Free serum cortisol during the postoperative acute phase response determined by equilibrium dialysis liquid chromatography-tandem mass spectrometry

In severely ill patients low concentrations of the corticosteroid binding globulin are typically found; the aim of this study was to quantify directly free bioactive cortisol concentrations in the sera of postoperative cardiosurgical patients. Serum samples of 12 consecutive patients undergoing aortocoronary bypass surgery taken preoperatively and on the postoperative days 1 to 4 were analyzed. Total serum cortisol was quantified using liquid chromatographytandem mass spectrometry with an online sample extraction system and trideuterated cortisol as the internal standard, and free serum cortisol was measured after overnight equilibrium dialysis. Whereas on the first postoperative day, the median total serum cortisol concentration was approximately twofold increased compared to preoperative samples (preoperatively, 245 nmol/l (interquartile range (IQR) 203293 nmol/l); first postoperative day, 512 nmol/l (IQR 410611 nmol/l)), median dialyzable free cortisol concentration was almost sevenfold increased (preoperatively, 14.2 nmol/l (IQR 10.920.7 nmol/l); first postoperative day, 98.3 nmol/l (IQR 81.3134 nmol/l)). On the fourth postoperative day, median free cortisol was still significantly increased compared to baseline sampling (p < 0.05), whereas median total cortisol was not. A median of 5.7% (IQR 5.47.0%) of total cortisol was found as free cortisol on the preoperative day, 21.2% (IQR 18.9 23.5%) on the first postoperative day and 10.5% (IQR 9.814.0%) on the fourth postoperative day. It is concluded that during the postoperative period the freeto bound ratio of cortisol is highly variable and that during the acute phase response direct quantification of free bioactive cortisol concentrations seems to be biologically more appropriate than the measurement of total cortisol concentrations

APOE polymorphism and its effect on plasma C-reactive protein levels in a large general population sample

The literature on association between apolipoprotein E (APOE) gene variations and plasma levels of C-reactive protein (CRP) remains inconsistent, mainly due to low statistical power of previous studies. To clarify this question, we analysed data from large population sample of randomly selected individuals from 7 Czech towns (2886 males and 3344 females, the HAPIEE study). In both males and females, the lowest levels of plasma hsCRP were observed in the carriers of the APOE ε4ε4 and ε4ε3 genotypes. The median (inter-quartile range, IQR) concentration of hsCRP in carriers of the most common APOE ε3ε3 genotype (two thirds of participants) was 1.13 (IQR 0.56; 2.33) mg/l in men and 1.23 (IQR 0.61; 2.65) mg/l in women, compared with 0.72 (IQR 0.61; 0.86) mg/l in male and 0.72 (IQR 0.61-0.85) mg/l in female carriers of APOE ε4ε3/ε4ε4 genotypes; the differences were statistically significant (p<0.001). The association between APOE and CRP was not materially affected by adjustment for age, sex, history of cardiovascular disease or cardiovascular risk factors. This study, the largest to date, provides robust evidence of an association between plasma hsCRP and the APOE genotype, an association not explained by history of cardiovascular disease nor its risk factors

Accuracy and feasibility of an android-based digital assessment tool for post stroke visual disorders - The StrokeVision App

Background: Visual impairment affects up to 70% of stroke survivors. We designed an app (StrokeVision) to facilitate screening for common post stroke visual issues (acuity, visual fields and visual inattention). We sought to describe the test-time, feasibility, acceptability and accuracy of our app based digital visual assessments against a) current methods used for bedside screening, and b) gold standard measures. Methods: Patients were prospectively recruited from acute stroke settings. Index tests were app based assessments of fields and inattention performed by a trained researcher. We compared against usual clinical screening practice of visual fields to confrontation including inattention assessment (simultaneous stimuli). We also compared app to gold standard assessments of formal kinetic perimetry (Goldman or Octopus Visual Field Assessment); and pencil and paper based tests of inattention (Albert’s, Star Cancellation, and Line Bisection). Results of inattention and field tests were adjudicated by a specialist Neuro-Ophthalmologist. All assessors were masked to each other’s results. Participants and assessors graded acceptability using a bespoke scale that ranged from 0 (completely unacceptable) to 10 (perfect acceptability). Results: Of 48 stroke survivors recruited, the complete battery of index and reference tests for fields was successfully completed in 45. Similar acceptability scores were observed for app-based (assessor median score 10 [IQR:9-10]; patient 9 [IQR:8-10]) and traditional bedside testing (assessor 10 [IQR:9-10; patient 10 [IQR:9-10]). Median test time was longer for app-based testing (combined time-to-completion of all digital tests 420 seconds [IQR:390-588]) when compared with conventional bedside testing (70 seconds, [IQR:40-70]) but shorter than gold standard testing (1260 seconds, [IQR:1005-1620]). Compared with gold standard assessments, usual screening practice demonstrated 79% sensitivity and 82% specificity for detection of a stroke-related field defect. This compares with 79% sensitivity and 88% specificity for StrokeVision digital assessment. Conclusion: StrokeVision shows promise as a screening tool for visual complications in the acute phase of stroke. The app is at least as good as usual screening and offers other functionality that may make it attractive for use in acute stroke

Behavioural and physiological responses of laying hens to automated monitoring equipment

Automated monitoring of behaviour can offer a wealth of information in circumstances where observing behaviour is difficult or time consuming. However, this often requires attaching monitoring devices to the animal which can alter behaviour, potentially invalidating any data collected. Birds often show increased preening and energy expenditure when wearing devices and, especially in laying hens, there is a risk that individuals wearing devices will attract aggression from conspecifics. We studied the behavioural and physiological response of 20 laying hens to backpacks containing monitoring devices fastened with elastic loops around the wing base. We hypothesised that backpacks would lead to a stress-induced decrease in peripheral temperature, increased preening, more aggression from conspecifics, and reduced bodyweights. This was evaluated by thermography of the eye and comb (when isolated after fitting backpacks), direct observations of behaviour (when isolated, when placed back into the group, and on later days), and weighing (before and after each 7-day experimental period). Each hen wore a backpack during one of the two experimental periods only and was used as her own control. Contrary to our hypothesis, eye temperature was higher when hens wore a backpack (No backpack: 30.2 °C (IQR: 29.0–30.6) vs. Backpack: 30.9 °C (IQR: 30.0–32.0), P < 0.001). Eye temperature of hens wearing a backpack was strongly correlated to the time spent preening (rs = 0.8, P < 0.001), suggesting that the higher temperatures may have been due to preening itself, or to a low head position or decreased heat dissipation when preening under the wings. Aggressive behaviour was very rare and no effect of the backpacks was found. In line with our hypothesis, backpacks increased preening on the day of fitting, both when isolated (No backpack: 0% (IQR: 0–1) vs. Backpack: 22% (IQR: 1–43), P < 0.01) and when back in the group (No backpack: 0% (IQR: 0–27) vs. Backpack: 43% (IQR: 5–77), P < 0.001). However, no effect on preening was observed 2–7 days afterwards. Other behavioural changes suggested that on the day of fitting hens prioritized attempts to (re)move the backpack and were less attentive to their surroundings. However, only equipment pecking (i.e., pecking the backpack or leg rings) was still affected 2–7 days after fitting (No backpack: 0 pecks/hen/minute (IQR: 0–0), vs. Backpack: 0 (IQR: 0–0.07), P < 0.05). We found no effect of our backpacks on bodyweight. In conclusion, our backpacks seem suitable to attach monitoring equipment to hens with only a very minor effect on their behaviour after a short acclimation period (≤2 days)

Low-level seaweed supplementation improves iodine status in iodine-insufficient women

Iodine insufficiency is now a prominent issue in the UK and other European countries due to low intakes of dairy products and seafood (especially where iodine fortification is not in place). In the present study, we tested a commercially available encapsulated edible seaweed (Napiers Hebridean Seagreens® Ascophyllum nodosumspecies) for its acceptability to consumers and iodine bioavailability and investigated the impact of a 2-week daily seaweed supplementation on iodine concentrations and thyroid function. Healthy non-pregnant women of childbearing age, self-reporting low dairy product and seafood consumption, with no history of thyroid or gastrointestinal disease were recruited. Seaweed iodine (712 μg, in 1 g seaweed) was modestly bioavailable at 33 (interquartile range (IQR) 28–46) % of the ingested iodine dose compared with 59 (IQR 46–74) % of iodine from the KI supplement (n 22). After supplement ingestion (2 weeks, 0•5 g seaweed daily, &lt;i&gt;n&lt;/i&gt; 42), urinary iodine excretion increased from 78 (IQR 39–114) to 140 (IQR 103–195) μg/l (&lt;i&gt;P&lt;/i&gt;&lt; 0•001). The concentrations of thyroid-stimulating hormone increased from 1•5 (IQR 1•2–2•2) to 2•1 (IQR 1•3–2•9) mIU/l (&lt;i&gt;P&lt;/i&gt;&lt; 0•001), with two participants having concentrations exceeding the normal range after supplement ingestion (but normal free thyroxine concentrations). There was no change in the concentrations of other thyroid hormones after supplement ingestion. The seaweed was palatable and acceptable to consumers as a whole food or as a food ingredient and effective as a source of iodine in an iodine-insufficient population. In conclusion, seaweed inclusion in staple foods would serve as an alternative to fortification of salt or other foods with KI

Exhaled Nitric Oxide is Not a Biomarker for Pulmonary Tuberculosis.

To reduce transmission of tuberculosis (TB) in resource-limited countries where TB remains a major cause of mortality, novel diagnostic tools are urgently needed. We evaluated the fractional concentration of exhaled nitric oxide (FeNO) as an easily measured, noninvasive potential biomarker for diagnosis and monitoring of treatment response in participants with pulmonary TB including multidrug resistant-TB in Lima, Peru. In a longitudinal study however, we found no differences in baseline median FeNO levels between 38 TB participants and 93 age-matched controls (13 parts per billion [ppb] [interquartile range (IQR) = 8-26] versus 15 ppb [IQR = 12-24]), and there was no change over 60 days of treatment (15 ppb [IQR = 10-19] at day 60). Taking this and previous evidence together, we conclude FeNO is not of value in either the diagnosis of pulmonary TB or as a marker of treatment response