Glycemic index of cracked corn, oat groats and rolled barley in horses

Muscle glycogen synthesis depends on glucose availability. This study was undertaken to determine the glycemic and insulinemic response of horses to equal amounts of hydrolyzable carbohydrates (starch and sugar) in the form of one of three grain meals or intragastric administration of a glucose solution. In a randomized crossover design, seven horses were fed each of three grain meals (cracked corn, steamed oat groats, or rolled barley) or were infused intragastrically with glucose solution at 2 g of hydrolyzable carbohydrate (starch plus sugar) per kilogram of BW. The quantity of hydrolyzable carbohydrate ingested was not different among all treatments (P = 0.70). Plasma glucose concentration peaked in all four treatments by 1.5 to 2 h after feeding. Plasma glucose concentration remained higher than baseline in oat groats or barley-fed horses throughout 8 h, whereas plasma glucose returned to baseline by 5 to 6 h in corn-fed horses or after glucose administration. Meal consumption was slower in oat groats-fed horses than in corn-fed ones, which may confound the glycemic and insulinemic responses observed after grain feeding. Plasma glucose area under the curve (AUC) was 63% both in corn and oat groats and 57% in barley-fed horses compared with that of horses administered glucose (P = 0.13). Serum immunoreactive insulin concentration peaked between 2 and 3 h after feeding or glucose administration, and barley-fed horses had lower serum immunoreactive insulin concentration by 3 to 4 h than corn-fed horses or after glucose administration (P < 0.05). We conclude, in horses, ingestion of oat groats, corn, and barley result in similar plasma glucose AUC and, compared with the glycemic index of 100 as the glucose reference, corn, oat groats, and barley had a glycemic index of approximately 60

Irradiated superficial femoral artery rupture after free flap: a case report and review of the literature.

Radical oncologic resection can result in large soft tissue defects with exposure of underlying vessels. Unless immediately covered with viable soft tissue, these vessels are vulnerable to desiccation from air exposure and mechanical trauma. Local radiation treatment also contributes to a decline in vessel wall strength. We present an index case of a patient with prolonged exposure of her femoral bone and superficial femoral artery after an initial failed reconstruction of a soft tissue sarcoma resection defect. We provided coverage using a free latissimus dorsi muscle flap. Two weeks after the initial free flap operation, the patient was readmitted to emergency service with profuse bleeding from beneath the free flap. Intraoperative inspection revealed a 2-cm defect of the irradiated superficial femoral artery. The defect was repaired with cryopreserved human arterial graft, and the flap was reset. This case highlights the importance of immediate coverage of soft tissue defects after oncologic resection. If any vessels are left exposed, they should be closely inspected before a delayed flap coverage to rule out future sources of bleeding that may jeopardize the outcomes of an otherwise successful free flap operation

Comparison of wound strength, histologic, and aesthetic outcomes after microsurgical versus conventional skin closure in a rat model.

The purpose of this study was to compare the healing, strength, and cosmetic outcome of linear incisions after repair with the naked eye, surgical loupes, or a surgical microscope. Two parallel incisions were made on the dorsal skin of Sprague-Dawley rats (n = 36) and the rats randomized into four groups. A single surgeon repaired the incisions using 5-0 poliglecaprone in a running subcuticular pattern using the naked eye (Group I), surgical loupes with 2.5× magnification (Group II), surgical microscope with 5-10× magnification (Group III), and 6-0 poliglecaprone with a surgical microscope (Group IV). Rats were sacrificed at 1, 3, and 6 weeks. At each time point, the tensile strength of each closure was assessed. Macroscopic outcomes were evaluated using the Vancouver Scar Scale (VSS) and histology assessed by a blinded observer. Microscope closure took significantly longer than closure with the naked eye (p &lt; 0.05). There was no significant difference in tensile strength or VSS ratings between the closure methods at any of the time points. On histopathologic analysis, there were a greater number of inflammatory cells and fibroblasts in the 6-0 microscope closure group versus the naked eye closure group at week 3 (p ≤ 0.05). In conclusion, wound repair under magnification did not yield a significant difference in cosmesis or wound tensile strength, but did increase operative time. Moreover, there was a trend toward increased inflammation with microscope-assisted closures, perhaps due to the increased suture burden

Can feedback approaches reduce unwarranted clinical variation? A systematic rapid evidence synthesis.

BACKGROUND:Assessment of clinical variation has attracted increasing interest in health systems internationally due to growing awareness about better value and appropriate health care as a mechanism for enhancing efficient, effective and timely care. Feedback using administrative databases to provide benchmarking data has been utilised in several countries to explore clinical care variation and to enhance guideline adherent care. Whilst methods for detecting variation are well-established, methods for determining variation that is unwarranted and addressing this are strongly debated. This study aimed to synthesize published evidence of the use of feedback approaches to address unwarranted clinical variation (UCV). METHODS:A rapid review and narrative evidence synthesis was undertaken as a policy-focused review to understand how feedback approaches have been applied to address UCV specifically. Key words, synonyms and subject headings were used to search the major electronic databases Medline and PubMed between 2000 and 2018. Titles and abstracts of publications were screened by two reviewers and independently checked by a third reviewer. Full text articles were screened against the eligibility criteria. Key findings were extracted and integrated in a narrative synthesis. RESULTS:Feedback approaches that occurred over a duration of 1 month to 9 years to address clinical variation emerged from 27 publications with quantitative (20), theoretical/conceptual/descriptive work (4) and mixed or multi-method studies (3). Approaches ranged from presenting evidence to individuals, teams and organisations, to providing facilitated tailored feedback supported by a process of ongoing dialogue to enable change. Feedback approaches identified primarily focused on changing clinician decision-making and behaviour. Providing feedback to clinicians was identified, in a range of a settings, as associated with changes in variation such as reducing overuse of tests and treatments, reducing variations in optimal patient clinical outcomes and increasing guideline or protocol adherence. CONCLUSIONS:The review findings suggest value in the use of feedback approaches to respond to clinical variation and understand when action is warranted. Evaluation of the effectiveness of particular feedback approaches is now required to determine if there is an optimal approach to create change where needed

Comparison of two cadaveric acellular dermal matrices for immediate breast reconstruction: A prospective randomized trial.

AlloDerm RTU® and AlloMaxTM are two acellular dermal matrices (ADMs) used in implant-based breast reconstruction. In this study, we examined whether different processing methods for the ADMs lead to a disparity in histologic, clinical, and financial outcomes after breast reconstruction. Thirty patients undergoing implant-based breast reconstruction were randomized into AlloMax or AlloDerm arms (n&nbsp;=&nbsp;15, each). ADM was placed at the time of immediate reconstruction. Patients were evaluated for complications on postoperative days 7, 14, and 30. During implant exchange, ADM biopsies were taken and compared histologically for vascular and cellular infiltration. Patient satisfaction was evaluated using the BRECON-31 questionnaire 1 year after implant exchange. A cost analysis was performed comparing the two ADMs. Patient demographics and complication rates were similar between the two groups (p&nbsp;&gt;&nbsp;0.05). Histologically, vessel density and fibroblast/inflammatory cell infiltrate were greater on the dermal side than on the implant side (p&nbsp;&lt;&nbsp;0.01) in both ADMs, suggesting greater vascular and cellular in-growth from the dermal side. Vessel density in the middle portion of the Allomax biopsies was significantly higher than the same site in the Alloderm biopsies (p&nbsp;&lt;&nbsp;0.05). The extent of fibroblast/inflammatory cell infiltration was similar in both arms (p&nbsp;&gt;&nbsp;0.05). The BRECON-31 satisfaction questionnaire yielded similar responses across all metrics between the two study arms. The negotiated price was slightly different when comparing the two ADMs, with no significant difference in ADM reimbursement. In this study, AlloDerm RTU and AlloMax were successfully used for implant-based breast reconstruction with comparable outcomes

Performance Characteristics of Pulmonary Function Tests for the Detection of Interstitial Lung Disease in Adults With Early Diffuse Cutaneous Systemic Sclerosis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163424/2/art41415.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163424/1/art41415_am.pd

Immunochip analysis identifies multiple susceptibility loci for systemic sclerosis

In this study, 1,833 systemic sclerosis (SSc) cases and 3,466 controls were genotyped with the Immunochip array. Classical alleles, amino acid residues, and SNPs across the human leukocyte antigen (HLA) region were imputed and tested. These analyses resulted in a model composed of six polymorphic amino acid positions and seven SNPs that explained the observed significant associations in the region. In addition, a replication step comprising 4,017 SSc cases and 5,935 controls was carried out for several selected non-HLA variants, reaching a total of 5,850 cases and 9,401 controls of European ancestry. Following this strategy, we identified and validated three SSc risk loci, including DNASE1L3 at 3p14, the SCHIP1-IL12A locus at 3q25, and ATG5 at 6q21, as well as a suggested association of the TREH-DDX6 locus at 11q23. The associations of several previously reported SSc risk loci were validated and further refined, and the observed peak of association in PXK was related to DNASE1L3. Our study has increased the number of known genetic associations with SSc, provided further insight into the pleiotropic effects of shared autoimmune risk factors, and highlighted the power of dense mapping for detecting previously overlooked susceptibility loci

Survival and Predictors of Mortality in Systemic Sclerosis‐Associated Pulmonary Arterial Hypertension: Outcomes From the Pulmonary Hypertension Assessment and Recognition of Outcomes in Scleroderma Registry

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106105/1/acr22121.pd