Objective
The pediatric cancer Psychosocial Standards of Care calls for psychosocial screening across the cancer trajectory. The current study aims to describe pediatric cancer family needs at the ...end of treatment (EOT) and summarize feedback on a clinical EOT screening and education program.
Methods
During a clinic visit, families attended an education session regarding general EOT considerations and caregivers and youth aged 11+ years completed questionnaires. Scores were coded for clinical significance based on cutoff scores per questionnaire, and clinical significance frequencies were calculated. Caregivers provided qualitative feedback on the EOT program via an open‐ended prompt.
Results
Screening was completed by 151 families. Ninety‐four patients (67.1%) endorsed risk by self‐ or proxy‐report in at least one domain. Across all patient age groups, a symptom of neurocognitive functioning was the most frequently endorsed risk, including executive functioning, sustained focused, and thinking slower than others. For caregivers, 106 (74.1%) endorsed risk in at least one domain, with concerns for ability to manage their child's medical condition as the most frequent endorsement. Families were agreeable to an EOT program with many caregivers advocating for receiving this program earlier.
Conclusions
Both patients and caregivers experienced clinically significant needs that require intervention at EOT. While patients are experiencing neurocognitive effects and distress, their caregivers are balancing management of their own distress with management of their child's needs during a transition to decreased support from the medical team. The findings affirm the need for systematic screening at EOT and anticipatory guidance for off treatment expectations.
The present study evaluated the use of camelina (CO) and black soldier fly larvae (BSFLO) oils as replacements of fish oil (FO) in diets for juvenile Totoaba macdonaldi, and their effect on growth, ...proximate composition, fatty acid (FA) profile of tissues, and gene expression of bile salt-dependent (BSDL) and colipase-dependent (CDPL) pancreatic lipases. Four isoproteic (51% crude protein) and isolipidic (14% crude fat) diets were formulated based on a 2 × 2 factorial design with two lipid sources, CO and BSFLO, each tested at two levels of replacement of FO, 30 and 60%. A control diet containing 100% FO was included as a reference. Fish with an overall initial weight (mean ± standard deviation, S.D.) of 3.0 ± 0.1 g were stocked at a density of 100 fish m−3. Each diet was randomly assigned to five replicate tanks, and four tanks for the control. After 7 weeks, weight gain (WG, P = 0.0302) and thermal growth coefficient (TGC, P = 0.0408) were significantly reduced in fish fed the 60% FO replacement level in comparison to the 30% level; fish fed diets containing 30% BSFLO were the only ones achieving statistically similar WG (59.40 g) and TGC (0.175) as fish fed the control diet (WG of 60.68 g and TGC of 0.177). Muscle and liver tissues of fish reflected the FA profiles of experimental diets; fish fed BSFLO showed greater content of lauric acid (12:0) in muscle (0.14–0.17 mg g−1), while alpha-linolenic acid (18:3n-3) was higher in those fed CO (0.25–0.51 mg g−1). Docosahexaenoic acid (22:6n-3) content was statistically similar in fillets from all different treatments, demonstrating selective retention of this biologically important FA, but eicosapentaenoic acid (20:5n-3) decreased as the level of FO replacement by CO or BSFLO in diets increased. The presence of BSDL and CDPL in the digestive tract of T. macdonaldi was confirmed for the first time, but regulation of their gene expression was not significantly affected at a transcriptional level by the progressive replacement of FO by CO or BSFLO under these experimental conditions. These findings suggest that 30% of FO can be successfully replaced by BSFLO in diets for juvenile T. macdonaldi, and a 100 g fillet from fish fed this diet would provide 284 mg of DHA + EPA, satisfying the daily intake recommended for adult consumers.
•Black soldier fly larvae oil can effectively replace 30% of fish oil in juvenile T. macdonaldi diets, but not camelina oil.•A 100 g fillet from fish fed this diet would provide 284 mg of DHA+EPA, satisfying the recommended daily intake for consumers.•Bile salt-dependent and colipase-dependent pancreatic lipases in T. macdonaldi were confirmed for the first time.•Their gene expression was not significantly affected at a transcriptional level by fish oil replacement under these conditions.
In a 6-week feeding trial with juvenile red drum, Sciaenops ocellatus (mean initial weight of 2.3±0.1g), a control diet was formulated to contain 40% crude protein, with equal contributions from ...fishmeal (FM) and soy protein concentrate (SPC) as the protein sources, and 10% crude fat, using fish oil (FO) as the main lipid source. Then, in five experimental diets, 10, 20, 30, 40 and 50% of FM, SPC, and FO in the control diet was replaced by combinations of meals from the freshwater autotroph Arthrospira sp. and the heterotroph thraustochytrid Schizochytrium limacinum. In a sixth diet, FO was completely replaced by S. limacinum meal. Growth, feed utilization, and the majority of the body condition indices evaluated in fish fed the microalgae meals were not significantly (P>0.05) different from that of fish receiving the control diet. While slight changes were observed in the proximate composition of whole fish after receiving the test diets, increased proportions of 22:6n−3 and 16:0, alongside decreases of 18:1n−9, 18:1n−5, and 18:2n−6 were observed in whole body, muscle tissue and liver of fish, which mirrored the diet composition. Overall, results of the present study indicate that up to 50% of dietary FM, SPC, and FO can be replaced by Arthrospira sp. and S. limacinum meals without compromising fish performance. In addition, S. limacinum meal can be used as the chief source of lipid for this species. In terms of absolute inclusion levels of the microalgae meals, the diet with the highest level of FM-FO replacement (50%) contained 28.87% Arthrospira sp. and 6.72% S. limacinum meals (35.59% altogether). While this is already a considerable level of incorporation of algal meals in diets for a carnivorous fish, there seems to be scope for further FM-FO replacement in the diet of red drum.
•Up to 50% of fishmeal and fish oil of a control diet can be replaced by algal meals in the diet of Sciaenops ocellatus.•Schizochytrium limacinum meal can be used as the chief source of dietary lipid for this species.•These results advance the use of sustainable alternative protein and lipid feedstuffs for marine carnivorous fish diets.•Also, they help minimize environmental impacts of the use of fishmeal and fish oil, the global supply of which is dwindling, although demand and price are increasing.•There seems to be scope for further fishmeal and fish oil replacement in the diet of S. ocellatus.
Juveniles of wild Pacific blue shrimp Litopenaeus stylirostris (mean initial weight ± standard deviation = 1.5 ± 0.1 g) were acclimated from a natural seawater salinity of 35‰ to salinities of 0, ...2.5, 5.0, 7.5, 10, 15, and 25‰. After reaching the desired salinities, L. stylirostris were cultured for 32 d and growth, feed conversion ratio, and survival, as well as hemolymph and culture water osmolality, were determined. The L. stylirostris exposed to 0‰ died before or shortly after reaching the salinity end point. Final mean body weight of L. stylirostris held at 2.5‰ (3.1 ± 0.8 g) was significantly reduced compared with all other treatments. In contrast, those held at salinities from 5‰ to 35‰ had similar performance, with mean body final weight ranging from 3.8 to 4.5 g, showing that L. stylirostris can be cultured across this range of salinities without adversely affecting growth, survival, or feed conversion ratio. Litopenaeus stylirostris is a euryhaline organism, able to maintain its hemolymph osmolality relatively constant despite changes in salinity. The isosmotic salinity of L. stylirostris, estimated from the point of intersection between the regression lines of water salinity versus water osmolality and water salinity versus hemolymph osmolality, was 26.7‰. Litopenaeus stylirostris is an efficient osmoregulator with potential for low‐salinity culture.
By-products from finfish processing from fisheries and aquaculture are often discarded. However, the enzymatic content of viscera has potential biotechnological and industrial applications. Such is ...the case for the sciaenids Cynoscion othonopterus, Cynoscion xanthulus, and Cynoscion parvipinnis, which are food and game fishes from the Gulf of California and whose viscera are commonly discarded after fish dressing. In this study, optimum temperature and pH for activity, as well as molecular weights of pepsin from the stomach of C. othonopterus, C. xanthulus, and C. parvipinnis were evaluated for the first time. Pepsin molecular weights were 30, 32.1, and 32.3 kDa, respectively. The highest activity of pepsin against hemoglobin was recorded between 40 and 45?C for C. othonopterus and C. xanthulus and at 40?C for C. parvipinnis. The optimum pH was 2.0 for the three sciaenids. Biochemical characteristics were comparable to pepsins from other marine and freshwater fish species, so they could likely be used in some processes using this enzyme, like collagen extraction, fish silage production, or fish processing, among others.
Some patients with spontaneous coronary artery dissection (SCAD) present as ST-segment-elevation myocardial infarction (STEMI). This study evaluates the characteristics, management and outcomes of ...SCAD patients presenting as STEMI compared to non-ST-segment elevation myocardial infarction (NSTEMI).
We analysed data from consecutive patients included in the prospective Spanish Registry on SCAD. All coronary angiograms were centrally reviewed. All adverse events were adjudicated by an independent Clinical Events Committee.
Between June 2015 to December 2020, 389 patients were included. Forty-two percent presented with STEMI and 56% with NSTEMI. STEMI patients showed a worse distal flow (TIMI flow 0–1 38% vs 19%, p < 0.001) and more severe (% diameter stenosis 85 ± 18 vs 75 ± 21, p < 0.001) and longer (42 ± 23 mm vs 35 ± 24 mm, p = 0.006) lesions. Patients with STEMI were more frequently treated with percutaneous coronary intervention (PCI) (31% vs 16%, p < 0.001) and developed more frequently left ventricular systolic dysfunction (21% vs 8%, p < 0.001). No differences were found in combined major adverse events during admission (7% vs 5%, p = 0.463), but in-hospital reinfarctions (5% vs 1.4%, p = 0.039) and cardiogenic shock (2.6% vs 0%, p = 0.019) were more frequently seen in the STEMI group. At late follow-up (median 29 months) no differences were found in the incidence of major adverse cardiac and cerebrovascular events (13% vs 13%, p-value = 0.882) between groups.
Patients with SCAD and STEMI had a worse angiographic profile and were more frequently referred to PCI compared to NSTEMI patients. Despite these disparities, both short and long-term prognosis were similar in STEMI and NSTEMI SCAD patients.
•In spontaneous coronary artery dissection (SCAD), patients presenting with STEMI showed a worse angiographic profile compared to NSTEMI.•SCAD STEMI patients were more frequently treated with PCI, had larger infarcts with more left ventricular systolic dysfunction.•In-hospital reinfarction and cardiogenic shock were more frequently seen in the STEMI SCAD group.•Long-term prognosis after SCAD did not differ between STEMI and NSTEMI SCAD patients.
The role of renal excretion of Pi in relation to vascular calcification (VC) in patients in the early stages of chronic kidney disease (CKD) is controversial. Thus, we determine the relation between ...fractional excretion of phosphorus (FEP) and VC, measured using two methods in a cross-sectional study of patients with stage 3 CKD. We recorded demographic data, anthropometry, comorbidities and active treatment. We measured 24-hour urine FEP and, in serum, measured fibroblast growth factor 23 (FGF23), α-Klotho, intact parathyroid hormone (iPTH), calcium and phosphorus. VC was measured by lateral abdominal radiography (Kauppila index (KI)) and CT of the abdominal aorta (measured in Agatston units). In 57% of subjects, abnormal VC was present when measured using CT, and in only 17% using lateral abdominal radiography. Factors associated with VC using CT were age, cardiovascular risk factors, vascular comorbidity, microalbuminuria and levels of FGF23, phosphorus and calcium x phosphorus product (CaxP); although only age (OR 1.25, 95% CI 1.11 to 1.41), smoking (OR 21.2, CI 4.4 to 100) and CaxP (OR 1.21, CI 1.06 to 1.37) maintained the association in a multivariate analysis. By contrast, only age (OR 1.35, 95% CI 1.07 to 1.74), CaxP (OR 1.14, CI 1.13 to 1.92) and FEP (OR 1.07,95% CI 1004 to 1.14) were associated with abnormal VC in the lateral abdominal radiography. In conclusion, in patients with stage 3 CKD, the detection of VC by abdominal CT is more sensitive than conventional X-rays. Moreover, CaxP is associated with cardiovascular risk factors and vascular comorbidity; quantification of FEPi in these patients provides additional clinical information in advanced VC detected by KI.
•Extrinsic compression of the LMCA by a pulmonary aneurysm may occur.•Stent implantation is the revascularization strategy of choice in this scenario.•IVUS is mandatory to evaluate LMCA compression, ...guide treatment and assess stent failure mechanism.
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