg/g. This work confirms that immunization against GnRF is effective in eliminating boar taint and reducing pork quality fail rates by approximately 10% compared to pork from entire males., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Three experiments were conducted to examine the overall hypothesis that addition of medium chain triglycerides (MCT) and cysteamine hydrochloride (CSH) into the diets of young and growing pigs would stimulate the endogenous somatotropic axis to improve growth and performance., Results: In Experiment 1, weaner pigs were given either a 5 d dietary supplement of 5 % MCT ( n  = 8) or a control diet ( n  = 8). MCT increased the plasma concentration of growth hormone (GH; P  < 0.05) and the GH secretagogue, ghrelin ( P  < 0.05). Additionally, the MCT treatment reduced scouring ( P  < 0.05), maintained villous height in the small intestine ( P  < 0.05) and stabilised daily weight gain ( P  < 0.05), compared to the controls. Experiment 2 compared the effects of 4 levels (0, 1, 3 and 6 % v/v) of MCT supplementation in grower-finisher male pigs, of approximately 35 kg live weight ( n  = 15 per treatment). Blood samples taken after 7 wk of treatment showed that the MCT supplementation increased circulating ghrelin ( P  < 0.001), GH ( P  < 0.01) and insulin ( P  < 0.05) concentrations in a dose-dependent manner. Daily weight gain, feed intake and feed conversion ratio were not affected by the MCT diets. In Experiment 3, 64 female pigs of approximately 60 kg live weight were allocated to one of three dietary treatments: control ( n  = 20); 6 % MCT ( n  = 21); and 70 mg/kg CSH ( n  = 21). After 3 wk of supplementation, the MCT treated pigs had a higher plasma concentration of ghrelin compared to the control and CSH pigs ( P  < 0.05). Plasma concentrations of GH and weight were not affected by any of the dietary treatments., Conclusions: Evidence is provided in Experiment 1 to support the use of dietary MCT supplements, perhaps acting via stimulation of somatotropic endocrine pathways, to minimise weaning-associated disorders such as slowing of growth and diarrhoea. In Experiments 2 and 3, although there was no effect on weight gain or feed conversion ratio in either experiment, MCT and CSH increased endocrine components of the somatotropic axis.

Background: This experiment was conducted to test the hypothesis that vitamin E (Vit E) and acetylsalicylic acid (ASA), a cyclooxygenase-2 (COX-2) inhibitor, will additively reduce the production of the immunosuppressive molecule prostaglandin E 2 (PGE 2 ) and hence reduce inflammatory responses in weaner pigs experimentally infected with an enterotoxigenic strain of E. coli ., Methods: The experiment was conducted in a research facility with 192 individually-housed male weaner pigs (Landrace × Large White) weighing 6.6 ± 0.04 kg (mean ± SEM). The pigs were experimentally infected with an enterotoxigenic strain of E. coli and were allocated to a 2 × 3 factorial design with the respective factors being without and with 125 ppm ASA and three levels of Vit E supplementation (50, 100 or 200 IU/kg diet, dl -α-tocopheryl acetate)., Results: Acetylsalicylic acid supplementation improved average daily gain ( P <  0.05) and tended to improve feed:gain ratio ( P <  0.10) during the first 14 d after weaning. Acetylsalicylic acid supplementation also improved ( P  < 0.001) amino acid utilization efficiency (as assessed by plasma urea level) and tended to decrease ( P  < 0.10) PGE 2 production in the liver without affecting small intestinal histology and tight junction protein mRNA expression in the jejunal epithelium. Vitamin E supplementation greater than 100 IU/kg diet sustained both the plasma Vit E concentration ( P  < 0.001) and plasma haptoglobin content ( P  < 0.001) after weaning. However, there was no additive effects of the combined supplementation of ASA and Vit E on performance, intestinal barrier function and inflammatory responses of weaned pigs., Conclusions: Although ASA and vitamin E improved amino acid utilization efficiency and reduced acute inflammatory responses, ASA and vitamin E did not additively reduce production of PGE 2 and inflammatory responses in weaner pigs experimentally infected with an enterotoxigenic strain of E. coli .

Pigs immunized against gonadotropin-releasing factor (GnRF) have increased carcass fatness compared to entire males; however, the timing of this increase in fatness after the second immunization against GnRF has not been determined. An experiment was conducted to identify and compare the growth performance, body composition, and physiological changes in immunocastrated males (IC males) at different BW and feeding levels. A total of 64 pigs were used in a 2 × 2 × 2 factorial experiment with the treatments being 1) sex (entire males or IC males), 2) initial BW (45.9 kg [light] or 78.3 kg [heavy]), and 3) feeding regime (2.5 times maintenance [restricted] or ad libitum). The pigs were individually housed, and the diets were fed for 4 wk after the second immunization against GnRF until slaughter at either 68.4 kg BW (light) or 105.8 kg BW (heavy). Immunocastrated males on a restricted feed intake had a lower ADG compared to entire males from d 15 to 28 and d 0 to 28 ( 0.011 and 0.011, respectively). Fat deposition was not affected by sex from d 0 to 14, but from d 15 to 28 IC males deposited 45 g/d more fat than entire males ( = 0.025). Immunocastrated male pigs fed ad libitum deposited 87 g/d more fat from d 15 to 28 than entire males fed ad libitum ( = 0.036). However, there was no difference in fat deposition between IC males and entire males when feed intake was restricted from d 15 to 28. Plasma urea nitrogen levels were greater in IC males compared to entire males from d 7 after the second immunization against GnRF ( 0.05 for d 7, 10, 14, 21, and 28). Plasma concentrations of IGF-1 were lower for IC males compared to entire males on d 3, 7, 10, and 28 ( 0.05 for all days). The following conclusions were made: 1) when pigs are immunized at a light BW (50 kg) and/or are on a restricted feed intake, they have a reduced propensity to deposit fat; however, the restriction in feed intake adversely affects growth rate. 2) The majority of fat deposition for males immunized at heavy BW (80 kg) occurs from d 15 to 28 after the second immunization against GnRF.

Objectives: This study aimed to characterize volume profiles and their differences in heart failure (HF) patients with preserved (HFpEF) and reduced (HFrEF) ventricular systolic function., Background: The extent and distribution of volume overload and the associated implications for volume management have not been studied in decompensated HFpEF compared with HFrEF., Methods: Total blood volume (TBV) was quantitated using a standardized computer-based radiolabeled albumin dilution technique., Results: Twenty HFpEF and 35 HFrEF patients were evaluated at hospital admission. TBV was expanded by 27 ± 21% (range -5.2% to 77%; p = 0.002) and 37 ± 25% (0% to 107%; p < 0.001), respectively, above normal volumes. Red cell mass (RBCM) was expanded in HFrEF (24 ± 31%; p = 0.004) but within normal limits in HFpEF (8 ± 34%; p = 0.660) with, however, large variability in both groups. RBCM excess was more prominent in HFrEF (63% vs. 45%) than the RBCM deficit in HFpEF (35% vs.14%). With diuresis, TBV decreased to 25 ± 20% (p = 0.029) in HFrEF but was not changed in HFpEF (18 ± 20% [p = 0.173]). Body weight declined 6.6 ± 4.4 kg in HFrEF and 10.5 ± 8.3 kg (p = 0.026) in HFpEF. Interstitial fluid losses accounted for 85 ± 13% (HFrEF) and 93 ± 6% (HFpEF) (p = 0.012) of total volume removed., Conclusions: TBV profiles differ between HFpEF and HFrEF patients with DCHF. Quantitated volume analysis revealed both significant RBCM (polycythemia) and plasma volume excess in HFrEF, whereas a higher RBCM deficit (true anemia) was demonstrated in HFpEF. Diuresis produced only a modest reduction in intravascular volumes with persistent hypervolemia in both groups at discharge, but overall more total body fluid was lost in HFpEF. These profile differences have implications for individualizing volume management., (Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

An experiment was conducted to determine the standardized ileal digestible (SID) Lys requirement of entire male and male pigs immunized against gonadotrophin releasing factor (GnRF; immunocastrates). A total of 420 entire male and immunocastrated (IC) male pigs weighing 60.1 kg BW (SEM 0.49) were used in a 2 × 5 factorial experiment with the main effects being gender (entire males or IC males) and 5 concentrations of SID Lys:DE ratio (0.32, 0.43, 0.54, 0.64, or 0.75 g SID Lys/MJ DE). The diets were fed for 6 wk until slaughter at 107.5 kg BW (SEM 5.72). Over the entire period, IC males had a greater ADG ( < 0.001), greater ADFI ( < 0.001), and lower G:F ( < 0.001) compared with entire males. Immunocastrated males had increased plasma urea nitrogen (PUN) concentrations compared with entire males from d 10 to 42 ( < 0.001 for all days). Plasma urea nitrogen concentration also increased as Lys concentrations increased from d 3 to 42 ( < 0.001 for all days). Using the linear-plateau model, the optimal ADG for entire males was achieved at SID Lys concentrations of 0.68, 0.62, 0.54, and 0.58 g/MJ DE whereas optimal G:F was achieved at SID Lys concentrations of 0.72, 0.60, 0.54, and 0.51 g/MJ DE for the time periods d 0 to 14, d 15 to 28, d 29 to 42, and d 0 to 42, respectively. For IC males, optimal ADG was achieved at SID Lys concentrations of 0.64, 0.43, 0.38, and 0.40 g/MJ DE whereas optimal G:F was achieved at SID Lys concentrations of 0.64, 0.43, 0.36, and 0.42 g/MJ DE for the same respective time periods. Using the quadratic polynomial model, maximum ADG for entire males was achieved at SID Lys concentrations of 0.62 and 0.58 g/MJ DE whereas maximum G:F was achieved at SID Lys concentrations of 0.59 and 0.68 g/MJ DE for d 29 to 42 and d 0 to 42, respectively. For IC pigs, maximum ADG was achieved at SID Lys concentrations of 0.69, 0.54, and 0.64 g/MJ DE whereas maximum G:F was achieved at SID Lys concentrations of 0.81, 0.54, and 0.64 g/MJ DE for d 0 to 14, d 29 to 42, and d 0 to 42, respectively. A solution could not be found using the quadratic polynomial model for entire males for d 0 to 14 for both ADG and G:F and for both entire males and IC males for d 15 to 28 within the range of Lys values tested. When both the growth performance and PUN values are considered, the results suggest that IC males show a response to dietary SID Lys similar to that of entire males for 2 wk after the second immunization against GnRF. After this, IC males have a lower requirement for SID Lys than entire males.

Introduction: Focused parathyroidectomy in primary hyperparathyroidism (1°HPT) is possible with accurate preoperative localization and intraoperative PTH monitoring (IOPTH). The added benefit of multimodal imaging techniques for operative success is unknown., Method: Patients with 1°HPT, who underwent parathyroidectomy in 2012-2014 at a single institution, were retrospectively reviewed. Only the patients who underwent the standardized multimodal imaging workup consisting of (123)I/(99)Tc-sestamibi subtraction scintigraphy, SPECT, and SPECT/CT were assessed., Results: Of 360 patients who were identified, a curative operation was performed in 96%, using pre-operative imaging and IOPTH. Imaging analysis showed that (123)I/(99)Tc-sestamibi had a sensitivity of 86% (95% CI 82-90%), positive predictive value (PPV) 93%, and accuracy 81%, based on correct lateralization. SPECT had a sensitivity of 77% (95% CI 72-82%), PPV 92% and accuracy 72%. SPECT/CT had a sensitivity of 75% (95% CI 70-80%), PPV of 94%, and accuracy 71%. There were 3 of 45 (7%) patients with negative sestamibi imaging that had an accurate SPECT and SPECT/CT. Of 312 patients (87%) with positive uptake on sestamibi (93% true positive, 7% false positive), concordant findings were present in 86% SPECT and 84% SPECT/CT. In cases where imaging modalities were discordant, but at least one method was true-positive, (123)I/(99)Tc-sestamibi was significantly better than both SPECT and SPECT/CT (p < 0.001). The inclusion of SPECT and SPECT/CT in 1°HPT imaging protocol increases patient cost up to 2.4-fold., Conclusion: (123)I/(99)Tc-sestamibi subtraction imaging is highly sensitive for preoperative localization in 1°HPT. SPECT and SPECT/CT are commonly concordant with (123)I/(99)Tc-sestamibi and rarely increase the sensitivity. Routine inclusion of multimodality imaging technique adds minimal clinical benefit but increases cost to patient in high-volume setting.

A 4 × 3 factorial experiment (n=8 pigs per treatment combination) was conducted with 96 female Landrace × Large White pigs to examine the required level of dietary vitamin E and optimum feeding duration before slaughter to maximise muscle vitamin E content in the Longissimus thoracis et lumborum (LTL) muscle. The respective factors were four dietary levels of vitamin E (supplemented as dl-α-tocopheryl acetate; 35, 300, 500, and 700 IU/kg) and three feeding durations (14, 28 and 42 days before slaughter). Vitamin E concentration in the LTL was maximised at 6 mg/kg, which was achieved by feeding a 700 IU vitamin E diet for 28 days before slaughter (P<0.001). There was no further increase in the vitamin E content of the LTL by feeding the high vitamin E diet more than 28 days before slaughter., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Forty crossbred (Large White × Landrace × Duroc) female pigs (16.4 kg ± 0.94 kg) were used to investigate the effect of dietary lecithin supplementation on growth performance and pork quality. Pigs were randomly allocated to a commercial diet containing either 0, 3, 15 or 75 g lecithin/kg of feed during the grower and finisher growth phase. Pork from pigs consuming the diets containing 15 g and 75 g lecithin/kg had lower hardness ( P < 0.001) and chewiness ( P < 0.01) values compared to the controls. Dietary lecithin supplementation at 75 g/kg significantly increased ( P < 0.05) the linoleic acid and reduced ( P < 0.05) the myristic acid levels of pork compared to the control and the 3 g/kg and 15 g/kg lecithin supplemented treatments. Pigs fed the 75 g/kg lecithin supplemented diet had lower plasma cholesterol ( P < 0.05) at slaughter compared to pigs fed the control diet and the 3 g/kg and 15 g/kg lecithin supplemented treatments. These data indicate that dietary lecithin supplementation has the potential to improve the quality attributes of pork from female pigs.

Peripheral venous hemoglobin (Hb) measurements are considered to accurately reflect circulating red blood cell mass (RBCM). In volume overload decompensated chronic heart failure (DCHF), reliance on Hb values may be misleading. Using quantitative radiolabel blood volume analysis (BVA), we evaluated the relation of RBCM to volume overload and reliability of Hb measurements to reflect RBC status in patients hospitalized for DCHF. Of 32 patients evaluated (LVEF <50 %), 19 met WHO Hb criteria for anemia. By BVA, however, only 4/19 had true anemia (low Hb and low RBCM) while 15/19 demonstrated plasma volume expansion dilution-related "anemia" (6 low Hb/normal RBCM, 9 low Hb/excess RBCM). The remaining 13/32 had normal range Hb (12 with excess RBCM). Overall, 66 % of cohort demonstrated RBCM excess. RBC profiles are highly variable in DCHF, and peripheral Hb values are often misleading in identifying RBC status. These findings have implications for volume management.

This study tested the hypothesis that vitamin E (Vit E) and omega-3 fatty acids will additively attenuate the production of proinflammatory cytokines and PGE2 in immune system–stimulated growing–finishing pigs. A total of 80 mixed sex pigs weighing 50.7 ± 0.76 kg (mean ± SE) were blocked and stratified based on sex and BW to a 2 × 2 factorial design with the respective factors being 1) without and with 300 IU Vit E and 2) without and with 25% replacement of tallow to linseed oil as a source of n-3 fatty acids. Each treatment consisted of 4 replicate pens with 5 pigs (3 barrows and 2 gilts) per pen. All pigs were challenged with an intramuscular injection of Escherichia coli lipopolysaccharide (LPS; O111:B4) twice weekly over the 6-wk experiment. After LPS challenge, pigs fed a diet supplemented with n-3 fatty acids had fewer (P < 0.05) white blood cells and tended to show both a reduced (P < 0.10) proportion of lymphocytes and IgG concentration compared with pigs fed a diet without any supplements. Supplementation of n-3 fatty acids reduced (P < 0.01 and P < 0.05) serum concentrations of cortisol and tumor necrosis factor α (TNF-α), respectively. The serum concentration of PGE2 was decreased (P < 0.05) with supplementation of both Vit E and n-3 fatty acids; however, the extent of the reduction was greater (P < 0.001) in pigs fed an n-3 fatty acid–supplemented diet. However, there were no additive effects of the combined supplementation of Vit E and n-3 fatty acids on serum concentrations of proinflammatory cytokines and PGE2. The results suggest that n-3 fatty acids independently attenuate production of TNF-α and PGE2 in immune system–stimulated growing–finishing pigs.

This experiment examined if immune system stimulation of weaner pigs, initiated by inoculation an enterotoxigenic strain of Escherichia coli (ETEC), increased the requirement for dietary tryptophan (Trp), modulated the inflammatory response, altered plasma levels of Trp and its metabolite kynurenine (Kyn) and effected post-weaning diarrhoea. Individually housed pigs (n = 72) weaned at 21 d of age were allocated to one of six treatments (n = 12) according to a two by three factorial arrangement of (1) with or without ETEC infection and (2) three dietary ratios of standardised ileal digestible (SID) Trp to lysine (Lys) (SID Trp:Lys) of 0.16, 0.20 or 0.24, in a completely randomised block design. Pigs had ad libitum access to diets (per kg 14.13 MJ ME, 12.4 g SID Lys, 195 g crude protein) for 3 weeks after weaning. Pigs were infected with ETEC (O149:K98:K88) at 72, 96 and 120 h after weaning and then bled on day 3, 11 and 19. An increased dietary Trp:Lys ratio increased plasma Trp and Kyn (p < 0.001) without effect of infection. On day 3, pigs fed 0.24 SID Trp:Lys had lower levels of plasma urea than at 0.20 Trp:Lys (p = 0.047) and on day 11, plasma urea was lower at 0.20 than at 0.16 SID Trp:Lys (p = 0.007). Infection increased (p = 0.039) the diarrhoea index and deteriorated faecal consistency from day 4-10 (p < 0.05). Treatments did not affect haptoglobin and acid soluble glycoprotein levels or daily gain and feed intake. However, 0.24 SID Trp:Lys improved (p = 0.021) feed efficiency without an effect of infection. In conclusion, in the absence of dietary antibiotic growth promotants, increasing the dietary SID Trp:Lys ratio to 0.24 improved feed conversion ratio after weaning and increased plasma levels of Trp and Kyn regardless of infection with E. coli.

Objectives: This study sought to quantitate total blood volume (TBV) in patients hospitalized for decompensated chronic heart failure (DCHF) and to determine the extent of volume overload, and the magnitude and distribution of blood volume and body water changes following diuretic therapy., Background: The accurate assessment and management of volume overload in patients with DCHF remains problematic., Methods: TBV was measured by a radiolabeled-albumin dilution technique with intravascular volume, pre-to-post-diuretic therapy, evaluated at hospital admission and at discharge. Change in body weight in relation to quantitated TBV was used to determine interstitial volume contribution to total fluid loss., Results: Twenty-six patients were prospectively evaluated. Two patients had normal TBV at admission. Twenty-four patients were hypervolemic with TBV (7.4 ± 1.6 liters) increased by +39 ± 22% (range, +9.5% to +107%) above the expected normal volume. With diuresis, TBV decreased marginally (+30 ± 16%). Body weight declined by 6.9 ± 5.2 kg, and fluid intake/fluid output was a net negative 8.4 ± 5.2 liters. Interstitial compartment fluid loss was calculated at 6.2 ± 4.0 liters, accounting for 85 ± 15% of the total fluid reduction., Conclusions: TBV analysis demonstrated a wide range in the extent of intravascular overload. Dismissal measurements revealed marginally reduced intravascular volume post-diuretic therapy despite large reductions in body weight. Mobilization of interstitial fluid to the intravascular compartment with diuresis accounted for this disparity. Intravascular volume, however, remained increased at dismissal. The extent, composition, and distribution of volume overload are highly variable in DCHF, and this variability needs to be taken into account in the approach to individualized therapy. TBV quantitation, particularly serial measurements, can facilitate informed volume management with respect to a goal of treating to euvolemia., (Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the benefit of statistical SPECT processing over traditional subtraction methods, we compared ictal-interictal SPECT analyzed by statistical parametric mapping (SPM) (ISAS), statistical ictal SPECT coregistered to MRI (STATISCOM), and subtraction ictal-interictal SPECT coregistered with MRI (SISCOM) in patients with MRI-negative focal temporal lobe epilepsy (nTLE) and extratemporal lobe epilepsy (nETLE)., Methods: We retrospectively identified 49 consecutive cases of drug-resistant focal epilepsy that had a negative preoperative MRI and underwent interictal and ictal SPECT prior to resective epilepsy surgery. Interictal and ictal SPECT scans were analyzed using SISCOM, ISAS, and STATISCOM to create hyperperfusion and hypoperfusion maps for each patient. Reviewers blinded to clinical data and the SPECT analysis method marked the site of probable seizure origin and indicated their confidence in the localization., Results: In nTLE and nETLE, the hyperperfusions detected by STATISCOM (71% nTLE, 57% nETLE) and ISAS (67% nTLE, 53% nETLE) were more often colocalized with surgery resection site compared to SISCOM (38% nTLE, 36% nETLE). In nTLE, localization of the hyperperfusion to the region of surgery was associated with an excellent outcome for STATISCOM (p = 0.005) and ISAS (p = 0.027), but not in SISCOM (p = 0.071). This association was not present in nETLE for any method., Conclusion: In an unselected group of patients with normal MRI and focal epilepsy, SPM-based methods of SPECT processing showed better localization of SPECT hyperperfusion to surgical resection site and higher interobserver agreement compared to SISCOM. These results show the benefit of statistical SPECT processing methods and further highlight the challenge of nETLE.

In most countries, male pigs are physically castrated soon after birth to reduce the risk of boar taint and to avoid behaviours such as fighting and mounting. However, entire male pigs are more feed efficient and deposit less fat than barrows. In addition, many animal welfare organizations are lobbying for a cessation of castration, with a likelihood that this could lead to inferior pork unless an alternative method is used to control boar taint. An alternative to physical castration is immunization against gonadotrophin releasing factor (GnRF) which allows producers to capitalize on the superior feed efficiency and carcass characteristics of boars without the risk of boar taint. From a physiological perspective, immunized pigs are entire males until shortly after the second dose, typically given 4 to 6 weeks before slaughter. Following full immunization, there is a temporary suppression of testicular function and a hormonal status that resembles that of a barrow. Nutrient requirements will be different in these two phases, before and after full immunization. Given that there have been few published studies comparing the lysine requirements of entire males and barrows in contemporary genotypes, it is useful to use gilt requirements as a benchmark. A series of meta-analyses comparing anti-GnRF immunized boars and physical castrates and use of nutritional models suggest that the lysine requirement of entire males before the second immunization is 5% higher than for gilts, from 25 to 50 kg BW, and by 8% from 50 to 95 kg. Given that the penalty in growth performance for having inadequate dietary lysine is greater in males than in gilts or barrows, it is important to ensure that lysine requirements are met to obtain the maximum benefits of entire male production during this phase. After the second immunization, the lysine requirement of immunized males decreases and may become more like that of barrows. In addition, a consistent effect of full immunization is a marked increase in voluntary feed intake from about 10 days after the second dose. Putting these together, the estimated lysine requirement, expressed in terms of diet composition, falls to 94% of the gilt level. Although general principles can be described now, further research is needed to fully define the lysine requirements of immunized boars. It is important that the temporal pattern of tissue deposition rates and feed intake be explored to be incorporated into models to predict nutrient requirements over the period of rapidly changing metabolism.

A split plot experiment with 72 male pigs weighing 52.9 ± 0.39 kg (mean ± SEM) was conducted to examine AA partitioning and body protein deposition (PD) in response to increasing dietary sulfur amino acids (SAA) with or without immune system (IS) activation. The main plot was with and without IS activation, and 4 diets containing different amounts of standardized ileal digestible (SID) SAA (SAA to Lys ratios of 0.45, 0.55, 0.65 and 0.75) were the subplots. Activation of IS was achieved by intramuscular injection of Escherichia coli lipopolysaccharides (LPS; serotype 055:B5, Sigma; 30 μg/kg BW) every Monday and Thursday, with control pigs injected with sterile saline. Maximum body PD, measured by dual-energy X-ray absorptiometry (DXA), and minimum plasma urea content were achieved at SID SAA:Lys ratio of 0.55 in saline-injected pigs but were achieved at a SID SAA:Lys ratio of 0.75 in IS-activated pigs. Immune system activation increased rectal temperature (P < 0.05), plasma haptoglobin (1.1 vs. 2.0 mg/mL; P < 0.001), and the proportion of neutrophils (0.39 vs. 0.42; P < 0.05) and decreased serum albumin content (38.4 vs. 36.8 g/L; P < 0.01). Increasing dietary SAA had no effects on these variables. Immune system-activated pigs had lower levels of homocysteine (Hcy; P < 0.001) and a lower Ser content (P < 0.05). Results showed that increasing dietary SAA as DL-methionine in growing and/or finishing pigs altered plasma AA contents, and that use efficiency of the AA was improved when greater levels of SAA were supplemented in IS-activated pigs.

This experiment examined if a higher ratio of dietary Trp:Lys in the absence of antimicrobials improves production indices and modulates diarrhea in weaned pigs infected with enterotoxigenic Escherichia coli (ETEC). Effects of the Trp:Lys ratio on plasma levels of Trp and its metabolite kynurenine (Kyn) were also examined. Individually housed mixed-sex pigs (n = 72) weaned at 21 d of age (Landrace × Large White; initial BW of 6.3 ± 0.32 kg) were stratified into 1 of 6 treatments (n = 12) according to a 2 × 3 factorial arrangement of (i) infection or without infection with ETEC and (ii) 3 dietary standardized ileal digestible (SID) Trp:Lys ratios of 0.17, 0.21, or 0.26 in a randomized complete block design. Pigs were fed diets (10.4 MJ NE; 1.24% SID Lys; 19.5% CP) ad libitum for 3 wk after weaning. Pigs were infected with ETEC (O149:K98:K88) at 72, 96, and 120 h after weaning and then bled on day 11. A Trp:Lys ratio of 0.26 improved (P = 0.021) G:F over the study period compared to other ratios, without an infection effect (P > 0.05). Treatments did not affect ADG or ADFI (P > 0.05). Infection increased (P = 0.039) the diarrhea index and increased fecal consistency scores (P = 0.010). Plasma Trp and Kyn were lower (P < 0.001) in pigs fed 0.17 Trp:Lys than those fed ratios of 0.21 and 0.26 and were not affected (P > 0.05) by infection. In conclusion, in the absence of antimicrobials, increasing the dietary Trp:Lys ratio to 0.26 improved G:F after weaning and increased plasma levels of Trp and Kyn.

Forty-two individually housed entire male pigs weighing 37.5 ± 0.15 kg (mean ± SEM) were used in a randomized block design having 7 dietary treatments (n = 6). The dietary treatments were 5 semisynthetic diets containing 350 g/kg of soybean (Glycine max) meal (SBM) with variable heat treatments (0, 7, 14, 21, and 28 min autoclaved at 135°C), a protein free (N-free) diet, and an enzymatically hydrolyzed casein (EHC) diet. Heat treatment linearly decreased (P < 0.001) total Lys content from 27.5 to 19.2 g/kg and reactive Lys content from 23.4 to 11.7 g/kg. Apparent, standardized, and true ileal digestible total and reactive Lys contents linearly decreased (P < 0.001) with increasing severity of heat treatment and were accurately predictable (P < 0.001) from total and reactive Lys content in heat-damaged SBM. These data indicate that excessive heat processing of SBM reduced both the content (P < 0.001) and digestibility (P < 0.001) of total and reactive Lys in SBM.

Unlabelled: Ninety six crossbred pigs were used in a 4×2×2 experiment to determine the influence of management strategy, moisture infusion and ageing on pork quality. The treatments were i) management strategy (MS) during the last 28days pre-slaughter (, Control: conventional diet; Ractopamine (Rac): porcine somatotropin (pST); and combined (Rac+pST): Rac for 28days and pST for the final 14days), ii) moisture infusion (MI) (0% and 10%) and iii) ageing period (24h and 7days). L* was decreased by pST and Rac+pST, followed by Rac and then the CONTROL MS. Shear force was increased by Rac and Rac+pST but not by either pST or the CONTROL MS. MI decreased L* and shear force while ageing for 7days increased L* and yellowness, and decreased drip loss and WB shear force. MI or ageing for 7days improved sensory pork quality. The results from this experiment indicated that as expected MI and ageing can be used to improve pork quality., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Differentiation of idiopathic Parkinson's disease (PD) from multiple system atrophy (MSA) can be difficult. Methods devised to help distinguish the two disorders include standardized autonomic testing and cardiac imaging with iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. MSA patients had more severe adrenergic and overall autonomic dysfunction when compared to control and PD patients. Area of anhidrosis on thermoregulatory sweat test was greater in MSA (67.4±12.42, p<0.001) versus PD patients (area of anhidrosis, 1.7±2.96). Postganglionic cardiac sympathetic innervation (iodine-123 meta-iodobenzylguanidine) expressed as heart to mediastinal ratio was significantly lower in Parkinson's disease patients (1.4±0.40, p=0.025) compared to controls (2.0±0.29), but not in multiple system atrophy (2.0±0.76). These findings indicate that autonomic dysfunction is generalized and predominantly preganglionic in multiple system atrophy, and postganglionic in Parkinson's disease. In our hands the thermoregulatory sweat test provides the best distinction between MSA and PD. However further confirmatory studies using larger patient numbers are required. Currently a combination of clinical judgment and autonomic testing is recommended to help differentiate MSA and PD., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objective: We previously developed an operator-interactive method for the measurement of left ventricular (LV) and right ventricular (RV) ejection fraction (EF) and end-systolic volume (ESV) and end-diastolic volume (EDV) using single-photon emission tomographic equilibrium radionuclide angiocardiography (SPECT ERNA). We aimed to compare our SPECT ERNA method with cardiac MRI (CMRI) for the determination of ventricular measures., Methods: Paired measurements of LV and RV EFs and ESV and EDV were carried out by SPECT ERNA and CMRI in a group of patients who had myocardial infarction due to left anterior descending coronary artery thrombosis., Results: SPECT ERNA and CMRI provided similar estimations of the mean (SD) LV ESV [61 (23) vs. 61 (32) ml; P=0.99] and LV EDV [134 (29) vs. 141 (44) ml; P=0.28]. The mean (SD) LV EF by SPECT ERNA was slightly but significantly smaller than that by CMRI [0.55 (0.10) vs. 0.58 (0.11) ml; P=0.03]. SPECT ERNA, compared with CMRI, produced similar mean (SD) values of RV ESV [62 (17) vs. 67 (17) ml; P=0.10] and RV EDV [153 (28) vs. 149 (29) ml; P=0.51] and somewhat larger mean (SD) RV EF [0.60 (0.06) vs. 0.55 (0.06) ml; P<0.001]. Excellent correlations were found between SPECT ERNA and CMRI for combined LV ESV and EDV (R=0.85, P<0.001) and combined RV ESV and EDV (R=0.85, P<0.001)., Conclusion: This study further validates SPECT ERNA as a method to measure LV and RV EF, ESV, and EDV.

Tc-99m ethyl cysteinate diethylester (ECD) and Tc-99m hexamethyl propylene amine oxime (HMPAO) are commonly used for single-photon emission computed tomography (SPECT) studies of a variety of neurologic disorders. Although these tracers have been very helpful in diagnosing and guiding treatment of neurologic disease, data describing the distribution and laterality of these tracers in normal resting brain are limited. Advances in quantitative functional imaging have demonstrated the value of using resting studies from control populations as a baseline to account for physiologic fluctuations in cerebral perfusion. Here, we report results from 30 resting Tc-99m ECD SPECT scans and 14 resting Tc-99m HMPAO scans of normal volunteers with no history of neurologic disease. Scans were analyzed with regions of interest and with statistical parametric mapping, with comparisons performed laterally (left vs. right), as well as for age, gender, and handedness. The results show regions of significant asymmetry in the normal controls affecting widespread areas in the cerebral hemispheres, but most marked in superior parietotemporal region and frontal lobes. The results have important implications for the use of normal control SPECT images in the evaluation of patients with neurologic disease.

The objective of this study was to evaluate whether altering the timing of the secondary anti-gonadotropin-releasing factor (GnRF) immunization closer to slaughter in male finishing pigs would reduce the increase in P2 fat depth (6.5 cm from the midline over the last rib), while still limiting the incidence of boar taint. Entire male pigs are immunized against GnRF to reduce the concentration of testicular steroids that in turn limits the incidence of boar taint. Additionally, testicle measurements and color measurements were taken to examine whether they could be used to differentiate nonimmunized entire males from immunized male pigs. A total of 175 Large White × Landrace entire male pigs aged 16 wk (59 kg of BW) were used in a completely randomized design with 5 treatment groups based on the time that pigs received the secondary immunization before slaughter. Pigs were housed in groups of 7 and randomly allocated to 1 of 5 treatments with 5 replicates per treatment. The treatment groups were as follows: no secondary immunization before slaughter, and the secondary immunization given at 2, 3, 4, or 6 wk before slaughter. The P2 fat depth levels were reduced (P = 0.054) with the secondary immunization closer to slaughter (11.7, 11.3, 12.8, 12.6, and 13.7 mm for no secondary immunization, secondary immunization at 2, 3, 4, and 6 wk before slaughter, respectively). Androstenone concentration did not exceed the generally accepted industry sensory threshold of 1.0 µg/g of fat, and both androstenone concentration in the adipose tissue and testosterone concentrations in the blood were suppressed (P < 0.001) in all immunized pigs regardless of timing of the secondary immunization compared with pigs that did not receive the secondary immunization. Skatole concentration of all pigs in the experiment did not exceed the generally accepted industry sensory threshold of 0.2 µg/g. Testes weight was reduced (P < 0.001) with increased time between slaughter and the secondary immunization. Immunized pigs, regardless of time before slaughter, had greater L* (lightness) and b* (yellowness) color of the testicle surface (P < 0.001 and P = 0.020, respectively), and less a* (redness) color compared with entire males (P < 0.001). The study provides further evidence of the efficacy of the anti-GnRF immunization and indicates that the secondary immunization can be moved closer to slaughter, while still limiting the incidence of boar taint. Testicle measurements and color measurements together could provide a method of discrimination between carcasses from immunized entire males clear of boar taint and tainted carcasses.

Objective: To explore the prognostic value of F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) in radioiodine-negative patients with differentiated follicular cell-derived thyroid carcinoma with circulating antithyroglobulin autoantibodies (TgAb)., Methods: We retrospectively reviewed cases of all patients with differentiated thyroid cancer and increased TgAb referred for FDG-PET at Mayo Clinic, Rochester, Minnesota, from August 2001 to December 2004. PET findings were compared with results of other imaging and laboratory studies. Follow-up information was recorded until 19 December 2009., Results: Of the 17 patients identified, PET results were true positive in 10 and false negative in two. In eight of these 12 patients with confirmed residual or recurrent disease, the increased TgAb level persisted and the disease progressed. In four of the 12 patients, TgAb decreased or disappeared after further treatment. In five patients, no residual or recurrent disease was found during follow-up. PET results were true negative in these five patients; TgAb disappeared spontaneously in four of these patients., Conclusions: Negative PET results were associated with the absence of active disease and disappearing TgAb over time. FDG-avid residual lesions were associated with more aggressive disease and persistently increased TgAb.

Background: In patients with heart failure and reduced left ventricular ejection fraction (LVEF), the effect of upgrading from right ventricular (RV) apical to biventricular pacing on RV and left ventricular (LV) volumes and ejection fraction (EF) is unknown. Also, the relationship of symptom improvement after biventricular upgrade to RV and LV volumes and EF has not been clarified., Methods and Results: Nineteen patients with long-standing persistent RV apical pacing who had heart failure symptoms and echocardiographic LVEF of 0.40 or less underwent upgrade to biventricular pacing. Patients had single-photon emission computed tomographic equilibrium radionuclide angiocardiography immediately before and at 3-6 months after the upgrade procedure, to measure RV and LV volumes and EF. Biventricular upgrade was associated with increase in LVEF and decrease in LV end-diastolic and end-systolic volumes; right ventricular ejection fraction (RVEF) and end-diastolic and end-systolic volumes were unaltered. Patients with improvement in New York Heart Association heart failure class of I or more had larger initial LV end-diastolic volumes than patients without an improvement and had decreased LV end-diastolic and end-systolic volumes comparatively. Symptom improvement was not associated with RVEF and volume change., Conclusion: Symptom improvement with LV remodeling, but not RV remodeling, occurs 3-6 months after biventricular upgrade in patients with heart failure.

Swine dysentery is a contagious mucohemorrhagic diarrheal disease caused by the intestinal spirochete Brachyspira hyodysenteriae that colonizes and induces inflammation of the cecum and colon. It has been reported that a diet containing chicory root and sweet lupin can prevent swine dysentery. This experiment was conducted to test the hypothesis that inulin in the chicory root rather than galactans in lupins was responsible for protective effects. An experiment with a 2 × 2 factorial arrangement of treatments was undertaken using pigs fed barley- and triticale-based diets, with the main effects being protein source [185 g/kg of canola meal (decreased galactans) or 220 g/kg of lupins (greater galactans)] and inulin supplementation (0 or 80 g/kg). Forty Large White × Landrace pigs weighing 21 ± 3 kg, with 10 pigs per diet, were allowed to adapt to the diets for 2 wk, and then each pig was challenged orally 4 times with a broth culture containing B. hyodysenteriae on consecutive days. Pigs were killed when they showed clinical signs of dysentery or 6 wk postchallenge. Pigs fed diets without inulin had 8.3 times greater risk (P = 0.017) of developing swine dysentery and were 16 times more likely (P = 0.004) to have colon contents that were culture-positive for B. hyodysenteriae, compared with the pigs fed a diet with 80 g/kg of inulin. Diets containing lupins did not prevent pigs from developing clinical swine dysentery; however, inclusion of lupins or inulin or both in the diets delayed the onset of disease compared with the diet based mainly on canola meal (P < 0.05). Diet did not influence the total concentration of organic acids in the ileum, cecum, or upper and lower colon; however, the molar proportions of the organic acids were influenced (P < 0.05). Consequently the pH values in the cecum, and upper and lower colon were not influenced (P > 0.05) by diet. However the pH values of the ileal digesta were decreased in pigs fed the diet with both lupins and inulin compared with the diet containing only lupins (P < 0.05). In conclusion, this study shows that diets supplemented with highly fermentable carbohydrates from inulin protected pigs against developing swine dysentery.

Purpose: To explore the prognostic value of 2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET) in patients with suspected residual or recurrent medullary thyroid carcinoma (MTC)., Procedures: This retrospective study included all patients with MTC examined with FDG-PET at Mayo Clinic, Rochester, Minnesota, from October 1999 to March 2008. The PET results were compared with other imaging studies and clinical findings, including carcinoembryonic antigen and calcitonin levels., Results: Twenty-nine patients with MTC were included. PET was positive in 14 patients, with follow-up information for 11; six died from metastatic disease, four had disease progression, and one remained in stable condition. PET was negative in 15 patients, with follow-up for 12; one had recurrent disease, and 11 had no evidence of clinical disease. Calcitonin doubling time was shorter for PET-positive than for PET-negative patients., Conclusion: FDG-PET has high prognostic value in patients with suspected residual or recurrent MTC.

The beta-agonist ractopamine is a dietary ingredient that improves growth and increases the lean mass with little change in fat mass in gilts and barrows. Limited data in boars indicate that dietary ractopamine may increase lean tissue and decrease fat deposition, whereas there are no data for immunocastrated boars. The aims of this investigation were 1) to assess whether the growth performance of all sexes could be maintained over 31 d by using a step-up dietary ractopamine feeding program of 5 mg/kg of ractopamine for the first 14 d, then increasing the dose to 10 mg/kg for a further 17 d, and 2) to determine if dietary ractopamine would increase lean mass in all sexes and decrease fat mass in boars and immunocastrated boars. The study involved 286 pigs randomized and proportionally allocated by breed into 24 groups of 11 or 12 pigs at 17 wk of age, with equal groups of boars, immunocastrated boars, and gilts. Dietary ractopamine decreased (P = 0.005) ADFI during the first 2 wk, particularly in the intact and immunocastrated boars, with the reduction in ADFI being maintained in the immunocastrated boars after the increment in dietary ractopamine. Daily BW gain was not altered by dietary ractopamine during the first 2 wk, but was increased (P < 0.001) after the increment in dietary ractopamine. Dietary ractopamine decreased (P < or = 0.033) feed conversion ratio in all sexes with the response being greater after the increase in dietary ractopamine. Carcass weight was increased (P < 0.001) by dietary ractopamine in all sexes, whereas back fat tended (P = 0.076) to be reduced in the immunocastrated boars. Dietary ractopamine increased (P = 0.018) lean tissue mass by 4.0, 4.8, and 6.5 kg in the intact boars, gilts, and immunocastrated boars, respectively. In the entire and immunocastrated boars, the increase in lean tissue was accompanied with a decrease (P = 0.004) in fat mass. There was little effect of dietary ractopamine on fat mass in gilts. However, carcass percent fat was decreased (P = 0.004) and percent lean increased (P = 0.006) in all sexes. Immunocastration caused a decrease in lean tissue mass and an increase in fat mass and an increase in ADFI in the last one-half of the study. Dietary ractopamine may decrease fat mass in intact and immunocastrated boars and offers an excellent means of maximizing the effects of immunocastration and minimizing the increase in fat mass sometimes observed in immunocastrated boars.