Lactogenic immunity is important for the protection of piglets against many pathogens including porcine epidemic diarrhea virus. Circulating neutralizing antibodies levels in sow sera may help ...determine if a detectable immune response could confer protection to piglets. Neutralizing antibodies can be detected through various diagnostic assays. This study evaluated the diagnostic characteristics of two neutralizing antibody assays for porcine epidemic diarrhea virus neutralizing antibodies in serum of challenged gilts. Four treatment groups, control, non-vaccinated, vaccinated prior to challenge, and vaccinated following challenge, were comprised of 20 gilts. Serum sample were collected from each gilt prior to and following challenge with porcine epidemic diarrhea virus. Samples were evaluated for the presence of neutralizing antibodies via a fluorescent focus neutralization assay and a high-throughput neutralization assay. Diagnostic sensitivity and specificity for the fluorescent focus neutralization and high-throughput neutralization assays for this study were optimized at a cutoff of a dilution of 80 and 80% fluorescent reduction respectively and demonstrated moderate agreement based off the kappa statistic. The focus fluorescent neutralization and high-throughput neutralization assays can be used to monitor the status of neutralizing antibodies within animals or a population of animals. The high-throughput assay has advantages over the focus fluorescent assay in that it has a higher specificity at the indicated cut-off and the nature of the results allows for more discrimination between individual results.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Clinicians intuitively recognize that faster time to hemostasis is important in bleeding trauma patients, but these times are rarely reported.
Prospectively collected data from the Pragmatic ...Randomized Optimal Platelet and Plasma Ratios trial were analyzed. Hemostasis was predefined as no intraoperative bleeding requiring intervention in the surgical field or resolution of contrast blush on interventional radiology (IR). Patients who underwent an emergent (within 90 minutes) operating room (OR) or IR procedure were included. Mixed-effects Poisson regression with robust error variance (controlling for age, Injury Severity Score, treatment arm, injury mechanism, base excess on admission missing values estimated by multiple imputation, and time to OR/IR as fixed effects and study site as a random effect) with modified Bonferroni corrections tested the hypothesis that decreased time to hemostasis was associated with decreased mortality and decreased incidence of acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), multiple-organ failure (MOF), sepsis, and venous thromboembolism.
Of 680 enrolled patients, 468 (69%) underwent an emergent procedure. Patients with decreased time to hemostasis were less severely injured, had less deranged base excess on admission, and lower incidence of blunt trauma (all p < 0.05). In 408 (87%) patients in whom hemostasis was achieved, every 15-minute decrease in time to hemostasis was associated with decreased 30-day mortality (RR, 0.97; 95% confidence interval CI, 0.94-0.99), AKI (RR, 0.97; 95% CI, 0.96-0.98), ARDS (RR, 0.98; 95% CI, 0.97-0.99), MOF (RR, 0.94; 95% CI, 0.91-0.97), and sepsis (RR, 0.98; 95% CI, 0.96-0.99), but not venous thromboembolism (RR, 0.99; 95% CI, 0.96-1.03).
Earlier time to hemostasis was independently associated with decreased incidence of 30-day mortality, AKI, ARDS, MOF, and sepsis in bleeding trauma patients. Time to hemostasis should be considered as an endpoint in trauma studies and as a potential quality indicator.
Therapeutic/care management, level III.
Temporal changes in fibrinolytic activity after injury and their impact on outcomes remain poorly defined. We conducted a prospective, multicenter cohort study to determine the incidence of ...fibrinolytic phenotypes after injury and the trajectories and associated outcomes of these phenotypes over time.
We included adults that arrived within 6 hours of injury to three American Level I trauma centers. Clot lysis at 30 minutes (LY-30) was measured at presentation and at 3 hours, 6 hours, 12 hours, 24 hours, 48 hours, 72 hours, 96 hours, and 120 hours. LY-30 was used to categorize patients into the following fibrinolytic phenotypes: fibrinolysis shutdown (SD, LY-30 ≤0.8%), physiologic fibrinolysis (PHYS, LY-30 >0.8% to <3%), or hyperfibrinolysis (HF, LY-30 ≥3%). We used multivariable logistic regression to estimate adjusted odds ratios for mortality.
We included 795 adults (median age, 38 years; median Injury Severity Scale score, 21). In total, 44% presented with SD, 36% with PHYS, and 21% with HF. Mortality was highest among those who presented with HF (20%) followed by SD (10%) and PHYS (7%) (p = 0.001). While mortality within the first 24 hours was highest with admission HF (14% vs. 5% SD vs. 4% PHYS; p = 0.001), both admission HF (7%) and SD (6%) had higher mortality after 24 hours compared with PHYS (3%) (p = 0.04). All patients who presented with HF switched into another phenotype or died within 24 hours. The majority of patients that presented in SD remained in that phenotype, including 71% at 24 hours and 72% at 120 hours. Persistent SD at 24 hours was independently associated with increased mortality after 24 hours (odds ratio, 3.20; 95% confidence interval, 1.51-6.67).
Approximately 70% of major trauma patients who present with SD remain in this phenotype up to 120 hours postinjury. In contrast, patients presenting with HF transition into another phenotype or die within 24 hours. While early mortality is highest with the HF phenotype, persistent SD at 24 hours is associated with elevated late mortality.
Prognostic and epidemiological study, level II.
Objective parameters predicting futility of care in severely injured pediatric patients are lacking. Although futility of care has been investigated in a limited number of studies in trauma patients, ...none of these studies achieves a 100% success rate in a large cohort of pediatric patients. The purpose of the current study was to identify extreme laboratory values that could be used to predict 100% mortality in severely injured children.
We evaluated a registry-based, historical cohort of all severely injured children (Level I trauma, younger than 16 years old) who were not dead on arrival between January 2010 and December 2016 from a single Level I trauma center. Extreme arrival laboratory data were evaluated both alone and in conjunction with traumatic brain injury.
There were 1,292 patients who met inclusion criteria, of which 1,169 (90.5%) survived and 123 (9.5%) died. Those who died were significantly younger, with higher head Abbreviated Injury Scale scores and overall Injury Severity Scores. Single extreme laboratory values were identified that predicted mortality perfectly (100% positive predictive value): international normalized ratio ≥3.0, pH ≤6.95, base excess ≤ -22, platelet count ≤30,000, hemoglobin ≤5.0 g/dL, rapid thromboelastography ≤30 mm, and rapid thromboelastography lysis at 30 minutes ≥50%. When 2 laboratory values or the presence of traumatic brain injury were added, lower thresholds for futility were noted.
Extreme admission laboratory values are capable of predicting 100% mortality and futility of additional care in severely injured children with a high level of accuracy. Validation of these single-center findings is warranted and, if supported, should initiate a discussion within the pediatric trauma community about application and cessation of resuscitation efforts to optimize resource use.
Summary
Background
There remains a need to understand how information sources can promote young children's healthy beverage consumption and prevent obesity.
Objectives
To examine associations of ...mothers' primary feeding information source with children's sugar‐sweetened beverage (SSB) intake, 100% juice intake and adiposity between ages 3 and 7 years.
Methods
We analyzed data from a prospective cohort study (n = 371 children; 13 visits). Mothers reported their primary feeding information source at baseline and completed child 3‐day dietary records each visit. Child adiposity indicators were calculated from repeated height/weight measurements and dual‐energy X‐ray absorptiometry. Longitudinal models examined beverage intakes and adiposity over time by source.
Results
Primary feeding information sources included doctors (48.2%), mothers (17.5%), grandmothers (13.5%), other healthcare professionals (11.3%) and other family/friends (9.4%). Children's juice intake with age differed by source (P interaction = 0.03), with steepest and slightest intake decreases in the doctor (−19.7% each year; 95% CI: −23.7%, −15.5%) and grandmother (−5.0%; −14.5%, 5.5%) subgroups, respectively. Children's SSB intake did not differ by source, but increased annually by 7.1% (4.5%, 9.8%) overall. The grandmother subgroup had the greatest child adiposity over time.
Conclusions
Mothers' primary feeding information source may have important, yet heterogeneous, influences on young children's beverage intakes and adiposity over time. Consistent evidence‐based messages are likely needed.
Variation in blood lead concentration is caused by a complex interaction of environmental, social, nutritional, and genetic factors. We evaluated the association between blood lead concentration and ...a vitamin D receptor (VDR) gene polymorphism. Environmental samples and blood were analyzed for lead, nutritional and behavioral factors were assessed, and VDR -Foki genotype was determined in 245 children. We found a significant interaction between floor dust lead and genotype on blood lead concentration. For every 1$\mug/ft^2$increase in floor dust, children with VDR -FF genotype had a 1.1% increase in blood lead 95% confidence interval (CI), 0.69-1.5, VDR -Ff, 0.53% increase (95% CI, 0.1-0.92), and VDR -iff 3.8% increase (95% CI, 1.2-6.3); however, at floor dust levels < 10$\mug/ft^2$, children with VDR -ffhad the lowest blood lead concentrations. These data suggest that VDR -Fokl is an effect modifier of the relationship of floor dust lead exposure and blood lead concentration.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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