Low pasture allowance until late gestation in ewes: behavioural and physiological changes in ewes and lambs from lambing to weaning

Low pasture allowance during gestation affects ewes’ BW at parturition, the bond with their lamb, lamb development, and thus also may affect their responses to weaning. The objectives were to determine if native pasture allowance from before conception until late pregnancy affects ewe–lamb behaviours at lambing, ewes’ milk yield, lambs’ BW, and the behavioural and physiological changes of ewes and lambs at weaning. From 23 days before conception until 122 days of pregnancy, 24 ewes grazed on two different native pasture allowances: high (10 to 12 kg of dry matter (DM)/100 kg of BW per day; HPA treatment; n=12) or low (5 to 8 kg of DM/100 kg of BW per day; LPA treatment; n=12). Thereafter, all ewes grazed on Festuca arundinacea and received rice bran and crude glycerine. Ewes’ body condition score (BCS) and BW were recorded during pregnancy and postpartum periods. Milk yield was determined on days 32, 41 and 54 after lambing. Lambs’ BW was recorded from birth until 72 days after lambing. Latency from parturition until the ewe licked her lamb, maternal behaviour score (a test that evaluates maternal attachment to the lamb) and latency for lamb to stand up and suckle were determined. The behaviour of the lambs and ewes was recorded before and after weaning (at 65 days). The ewes’ serum total protein, albumin and globulin concentrations were measured before and after weaning. The HPA ewes presented greater BW (P<0.005) and BCS (P<0.005) than the LPA ewes during pregnancy and postpartum (P<0.04), and had a greater milk yield than the LPA ewes (P<0.03). Treatments did not influence any behaviour at lambing, lambs’ BW, neither the ewes’ behavioural and physiological changes at weaning. HPA lambs paced and vocalized more than LPA lambs (P<0.0001). The variation of albumin concentration before and after weaning was greater in the HPA lambs than in the LPA lambs (P<0.0001). In conclusion, although ewes’ BW, BCS and milk production were affected by pasture allowance until late pregnancy, this did not affect the behaviours that lead to the establishment of the mother–young bond, nor the ewes’ behavioural responses at weaning. Lambs reared by ewes that grazed on low pasture allowance during pregnancy presented fewer behavioural changes and a lower decrease of albumin concentration after weaning. Lambs’ BW was not affected by the feeding received by their mothers.     

沙利度胺对原发性肝癌介入后血管内皮生长因子及生存质量的影响

目的:探讨沙利度胺对原发性肝癌(HCC)介入后血管内皮生长因子(VEGF)及生存质量的影响。方法:将2014年1月至2016年1月期间我院收治的拟行肝动脉栓塞化疗(TACE)的HCC患者60例按照随机数字表法分为A、B两组,各30例。A组患者采用TACE+沙利度胺治疗,每晚200 mg,口服一个月;B组患者单行TACE治疗。分别于治疗前、治疗后3周检测两组患者的VEGF水平,于治疗前、治疗后1个月应用生存质量评分量表(QOL)评价患者生存质量,并比较两组患者治疗前后的体重及治疗过程中的不良反应。结果:治疗前两组患者血清VEGF水平差异无统计学意义(P0.05)。治疗后两组患者VEGF水平均较治疗前升高,其中A组患者治疗后VEGF水平显著低于B组患者(P0.01)。治疗前两组患者QOL分数和体重比较差异无统计学意义(P0.05)。而治疗后两组患者的QOL分数较治疗前均有所降低,但A组患者的QOL分数显著高于B组患者(P0.05),而两组患者治疗后的体重无统计学差异(P0.05)。A组30例患者中有1例(3.33%)患者因严重嗜睡、2例(6.67%)患者因严重口腔干燥而终止口服沙利度胺,其余27例患者均能耐受。结论:沙利度胺联合TACE方法治疗HCC可降低VEGF水平和改善癌症患者的生存质量,值得在临床上推广使用。     

Cardiac resynchronization: insight from experimental and computational models

Cardiac resynchronization therapy (CRT) is a promising therapy for heart failure patients with a conduction disturbance, such as left bundle branch block. The aim of CRT is to resynchronize contraction between and within ventricles. However, about 30% of patients do not respond to this therapy. Therefore, a better understanding is needed for the relation between electrical and mechanical activation. In this paper, we focus on to what extent animal experiments and mathematical models can help in order to understand the pathophysiology of asynchrony to further improve CRT.     

Major threats to early safety after transcatheter aortic valve implantation in a contemporary cohort of real-world patients

IntroductionDespite considerable advances in the last decade, major adverse events remain a concern after transcatheter aortic valve implantation (TAVI). The aim of this study was to provide a detailed overview of their underlying causes and contributing factors in order to identify key domains for quality improvement.MethodsThis observational, prospective registry included all patients undergoing TAVI between 31 December 2015 and 1 January 2020 at the St. Antonius Hospital in Nieuwegein and the University Medical Centre in Utrecht. Outcomes of interest were all-cause mortality, stroke, major bleeding, life-threatening or disabling bleeding, major vascular complications, myocardial infarction, severe acute kidney injury and conduction disturbances requiring permanent pacemaker implantation within 30 days after TAVI, according to the Valve Academic Research Consortium‑2 criteria.ResultsOf the 1250 patients who underwent TAVI in the evaluated period, 146 (11.7%) developed a major complication. In 54 (4.3%) patients a thromboembolic event occurred, leading to stroke in 36 (2.9%), myocardial infarction in 13 (1.0%) and lower limb ischaemia in 11 (0.9%). Major bleeding occurred in 65 (5.2%) patients, most frequently consisting of acute cardiac tamponade (n = 25; 2.0%) and major access-site bleeding (n = 21; 1.7%). Most complications occurred within 1 day of the procedure. Within 30 days a total of 54 (4.3%) patients died, the cause being directly TAVI-related in 30 (2.4%). Of the patients who died from causes that were not directly TAVI-related, 14 (1.1%) had multiple hospital-acquired complications.ConclusionA variety of underlying mechanisms and causes form a wide spectrum of major threats affecting early safety in 11.7% of patients undergoing TAVI in a contemporary cohort of real-world patients.Supplementary InformationThe online version of this article (10.1007/s12471-021-01638-8) contains supplementary material, which is available to authorized users.     

Transcatheter tricuspid valve repair: early experience in the Netherlands

BackgroundSymptomatic tricuspid regurgitation (TR) is increasingly prevalent and impairs quality of life and survival, despite medical treatment. Transcatheter tricuspid valve repair (TTVR) has recently become available as a treatment option for patients not eligible for tricuspid valve surgery. In this study we describe the early experience with TTVR in the Netherlands.MethodsAll consecutive patients scheduled for TTVR in two tertiary hospitals were included in the current study. Patients were symptomatic and had severe functional TR. TTVR was performed either with the MitraClip (off-label use) or dedicated TriClip delivery system and device. Procedural success was defined as achievement of clip implantation, TR reduction ≥ 1 grade and no need for re-do surgical or transcatheter intervention. Clinical improvement was evaluated after 4 weeks.ResultsTwenty-one patients (median age 78 years, 33% male, 95% New York Heart Association class ≥ 3, 100% history of atrial fibrillation) underwent TTVR. Procedural success was achieved in 16 patients, of whom 15 reported symptomatic improvement (New York Heart Association class 1 or 2). There was no in-hospital mortality and no major complications occurred. Baseline glomerular filtration rate and TR coaptation gap size were associated with procedural success.ConclusionThe current study showed that TTVR seems a promising treatment option for patients with severe functional TR deemed high risk for surgery. Successful TR reduction is most likely in patients with limited coaptation gap size and strongly determines clinical benefit. Adequate patient selection and timing of treatment seem essential for an optimal patient outcome.Supplementary InformationThe online version of this article (10.1007/s12471-021-01613-3) contains supplementary material, which is available to authorized users.     

Correlation between the sudden jump-like increases of the atrio-Hisian interval induced during burst atrial pacing and during programmed atrial stimulation in patients with atrioventricular nodal reentrant tachycardia

Purpose

To study the correlation between the sudden prolongations of the atrio-Hisian (AH) interval with ≥50 ms during burst and programmed atrial stimulation, and to define whether the AH jump during burst atrial pacing is a reliable diagnostic criterion for dual AV nodal physiology.

TACE与手术治疗原发性大肝癌的临床疗效比较

目的:比较经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)和手术治疗原发性大肝癌(肿瘤最大直径≥5 cm)的临床疗效和安全性。方法:回顾性分析48例经TACE或手术(Operation)治疗的原发性大肝癌患者,其中TACE组25例,Operation组23例,治疗后随访24个月,评价和比较其治疗效果、生存曲线、镇痛剂的日平均用量及不良反应的发生情况。结果:治疗后3个月,TACE组患者的Karnofsky评分(P=0.033)显著高于Operation组,而血清甲胎蛋白(AFP)水平(P=0.022)显著低于Operation组。此外,TACE组的镇痛药杜冷丁的日均使用量显著低于Operation组(P=0.031),便秘的日均发生次数(P=0.045)显著少于Operation组。治疗后24个月,TACE组和Operation组的生存率分别为48.0%和17.4%,TACE组显著高于Operation组(P=0.0415,95%CI of ratio:1.006 to 1.994)。结论:TACE治疗原发性大肝癌的临床疗效可能优于手术治疗,且安全性高。     

DynaCT对肝转移瘤介入治疗具有指导意义

为了探讨锥形束CT (DynaCT)在肝癌患者实施经导管肝动脉化疗栓塞(TACE)手术治疗中的指导作用、栓塞效果评估中的价值,本研究选取了2012年3月至2015年5月在本院实施TACE手术治疗的102例原发性肝癌或转移性肝癌患者进行研究。通过对102例患者病灶进行手术前螺旋CT检测、术中数字减影血管造影(DSA)及DynaCT检测,并对比DSA与DynaCT对肝癌病灶、供血动脉、术后栓塞效果的检测结果。本研究发现术前普通螺旋CT共计检出病灶105个,术中DSA检出病灶数目176个,DynaCT术中检出肿瘤病灶285个;DynaCT和DSA的平均检出病灶数目均显著的高于普通螺旋CT (p<0.05),DynaCT平均检出病灶数目均显著的高于DSA (p<0.05);DynaCT的病灶供血动脉检出率为86.67%,显著地高于DSA (55.68%)(p<0.05);DynaCT检出的285个病灶对栓塞效果评估结果与实际栓塞效果一致的有271个病灶(95.09%),DSA评估结果与实际结果一致的有138个病灶(78.41%),DynaCT对于TACE术后效果评估的一致性高于DSA (p<0.05)。本研究表明,DynaCT在肝癌患者实施TACE手术治疗中能够更有效的发现病灶,指导栓塞操作。     

碳酸氢钠+载药微球经肝动脉化疗栓塞治疗中晚期肝癌的临床效果

目的:探讨碳酸氢钠+载药微球经肝动脉化疗栓塞治疗中晚期肝癌的临床效果及安全性。方法:选择2015年2月到2018年6月在我院诊治的中晚期肝癌患者78例,根据随机数字表法将其均分为两组,每组各39例。对照组给予载药微球经肝动脉化疗栓塞治疗,实验组给予碳酸氢钠+载药微球经肝动脉化疗栓塞治疗,比较两组的临床疗效,治疗前后CD3~+CD4~+、CD3~+CD8~+T细胞比例的变化,治疗期间不良反应的发生情况及预后。结果:治疗后,实验组与对照组的治疗总有效率分别为74.4%和43.6%,实验组显著高于对照组(P0.05)。实验组治疗期间的发热、腹痛、腹胀、呕吐等不良反应发生情况与对照组的对比差异无统计学意义(P0.05)。两组治疗前后CD3CD4~+T比例对比差异无统计学意义(P0.05),两组治疗后的CD3~+CD8~+T比例显著低于治疗前,且实验组明显低于对照组(P0.05)。治疗后,实验组的躯体功能、心理功能、社会功能、共性症状及副作用评分都低于对照组(P0.05)。结论:碳酸氢钠+载药微球经肝动脉化疗栓塞治疗中晚期肝癌能提高治疗效果,改善机体的免疫功能,提高患者的生活质量,且不会增加不良反应。     

Transcatheter aortic valve implantation amid the COVID-19 pandemic: a nationwide analysis of the first COVID-19 wave in the Netherlands

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic has put tremendous pressure on healthcare systems. Most transcatheter aortic valve implantation (TAVI) centres have adopted different triage systems and procedural strategies to serve highest-risk patients first and to minimise the burden on hospital logistics and personnel. We therefore assessed the impact of the COVID-19 pandemic on patient selection, type of anaesthesia and outcomes after TAVI.MethodsWe used data from the Netherlands Heart Registration to examine all patients who underwent TAVI between March 2020 and July 2020 (COVID cohort), and between March 2019 and July 2019 (pre-COVID cohort). We compared patient characteristics, procedural characteristics and clinical outcomes.ResultsWe examined 2131 patients who underwent TAVI (1020 patients in COVID cohort, 1111 patients in pre-COVID cohort). EuroSCORE II was comparable between cohorts (COVID 4.5 ± 4.0 vs pre-COVID 4.6 ± 4.2, p = 0.356). The number of TAVI procedures under general anaesthesia was lower in the COVID cohort (35.2% vs 46.5%, p < 0.001). Incidences of stroke (COVID 2.7% vs pre-COVID 1.7%, p = 0.134), major vascular complications (2.3% vs 3.4%, p = 0.170) and permanent pacemaker implantation (10.0% vs 9.4%, p = 0.634) did not differ between cohorts. Thirty-day and 150-day mortality were comparable (2.8% vs 2.2%, p = 0.359 and 5.2% vs 5.2%, p = 0.993, respectively).ConclusionsDuring the COVID-19 pandemic, patient characteristics and outcomes after TAVI were not different than before the pandemic. This highlights the fact that TAVI procedures can be safely performed during the COVID-19 pandemic, without an increased risk of complications or mortality.Supplementary InformationThe online version of this article (10.1007/s12471-022-01704-9) contains supplementary material, which is available to authorized users.