Low intestinal inflammation model (HP48) in Atlantic salmon (Salmo salar) and inflammatory mitigation by Bactocell

Moderate levels of intestinal damage and inflammation are often seen in intensive fish aquaculture. The causes may be due to antinutrients from plant meals, stress or other causes. There is currently a lack of good models to explore these effects and so how to mitigate the consequences. Most studies have used full-fat soy or other compounds that cause intestinal damage that are likely not reversible. In this study we have explored the possibility of using soybean HP48, made from solvent extracted peeled soybeans, as a low-inflammation model in post-smolt Atlantic salmon, and then investigated whether supplementation of the probiotic Pediococcus acidilactici CNCM I-4622 – MA 18/5 M (Bactocell) could diminish this effect. The fish were fed triplicate diets. A Control diet containing 18.08% soy protein concentrate (SPC), a HP48 diet where most of the SPC was replaced by HP48 (5.00% SPC and 17.68% HP48), and a Bactocell diet that was identical to the HP48 diet but contained 0.03% Bactocell. After 10 weeks of feeding, the mid- and hind-intestinal health were assessed by histology, integrity (Ussing chamber) and gene expression (RNAseq). Transcriptomic and integrity data suggests that HP48 led to a disturbed mid-intestinal homeostasis with impaired cellular integrity and increased inflammation and cell turnover. Most of the transcriptomic effects were reversed with Bactocell including downregulation of immune genes and upregulation of transmembrane proteins such as type IV collagen, which is important in restoring epithelial homeostasis. In the hind-intestine, the HP48 diet led to deleterious morphological changes such as widening of lamina propria and stratum granulosum, disrupted mucosal folds, loss of absorptive vacuoles, and upregulation of several immune regulated genes and downregulation of genes involved in solute- and water transport. The intestinal integrity assessed by Ussing chamber was not affected. Bactocell supplementation did alleviate several of the morphological effects. However, it was not able to completely reverse the expression of immune- or transport related genes, suggesting a higher effect of probiotic supplement in the mid-intestine compared to the hind-intestine. This study demonstrates that the level of HP48 used here is sufficient to create low-level intestinal changes in Atlantic salmon, which is within range for functional feed ingredients to reverse.publishedVersio

Intestinal health in Atlantic salmon post-smolt (Salmo salar) when fed low- and high HUFA diets

It is well established that farmed Atlantic salmon (Salmo salar) need n3-highly unsaturated fatty acids (HUFA) in their diet to thrive and grow. However, the biological functions to the individual HUFAs may differ, implying that future supplementation could require fixed ratios for maximum benefit. The intestinal barrier is essential to f ish health, and any disruption of the barrier can have detrimental effects. The current experiment was designed to examine the response of the intestinal hindgut when fed a low HUFA diet with 8.5 g/kg EPA + DHA (4.5% total fatty acid) or two high HUFA diets, with either high DHA (28.7 g/kg and 5.9% total fatty acid) or high EPA (25 g/kg and 14.2% total fatty acid). The diets were fed to Atlantic salmon post-smolt over 10 weeks and thereafter exposed to 3 weeks of chronic stress. After 10 weeks of feeding there were no differences in intestinal permeability and integrity, but intestinal morphology indicated increased intestinal health in the high EPA group. Gene expression also suggest that fish fed the high EPA diet had more regulation of pathways related to protein turnover compared to the high DHA fed fish. There was also indication of lower energy utilization in the low HUFA fed fish than high HUFA. Subjecting fish to 3 weeks of chronic stress led to a reduction in transepithelial resistance, increased ion flux and active L-lysine transport across the intestinal barrier in addition to a decrease in mucosal fold, enterocyte height and supranuclear vacuole density and an increase in thickness of the intestinal muscularis. After stress, the low HUFA group showed signs of inflammation with increased infiltration of MHCII positive cells. Gene expression also showed that low HUFA fed fish had a lower response to chronic stress compared to the high HUFA groups. Comparing fish fed either high DHA or EPA exposed to chronic stress showed few physical effects, but a lower density of supranuclear vacuoles and upregulation in immune-related gene expression indicate inflammation in the high DHA group.publishedVersio

Open chest and pericardium facilitate transpulmonary passage of venous air emboli

Background: Transpulmonary passage of air emboli can lead to fatal brain- and myocardial infarctions. We studied whether pigs with open chest and pericardium had a greater transpulmonary passage of venous air emboli than pigs with closed thorax. Methods: We allocated pigs with verified closed foramen ovale to venous air infusion with either open chest with sternotomy and opening of the pleura and pericardium (n = 8) or closed thorax (n = 16). All pigs received a five-hour intravenous infusion of ambient air, starting at 4-6 mL/kg/h and increased by 2 mL/kg/h each hour. We assessed transpulmonary air passage by transesophageal M-mode echocardiography and present the results as median with inter-quartile range (IQR). Results: Transpulmonary air passage occurred in all pigs with open chest and pericardium and in nine pigs with closed thorax (56%). Compared to pigs with closed thorax, pigs with open chest and pericardium had a shorter to air passage (10 minutes (5-16) vs. 120 minutes (44-212), P < .0001), a smaller volume of infused air at the time of transpulmonary passage (12 mL (10-23) vs.170 mL (107-494), P < .0001), shorter time to death (122 minutes (48-185) vs 263 minutes (248-300, P = .0005) and a smaller volume of infused air at the time of death (264 mL (53-466) vs 727 mL (564-968), P = .001). In pigs with open chest and, infused air and time to death correlated strongly (r = 0.95, P = .001). Conclusion: Open chest and pericardium facilitated the transpulmonary passage of intravenously infused air in pigs

Digital Outpatient Services for Adults: Development of an Intervention and Protocol for a Multicenter Non–Randomized Controlled Trial

Background: Health care services are being challenged by an increasing number of patients and limited resources. Hence, research investigating options to reduce costs and increase effectiveness is warranted. Digital outpatient services can provide flexible and tailored follow-up, improve patients’ health literacy, and facilitate the identification of adverse courses of disease. However, previous research largely focused on disease-specific contexts and outcomes. Therefore, research on digital services investigating generic outcomes such as health literacy is warranted. Objective: This article aims to describe the “digital outpatient service” intervention and present the protocol for an ongoing multicenter, nonrandomized trial evaluating this intervention. Methods: Based on previous experiences and evidence-based knowledge, we developed this intervention through patient-journey maps in collaboration with each clinical specialty. The patients gain access to a mobile app for self-monitoring and patient-reported outcomes and a chat for contact between the patients and health care workers. The health care workers’ dashboard includes a traffic light system to draw attention to the most urgent patient reports. In this multicenter, non–randomized controlled trial, patients are allocated to the control group receiving standard care or the 6-month intervention. Eligible patients are aged 18 years or older who receive outpatient care at the neurology, lung, pain, or cancer departments at 2 university hospitals in Norway. Our evaluation will include patient-reported outcomes, qualitative interviews, and clinical measures. The primary outcome will be health literacy using the Health Literacy Questionnaire. A sample size of 165 participants is split into a 1:2 ratio in favor of the intervention. We will analyze quantitative data in SPSS (IBM Corp) using descriptive statistics and logistic regression, and qualitative data using thematic analysis. Results: This trial started in September 2021, and the intervention started in January 2022. Recruitment has ended, with 55 patients in the control group and 107 patients in the intervention group. Follow-up is expected to end in July 2023, with results expected to be obtained in December 2023. Conclusions: This study will evaluate an intervention facilitated by an already certified digital multicomponent solution, with intervention content based on patient-reported outcomes, health literacy, and self-monitoring. The intervention is specifically tailored to each participating center and the needs of their patients using patient journey maps. The comprehensive and generic evaluation of this digital outpatient service intervention is a strength as it targets a heterogeneous sample of patients. Thus, this study will provide important knowledge about the applicability and effects of digital health care services. As a result, patients and health care workers will gain a new, evidence-based understanding of whether and how digital tools may be used in clinical care.Background: Health care services are being challenged by an increasing number of patients and limited resources. Hence, research investigating options to reduce costs and increase effectiveness is warranted. Digital outpatient services can provide flexible and tailored follow-up, improve patients’ health literacy, and facilitate the identification of adverse courses of disease. However, previous research largely focused on disease-specific contexts and outcomes. Therefore, research on digital services investigating generic outcomes such as health literacy is warranted.<p

Feasibility of a three-axis epicardial accelerometer in detecting myocardial ischemia in cardiac surgical patients

ObjectiveWe investigated the feasibility of continuous detection of myocardial ischemia during cardiac surgery with a 3-axis accelerometer.MethodsTen patients with significant left anterior descending coronary artery stenosis underwent off-pump coronary artery bypass grafting. A 3-axis accelerometer (11 × 14 × 5 mm) was sutured onto the left anterior descending coronary artery–perfused region of left ventricle. Twenty episodes of ischemia were studied, with 3-minute occlusion of left anterior descending coronary artery at start of surgery and 3-minute occlusion of left internal thoracic artery at end of surgery. Longitudinal, circumferential, and radial accelerations were continuously measured, with epicardial velocities calculated from the signals. During occlusion, accelerometer velocities were compared with anterior left ventricular longitudinal, circumferential, and radial strains obtained by echocardiography. Ischemia was defined by change in strain greater than 30%.ResultsIschemia was observed echocardiographically during 7 of 10 left anterior descending coronary artery occlusions but not during left internal thoracic artery occlusion. During ischemia, there were no significant electrocardiographic or hemodynamic changes, whereas large and significant changes in accelerometer circumferential peak systolic (P < .01) and isovolumic (P < .01) velocities were observed. During 13 occlusions, no ischemia was demonstrated by strain, nor was any change demonstrated by the accelerometer. A strong correlation was found between circumferential strain and accelerometer circumferential peak systolic velocity during occlusion (r = −0.76, P < .001).ConclusionsThe epicardial accelerometer detects myocardial ischemia with great accuracy. This novel technique has potential to improve monitoring of myocardial ischemia during cardiac surgery

Cerebral microembolization during off-pump coronary artery bypass surgery with the Symmetry aortic connector device

ObjectiveThe use of aortic connector systems for proximal vein grafts in off-pump coronary artery bypass grafting might minimize aortic manipulation by eliminating the need for partial aortic clamping. The objective of this study was to asses whether use of a Symmetry connector (St Jude Medical, Inc, St Paul, Minn) reduced intraoperative cerebral embolization.MethodsThirty-two consecutive patients underwent off-pump coronary artery bypass grafting. Sixteen patients received at least one mechanical proximal vein graft anastomosis with a Symmetry aortic connector system. Sixteen patients representing the control group underwent operations with standard suturing techniques using partial aortic clamping. During surgical intervention, all patients were monitored continuously with multifrequency transcranial Doppler scanning, which detected and differentiated cerebral emboli.ResultsThere were significantly more cerebral emboli in the Symmetry group (median, 36) compared with the control group (median, 11; P = .027). This was due to a higher number of gaseous emboli in the Symmetry group than in the control group (median, 27 vs 8; P = .014), whereas there was no significant difference regarding the number of solid emboli (median, 7 vs 3; P = .139).ConclusionUse of a Symmetry connector system during proximal vein graft anastomosis increased the number of emboli to the brain compared with a standard technique in coronary bypass surgery without cardiopulmonary bypass

Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: A population-based birth cohort study

Objective To assess the differences in rates and odds for emergency caesarean section among singleton pregnancies in six governmental Palestinian hospitals. Design A prospective population-based birth cohort study. Setting Obstetric departments in six governmental Palestinian hospitals. Participants 32 321 women scheduled to deliver vaginally from 1 March 2015 until 29 February 2016. Methods To assess differences in sociodemographic and antenatal obstetric characteristics by hospital, χ2 test, analysis of variance and Kruskal-Wallis test were applied. Logistic regression was used to estimate differences in odds for emergency caesarean section, and ORs with 95% CIs were assessed. Main outcome measures The primary outcome was the adjusted ORs of emergency caesarean section among singleton pregnancies for five Palestinian hospitals as compared with the reference (Hospital 1). Results The prevalence of emergency caesarean section varied across hospitals, ranging from 5.8% to 22.6% among primiparous women and between 4.8% and 13.1% among parous women. Compared with the reference hospital, the ORs for emergency caesarean section were increased in all other hospitals, crude ORs ranging from 1.95 (95% CI 1.42 to 2.67) to 4.75 (95% CI 3.49 to 6.46) among primiparous women. For parous women, these differences were less pronounced, crude ORs ranging from 1.37 (95% CI 1.13 to 1.67) to 2.99 (95% CI 2.44 to 3.65). After adjustment for potential confounders, the ORs were reduced but still statistically significant, except for one hospital among parous women. Conclusion Substantial differences in odds for emergency caesarean section between the six Palestinian governmental hospitals were observed. These could not be explained by the studied sociodemographic or antenatal obstetric characteristics.publishedVersio

Invasive Electrical Impedance Tomography for Blood Vessel Detection

We present a novel method for localization of large blood vessels using a bioimpedance based needle positioning system on an array of ten monopolar needle electrodes. The purpose of the study is to develop a portable, low cost tool for rapid vascular access for cooling and controlled reperfusion of cardiac arrest patients. Preliminary results show that localization of blood vessels is feasible with this method, but larger studies are necessary to improve the technology

Evaluering av forsøk med primærhelseteam og alternative finansieringsordninger. Statusrapport V

Source at https://osloeconomics.no/publikasjoner/.Primærhelseteam (PHT) er tverrfaglige team som inkluderer fastlege, sykepleier og helsesekretær. Sentrale målgrupper for PHT er brukere med kronisk sykdom, brukere med psykiske lidelser og rusavhengighet, brukere som omtales som «skrøpelige eldre» og brukere med utviklingshemming og funksjonsnedsettelser, samt «svake etterspørrere». For å finne ut om PHT, med mer systematisk oppfølging av målgruppen, gir et bedre tilbud til listeinnbyggerne enn den vanlige fastlegeordningen, ble forsøk med PHT startet 1. april 2018 på 13 legekontor, mens fire nye legekontor kom til fra 2020. Forsøket prøver ut to ulike finansieringsmodeller; 12 av legekontorene har valgt honorarmodellen og fem har valgt driftstilskuddsmodellen. Evalueringen bygger på analyser av data fra helseregistre og administrative registre, pasientjournaler, spørreundersøkelser, intervjuundersøkelser og dokumenter. I denne rapporten undersøker vi særlig: Pasienters erfaring med PHT Likheter og ulikheter mellom PHT-legekontor med ulike finansieringsmodeller Variasjon i teamarbeid og teameffektivitet ved et utvalg PHT-legekontor Samspill mellom PHT og øvrig helsetjeneste </uli