Publications by authors named "Palazzo F"

223 Publications

Biochemical Profile Affects IoPTH Kinetics and Cure Rate in Primary Hyperparathyroidism.

Authors:
F Fausto Palazzo

World J Surg 2020 02;44(2):496-497

Hammersmith Hospital, Imperial College London, London, UK.

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http://dx.doi.org/10.1007/s00268-019-05222-5DOI Listing
February 2020

Parathyroid surgery: an evidence-based volume-outcomes analysis : European Society of Endocrine Surgeons (ESES) positional statement.

Langenbecks Arch Surg 2019 Dec 8;404(8):919-927. Epub 2019 Oct 8.

Department of Endocrine Surgery, Hammersmith Hospital, London, UK.

Background: The interest in correlation between hospital and surgeon practice volume and postoperative outcomes has grown considerably over the last decades; it has been suggested that surgery is likely to be associated with higher cure rates, lower morbidity and more favourable results in cost-effectiveness when performed in a high-volume setting. The aim of this paper is to undertake an evidence-based literature review of the relationship between surgical volume and clinical outcomes in parathyroidectomy for primary hyperparathyroidism. We used accepted quality markers to identify the relationship between volume and outcome with a view to defining a reproducible minimal surgical volume-related standard of care in parathyroid surgery.

Methods: A peer review literature analysis of volume and outcomes in parathyroid surgery was carried out and assessed from an evidence-based perspective. Results were discussed at the 2019 Conference of the European Society of Endocrine Surgeons devoted to "Volumes, Outcomes and Quality Standards in Endocrine Surgery".

Results: Literature reports no prospective randomised studies; thus, a low level of evidence may be achieved.

Conclusions: Parathyroid surgery is at increased risk of failures, morbidity and need for reoperations and cost when performed in low-volume settings; thus, it should be concentrated in dedicated settings, with adequate annual volume and expertise. Acceptable results may be achieved moving parathyroid surgery cases away from low-volume settings (< 15 parathyroidectomies/year). Challenging procedures (primary hyperparathyroidism without unequivocal preoperative localization, hereditary variants, paediatric patients, reoperations) should be confined to high-volume settings (> 40 parathyroidectomies/year).
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http://dx.doi.org/10.1007/s00423-019-01823-9DOI Listing
December 2019

Optimal timing and route of nutritional support after esophagectomy: A review of the literature.

World J Gastroenterol 2019 Aug;25(31):4427-4436

Department of Surgery, Thomas Jefferson University Hospital. Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA 19107, United States,

Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy. Variation in practices during the perioperative period exists including the type of nutrition started, the delivery route, and its timing. Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery, which can affect their ability to regain or maintain weight. Methods of feeding after an esophagectomy include total parenteral nutrition, nasoduodenal/nasojejunal tube feeding, jejunostomy tube feeding, and oral feeding. Recent evidence suggests that early oral feeding is associated with shorter LOS, faster return of bowel function, and improved quality of life. Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe, feasible, and cost-effective, albeit with limited data. However, data on anastomotic leaks is mixed, and some studies suggest that the incidence of leaks may be higher with early oral feeding. This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach. No definitive data is currently available to definitively answer this question, and further studies should look at how these early feeding regimens vary by surgical technique. This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.
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http://dx.doi.org/10.3748/wjg.v25.i31.4427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710171PMC
August 2019

Chemical-nutritional parameters and volatile profile of eggs and cakes made with eggs from ISA Warren laying hens fed with a dietary supplementation of extruded linseed.

Asian-Australas J Anim Sci 2020 Jul 26;33(7):1191-1201. Epub 2019 Aug 26.

Faculty of BioScience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo 64100, Italy.

Objective: The aim of this study was to evaluate the chemical-nutritional parameters, oxidative stability and volatile profile of eggs and cakes made with eggs from laying hens fed with a dietary supplementation of extruded linseed.

Methods: Two thousand ISA Warren laying hens were randomly divided into two groups: a control group was fed with a standard diet while the experimental group received the same diet supplemented with 7% of extruded linseed. The trial lasted 84 days, in which three samplings of laid eggs were performed. Samples of eggs and food systems arising from eggs were then analyzed in order to obtain information about β-carotene and total flavonoid content, antioxidant activity, fatty acid profile, lipid oxidation, and volatile profile.

Results: Linseed induced the increase of α-linolenic acid with consequent reduction of the ω-6/ω-3 ratio (4.3:1 in egg yolk); in addition to this, was evidenced the cholesterol reduction and the significant increase in total flavonoids and β-carotene, although no variations were detected in antioxidant capacity. Even in cooked products there was not only a direct effect of linseed in increasing α-linolenic acid, but also in inducing the reduction of cholesterol and its major oxidation product, 7-ketocholesterol. The dietary linseed integration was also shown to affect the volatile profile of baked products.

Conclusion: Data confirmed that dietary supplementation with extruded linseed resulted in food products with interesting implications for human health. With regard to the volatile profile of baked products it would be necessary undertake further sensorial analysis in order to evaluate any variations on flavor and consumer acceptability.
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http://dx.doi.org/10.5713/ajas.19.0309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322661PMC
July 2020

Six-month readmissions after bariatric surgery: Results of a nationwide analysis.

Surgery 2019 11 6;166(5):926-933. Epub 2019 Aug 6.

Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.

Background: Morbidity and mortality after laparoscopic bariatric surgery have decreased steadily during the past 2 decades. National data on the rates at which these patients may require return to the hospital beyond 30 days are lacking. We aimed to determine the national burden and causes of readmission after the 3 most common bariatric procedures in the United States.

Methods: All adult patients with morbid obesity (>18 years old) who underwent a laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, or laparoscopic gastric bypass between 2010 and 2015 were identified using International Classification of Diseases, Ninth Revision codes from the Nationwide Readmission Database. The Nationwide Readmission Database permits longitudinal tracking of patients between hospital admissions and allows for nationally weighted estimates. The primary outcome was 180-day readmission; secondary outcomes included causes, mortality, time to readmission, costs, and procedures during readmission. Multivariate logistic regression models were used to determine factors associated with increased 180-day readmission after adjusting for differences in patient and hospital characteristics.

Results: Records from 228,043 patients were identified, of whom 10.1%, 36.1%, and 53.9% underwent laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass, respectively. The overall 180-day readmission rate was 10.8% (laparoscopic adjustable gastric banding 8.3%, LGS 7.8% and laparoscopic gastric bypass 13.2%). Readmission analysis showed that 64.5% were directly relates directly to the index procedure, 31.2% were readmitted to a different hospital, the median time to readmission was 28 days (interquartile ratio 9-77), 23.9% had a gastrointestinal procedure, and 0.48% died within the 180-day readmissions. Factors independently associated with increased readmission were the following: greater preoperative comorbidities (Charlson Comorbidity Index ≥2, odds ratio 1.32; 95% confidence interval, 1.22-1.44); either Medicare status (1.84 [1.72-1.97]) or Medicaid status (1.60 [1.48-1.73]) relative to private insurance; moderate (1.09 [1.03-1.15]) or major (1.33 [1.13-1.56]) severity of illness relative to minor Nationwide Readmission Database-provided severity of illness; nonresident of state where they were admitted initially (1.49 [1.31-1.69]); discharge to a health care system other than home (1.70 [1.46-1.97]); short-term hospital 1.70 [1.46-1.97]); admission to private hospital (1.11 [1.01-1.22]) relative to nonprofit hospital; prolonged duration of initial hospital stay (1.81 [1.70-1.92]); and a serious adverse event occurring during the index admission (1.20 [1.02-1.42]). Patients who were readmitted had an incremental mean difference of $15,781 (95% confidence interval, $15,168-$16,394.4; P < .001) in total costs.

Conclusion: Readmissions after bariatric surgery continue to occur even 6 months after discharge. Most of these readmissions were related directly to the index procedure. Almost a fourth of those patients who were readmitted d required a procedure and almost a third presented to a different hospital than the hiatal of their initial operation. These readmissions carry a substantial burden for the health care system and may impair quality of life for patients. Strategies targeted to prevent readmissions beyond the traditional 30-day benchmark are warranted in this population.
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http://dx.doi.org/10.1016/j.surg.2019.06.003DOI Listing
November 2019

Does fluoroscopy prevent inadvertent parathyroidectomy in thyroid surgery?

Ann R Coll Surg Engl 2019 Sep 15;101(7):508-513. Epub 2019 Jul 15.

Department of Endocrine Surgery, Hammersmith Hospital, London, UK.

Introduction: Near-infrared imaging may facilitate intraoperative identification of parathyroid glands by causing autofluorescence but its clinical value has not been established. Inadvertent parathyroidectomy occurs in 5-22% of thyroidectomies and is associated with temporary and permanent hypoparathyroidism. The aim of this study was to determine whether near-infrared imaging prevents inadvertent parathyroidectomy and early hypocalcaemia as a surrogate for permanent hypoparathyroidism.

Materials And Methods: Near-infrared imaging was used in a prospective cohort of consecutive thyroidectomies. Thyroidectomies performed prior to the introduction of near-infrared imaging formed a control group. The thyroid bed and specimen were scanned with near-infrared imaging. Areas of autofluorescence on the specimen were examined and any parathyroid tissue found was autotransplanted. Inadvertent parathyroidectomy was therefore recorded as established intraoperatively by near-infrared imaging (allowing autotransplantation) or on subsequent histology (missed). Serum calcium and parathyroid hormone were measured on day one and at two weeks and six months postoperatively.

Results: A total of 269 patients were included: 106 near-infrared imaging and 163 controls. Inadvertent parathyroidectomy was detected by near-infrared imaging in two (and autotransplantation performed) and histologically (i.e. missed by near-infrared imaging in 13, 12.3% vs 17, 10.4% controls). Neither result was statistically significant ( = 0.08, 0.89). There was no significant difference in serum calcium or parathyroid hormone between near-infrared imaging and control groups at one day, two weeks or thereafter.

Discussion: Near-infrared imaging may detect inadvertent parathyroidectomy and may allow autotransplantation. It did not, however, reduce the incidence of missed inadvertent parathyroidectomy and no difference was seen in early hypocalcaemia or late hypoparathyroidism. Current near-infrared imaging technology does not appear to confer a clinical benefit sufficient to justify its use.
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http://dx.doi.org/10.1308/rcsann.2019.0065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667958PMC
September 2019

Association Between hsa-miR-30e Polymorphisms and Sporadic Primary Hyperparathyroidism Risk.

In Vivo 2019 Jul-Aug;33(4):1263-1269

Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Background/aim: Almost 15% of patients with sporadic primary hyperparathyroidism (sPHPT) present with multiple gland disease (MGD). The aim of this study was to investigate the potential role of two polymorphisms of the hsa-miR-30e, in sPHPT tumorigenesis.

Patients And Methods: One-hundred twenty sPHPT patients, 77 presenting a single adenoma and 43 with MGD, and 54 healthy controls were genotyped. The SNPs were identified using the allele-specific PCR methodology, while the hsa-miR-30e expression was analyzed by real-time quantitative reverse transcriptase PCR.

Results: Hsa-miR-30e expression was found to be significantly higher in patients with MGD compared to patients with single adenomas (p=0.0019), but no differences were found regarding specific genotype carriers. The genotype frequencies for ss178077483 and rs7556088 were significantly different between patients and healthy controls.

Conclusion: Although the polymorphisms cannot be used as biomarkers for the differential diagnosis of MGD, hsa-miR-30e expression could potentially serve as a biomarker for this purpose.
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http://dx.doi.org/10.21873/invivo.11598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689336PMC
December 2019

DLK1/PREF1 marks a novel cell population in the human adrenal cortex.

J Steroid Biochem Mol Biol 2019 10 29;193:105422. Epub 2019 Jun 29.

Centre for Endocrinology, William Harvey Research Institute, Bart's and the London, School of Medicine and Dentistry, Queen Mary University of London, London, UK. Electronic address:

The adrenal cortex governs fundamental metabolic processes though synthesis of glucocorticoid, mineralocorticoids and androgens. Studies in rodents have demonstrated that the cortex undergoes a self-renewal process and that capsular/subcapsular stem/progenitor cell pools differentiate towards functional steroidogenic cells supporting the dynamic centripetal streaming of adrenocortical cells throughout life. We previously demonstrated that the Notch atypical ligand Delta-like homologue 1 (DLK1)/preadipocyte factor 1 (PREF1) is expressed in subcapsular Sf1 and Shh-positive, CYP11B1-negative and CYP11B2-partially positive cortical progenitor cells in rat adrenals, and that secreted DLK1 can modulate GLI1 expression in H295R cells. Here we show that the human adrenal cortex remodels with age to generate clusters of relatively undifferentiated cells expressing DLK1. These clusters (named DLK1-expressing cell clusters or DCCs) increased with age in size and were found to be different entities to aldosterone-producing cell clusters, another well-characterized and age-dependent cluster structure. DLK1 was markedly overexpressed in adrenocortical carcinomas but not in aldosterone-producing adenomas. Thus, this data identifies a novel cell population in the human adrenal cortex and might suggest a yet-to be identified role of DLK1 in the pathogenesis of adrenocortical carcinoma in humans.
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http://dx.doi.org/10.1016/j.jsbmb.2019.105422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736711PMC
October 2019

Perioperative Outcomes and Quality of Life after Repair of Recurrent Hiatal Hernia Are Compromised Compared with Primary Repair.

Am Surg 2019 May;85(5):556-560

Paraesophageal hernia repair (PEHR) is burdened by high recurrence rates that frequently lead to redo PEHR. Revisional surgery, because of higher complexity, higher risk of injury, and the intrinsic risk of recurrence, has increased likelihood of higher complication rates and decreased quality of life (QOL) postoperatively. We aimed to compare perioperative outcomes and QOL after revisional and primary PEHR. A retrospective review of all patients who underwent PEHR for a recurrent hernia between January 2011 and July 2016 was completed. These were matched with a contemporary cohort of patients who underwent primary PEHR by age, gender, and BMI. Perioperative measures were compared. The patients were invited to complete the Gastrointestinal Quality of Life Index (GIQLI) to assess response to surgical intervention. There were 24 patients (group 1) who underwent revisional PEHR, and they were matched to 48 patients (group 2) who had a primary hernia repair. Thirteen patients in group 1 responded to the survey (54%), whereas 21 patients' responses were received from group 2 (44%). Conversion rates, LOS, and mean Gastrointestinal Quality of Life Index scores were significantly different between the two groups. Reoperative procedures for paraesophageal and hiatal hernias are burdened by higher conversion rates and length of stay, with similar overall complication rates. Patients who are undergoing repair of a recurrent hernia should be preoperatively counseled, and should have realistic expectations of their GI QOL after surgery.
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May 2019

Seventeen Cases of Primary Hyperparathyroidism in Pregnancy: A Call for Management Guidelines.

J Endocr Soc 2019 May 20;3(5):1009-1021. Epub 2019 Feb 20.

Department of Surgery and Cancer, Imperial College, London, United Kingdom.

Context: The risks of primary hyperparathyroidism (pHPT) to pregnant women and their fetuses appear to increase commensurate with serum calcium levels. The management strategy for pHPT must be adapted in pregnancy and should reflect the severity of hypercalcemia. However, no guidelines exist to assist clinicians.

Methods: The experience of a high-volume multidisciplinary endocrine surgical service in treating a consecutive series of pregnant women with pHPT referred for parathyroidectomy is presented and data are compared with a nonpregnant cohort with pHPT. A review of pHPT and pregnancy outcomes in the literature is provided.

Results: Seventeen pregnant women and 247 age range-matched nonpregnant women with pHPT were referred for surgery over 11 years. Mean serum calcium level was higher in the pregnant cohort (2.89 vs 2.78 mmol/L; = 0.03). Preoperative localization with ultrasound succeeded in eight pregnant women (47%) and sestamibi scanning did in two of six (33% imaged preconception), compared with 84 (34%) and 102 (42%) control subjects, respectively (not significant). Parathyroidectomy was performed under general anesthesia between 12 and 28 weeks' gestation with no adverse pregnancy outcomes resulting. Cure rate was 100% vs 96% in controls.

Conclusion: pHPT in pregnancy is a threat to mother and child. Medical management may be appropriate in mild disease, but in moderate to severe disease, parathyroidectomy under general anesthesia in the second trimester is safe. Localization using ionizing radiation/MRI is unnecessary, because surgical intervention in a high-volume multidisciplinary setting has excellent outcomes. Guidelines on the topic would assist clinicians.
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http://dx.doi.org/10.1210/js.2018-00340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497920PMC
May 2019

VISUAL VIGNETTE.

Endocr Pract 2020 02 23;26(2):252. Epub 2019 Apr 23.

Department of Endocrine and Thyroid Surgery, Hammersmith Hospital, ImperialCollege London, London, United Kingdom.

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http://dx.doi.org/10.4158/EP-2019-0118DOI Listing
February 2020

Patients with Non-response to Neoadjuvant Chemoradiation for Esophageal Cancer Have No Survival Advantage over Patients Undergoing Primary Esophagectomy.

J Gastrointest Surg 2020 02 26;24(2):288-298. Epub 2019 Feb 26.

Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA.

Background: Survival for patients with locally advanced esophageal cancer remains dismal. Non-response to neoadjuvant chemoradiation (nCRT) portends worse survival. We hypothesized that patients undergoing up-front esophagectomy may have better survival than those who do not respond to nCRT.

Methods: We identified all patients undergoing esophagectomy with a pathologic stage of II or greater at our institution between 1994 and 2015 and separated them into two groups: those who received nCRT and those undergoing up-front esophagectomy. The neoadjuvant group was further separated into patients downstaged to pathologic stage 0 or I (responders) and patients with either the same or higher pathologic stage after nCRT, or with pathologic stage II disease or greater (non-responders). Overall survival was compared between groups using Kaplan-Meier statistics. Covariate-adjusted Cox modeling was used to estimate hazard ratios (HR) for mortality associated with non-response.

Results: Overall, 287 patients met inclusion criteria. Fifty-nine percent of the responders had pathologic complete response (pCR). The majority of non-responders and primary esophagectomy patients had stage II or III disease (94%). Median survival was 58.3 months in responders, 23.9 months in non-responders, and 29.1 months in primary esophagectomy patients (p < 0.01). The HR for mortality associated with non-response was 1.82 compared to response to nCRT (p < 0.01) and 1.09 compared to primary esophagectomy (p = 0.71).

Conclusions: In patients with esophageal cancer who do not respond to nCRT, neoadjuvant therapy may represent a toxic and costly treatment modality that does not improve survival and may delay potentially curative resection. Further research is needed to identify potential non-responders with advanced resectable disease and allow individual tailoring of pre-surgical decision-making.
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http://dx.doi.org/10.1007/s11605-019-04161-9DOI Listing
February 2020

Autofluorescence in Parathyroidectomy: Signal Intensity Correlates with Serum Calcium and Parathyroid Hormone but Routine Clinical Use is Not Justified.

World J Surg 2019 06;43(6):1532-1537

Department of Endocrine Surgery, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.

Background: The inability to identify the pathological gland at surgery results in failure to cure hyperparathyroidism in 2-5%. The poorly understood characteristic of parathyroid tissue to manifest autofluorescence (AF) under near-infrared (NIR) light has been promoted as an intraoperative adjunct in parathyroid surgery. This study sought to explore potential clinical correlates for AF and assess the clinical utility of AF in parathyroid surgery.

Methods: Consecutive patients undergoing parathyroid surgery for primary and renal disease were included. NIR imaging was used intraoperatively and the degree of AF of parathyroid glands graded by the operating surgeon. Variables assessed for correlation with AF were: pre-operative serum calcium and PTH, SestaMIBI positivity, gland weight and histological composition.

Results: Ninety-six patients underwent parathyroidectomy over an 8-month period: 49 bilateral explorations, 41 unilateral and 6 focussed lateral approaches: 284 potentially 'visualisable' glands in total. Two hundred and fifty-seven glands (90.5%) were visualised with NIR. Correlation was found between the degree of fluorescence and pre-operative serum calcium and PTH, but not between gland weight and SestaMIBI positivity. In those with renal hyperparathyroidism, a predominance of oxyphil cells correlated with increased AF.

Conclusion: Autofluorescence intensity correlates with serum calcium, PTH and gland composition. Further refinements would be required for this information to be of value in a clinical setting. Improvements allowing NIR to visualise the additional 9.5% of parathyroids and overcome the variation in signal intensity due to depth of access are required for the routine adoption of this technology. At present, its routine use in a clinical setting cannot be justified.
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http://dx.doi.org/10.1007/s00268-019-04929-9DOI Listing
June 2019

Transcervical excision of a giant mediastinal parathyroid adenoma.

BMJ Case Rep 2019 Feb 7;12(2). Epub 2019 Feb 7.

Department of Endocrine Surgery, Hammersmith Hospital, London, UK.

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http://dx.doi.org/10.1136/bcr-2018-228292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6381945PMC
February 2019

VISUAL VIGNETTE.

Endocr Pract 2019 Aug 18;25(8):862. Epub 2019 Jan 18.

Department of Endocrine and Thyroid Surgery, Hammersmith Hospital, Imperial College London, London, UK.

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http://dx.doi.org/10.4158/EP-2018-0579DOI Listing
August 2019

Rumen microbiome in dairy calves fed copper and grape-pomace dietary supplementations: Composition and predicted functional profile.

PLoS One 2018 29;13(11):e0205670. Epub 2018 Nov 29.

Faculty of Bioscience and Technology for Food, Agriculture and Environment, Università di Teramo, Teramo, Italy.

The rumen microbiome is fundamental for the productivity and health of dairy cattle and diet is known to influence the rumen microbiota composition. In this study, grape-pomace, a natural source of polyphenols, and copper sulfate were provided as feed supplementation in 15 Holstein-Friesian calves, including 5 controls. After 75 days of supplementation, genomic DNA was extracted from the rumen liquor and prepared for 16S rRNA-gene sequencing to characterize the composition of the rumen microbiota. From this, the rumen metagenome was predicted to obtain the associated gene functions and metabolic pathways in a cost-effective manner. Results showed that feed supplementations did alter the rumen microbiome of calves. Copper and grape-pomace increased the diversity of the rumen microbiota: the Shannon's and Fisher's alpha indices were significantly different across groups (p-values 0.045 and 0.039), and Bray-Curtis distances could separate grape-pomace calves from the other two groups. Differentially abundant taxa were identified: in particular, an uncultured Bacteroidales UCG-001 genus and OTUs from genus Sarcina were the most differentially abundant in pomace-supplemented calves compared to controls (p-values 0.003 and 0.0002, respectively). Enriched taxonomies such as Ruminiclostridium and Eubacterium sp., whose functions are related to degradation of the grape- pomace constituents (e.g. flavonoids or xyloglucan) have been described (p-values 0.027/0.028 and 0.040/0.022 in Pomace vs Copper and Controls, respectively). The most abundant predicted metagenomic genes belonged to the arginine and proline metabolism and the two- component (sensor/responder) regulatory system, which were increased in the supplemented groups. Interestingly, the lipopolysaccharide biosynthetic pathway was decreased in the two supplemented groups, possibly as a result of antimicrobial effects. Methanogenic taxa also responded to the feed supplementation, and methane metabolism in the rumen was the second most different pathway (up-regulated by feed supplementations) between experimental groups.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205670PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6264861PMC
April 2019

FA01.02: THE EFFECT OF POSTOPERATIVE COMPLICATIONS AFTER MIE ON LONG-TERM SURVIVAL: A RETROSPECTIVE, MULTI-CENTER COHORT STUDY.

Dis Esophagus 2018 Sep;31(13)

IRCCS Policlinico San Donato, University of Milan, Milan/ITALY.

Background: Esophagectomy has a high incidence of postoperative morbidity. Complications lead to a decreased short-term survival, however the influence of those complications on long-term survival is still unclear. Most of the performed studies are small, single center cohort series with inconclusive or conflicting results. Minimally invasive esophagectomy (MIE) has been shown to be associated with a reduced postoperative morbidity. In this study, the influence of complications on long-term survival for patients with esophageal cancer undergoing a MIE were investigated.

Methods: Data was collected from the EsoBenchmark database, a collaboration of 13 high-volume centers routinely performing MIE. Patients were included in this database from June 1, 2011 until May 31, 2016. Complications were scored according to the Clavien-Dindo (CD) classification for surgical complications. Major complications were defined as a CD grade ≥ 3. The data were corrected for 90-day mortality to correct for the short-term effect of postoperative complications on mortality. Overall survival was analyzed using the Kaplan Meier, log rank- and (uni- and multivariable) Cox-regression analyses.

Results: A total of 926 patients were eligible for analysis. Mean follow-up time was 30.8 months (SD 17.9). Complications occurred in 543 patients (59.2%) of which 39.3% had a major complication. Anastomotic leakage (AL) occurred in 135 patients (14.5%) of which 9.2% needed an intervention (CD grade ≥ 3). A significant worse long-term survival was observed in patients with any AL (HR 1.73, 95% CI 1.29-2.32, P < 0.001) and for patients with AL CD grade ≥3 (HR 1.86, 95% CI 1.32-2.63, P < 0.001). Major cardiac complications occurred in 18 patients (1.9%) and were related to a decreased long-term survival (HR 2.72, 95% CI 1.38-5.35, p 0.004). For all other complications, no significant influence on long-term survival was found.

Conclusion: The occurrence and severity of anastomotic leakage and cardiac complications after MIE negatively affect long-term survival of esophageal cancer patients.

Disclosure: All authors have declared no conflicts of interest.
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http://dx.doi.org/10.1093/dote/doy089.FA01.02DOI Listing
September 2018

The art and science of surgery: Do the data support the banning of surgical skull caps?

Surgery 2018 Nov 30;164(5):921-925. Epub 2018 Jul 30.

Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.

Background: Recommendations of the Joint Commission discourage the use of surgical skull caps in favor of bouffant or helmet headwear; however, data supporting such recommendations are limited and have been questioned in recent studies, as well as by our departmental and hospital leadership. At the end of December 2015, surgical caps were removed from our institution with the theoretic goal of decreasing surgical site infections. We aimed to assess the impact of this intervention on surgical site infection occurrence at our institution.

Methods: Using our institutional American College of Surgeons National Surgical Quality Improvement Program General and Vascular procedure-targeted data, we identified patients undergoing any surgical procedure classified as clean or clean-contaminated during a 12-month period before and after implementation of the surgical headwear policy. Patients without complete 30-day follow-up were excluded. Cases with active infection at the time of operation were excluded. Vascular surgery operations were excluded because of the implementation of a separate intervention to decrease surgical site infections during the study period. Patients were grouped according to timing of the operation in relation to the policy change (12 months before or after). Descriptive statistics focused on proportions and adjusted logistic regression models were used to investigate the association of alternative headwear use with any type of surgical site infection. Models were adjusted for potential confounders that included demographics and clinical characteristics (age, sex, race or ethnicity, obesity, diabetes, steroid use, smoking status, cancer, urgency of the operation, and wound classification).

Results: A total of 1,901 patients underwent 1,950 procedures during the study period, with 767 (40%) before and 1,183 (60%) after the headwear policy measure was adopted. The most common procedures overall were colectomy (18%), pancreatectomy (13.5%), and ventral hernia repair (8.9%). The overall rate of any surgical site infection was 5.4%, with no difference before and after policy implementation (5.3% versus 5.5%; P = .81). Multivariate analysis controlling for age, sex, race or ethnicity, obesity, diabetes, smoking status, steroid use, cancer diagnosis, and type of wound classification showed no association between implementation of this new policy and surgical site infections occurrence (odds ratio 1.12 [95% confidence interval 0.73-1.71]; P = .59).

Conclusion: In our institution, the strict implementation of bouffant or helmet headwear, with removal of skull caps from the operating room, was not associated with decreased surgical site infections for clean and clean-contaminated cases. Further evidence is required to assess the validity of this headwear guideline of the Joint Commission and support nationwide implementation of this policy.
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http://dx.doi.org/10.1016/j.surg.2018.05.015DOI Listing
November 2018

AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons.

Head Neck 2018 08 2;40(8):1617-1629. Epub 2018 Aug 2.

Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts.

Background: Revision parathyroid is challenging due to possible diagnostic uncertainty as well as the technical challenges it can present.

Methods: A multidisciplinary panel of distinguished experts from the American Head and Neck Society (AHNS) Endocrine Section, the British Association of Endocrine and Thyroid Surgeons (BAETS), and other invited experts have reviewed this topic with the purpose of making recommendations based on current best evidence. The literature was also reviewed on May 12, 2017. PubMed (1946-2017), Cochrane SR (2005-2017), CT databases (1997-2017), and Web of Science (1945-2017) were searched with the following strategy: revision and reoperative parathyroidectomy to ensure completeness.

Results: Guideline recommendations were made in 3 domains: preoperative evaluation, surgical management, and alternatives to surgery. Eleven guideline recommendations are proposed.

Conclusion: Reoperative parathyroid surgery is best avoided if possible. Our literature search and subsequent recommendations found that these cases are best managed by experienced surgeons using precision preoperative localization, intraoperative parathyroid hormone (PTH), and the team approach.
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http://dx.doi.org/10.1002/hed.25023DOI Listing
August 2018

Preoperative anemia: a common finding that predicts worse outcomes in patients undergoing primary hiatal hernia repair.

Surg Endosc 2019 02 11;33(2):535-542. Epub 2018 Jul 11.

Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, 1100 Walnut St. 5th Floor, Philadelphia, PA, 19107, USA.

Background: The increased incidence of anemia in patients with hiatal hernias (HH) and resolution of anemia after HH repair (HHR) have been clearly demonstrated. However, the implications of preoperative anemia on postoperative outcomes have not been well described. In this study, we aimed to identify the incidence of preoperative anemia in patients undergoing primary HHR at our institution and sought to determine whether preoperative anemia had an impact on postoperative outcomes.

Methods: Using our IRB-approved institutional HH database, we retrospectively identified patients undergoing primary HHR between January 2011 and April 2017 at our institution. We identified patients with anemia, defined as serum hemoglobin levels less than 13 mg/dL in men and 12 mg/dL in women, measured within two weeks prior to surgery, and compared this group to a cohort of patients with normal preoperative hemoglobin. Perioperative outcomes analyzed included estimated blood loss (EBL), operative time, perioperative blood transfusions, failed postoperative extubation, intensive care unit (ICU) admission, postoperative complications, length of stay (LOS), and 30-day readmission. Outcomes were compared by univariable and multivariable analyses, with significance set at p < 0.05.

Results: We identified 263 patients undergoing HHR. The median age was 66 years and most patients were female (78%, n = 206). Seventy patients (27%) were anemic. In unadjusted analyses, anemia was significantly associated with failed postoperative extubation (7 vs. 2%, p = 0.03), ICU admission (13 vs. 5%, p = 0.03), postoperative blood transfusions (9 vs. 0%, p < 0.01), and postoperative complications (41 vs. 18%, p < 0.01). On adjusted multivariable analysis, anemia was associated with 2.6-fold greater odds of postoperative complications (OR 2.57; 95% CI 1.36-4.86; p < 0.01).

Conclusions: In this study, anemia had a prevalence of 27% in patients undergoing primary HHR. Anemic patients had 2.6-fold greater odds of developing postoperative complications. Anemia is common in patients undergoing primary HHR and warrants consideration for treatment prior to elective repair.
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http://dx.doi.org/10.1007/s00464-018-6328-4DOI Listing
February 2019

Morbidity in parathyroid surgery for renal disease is under reported: a comparison of outcomes with primary hyperparathyroidism.

Ann R Coll Surg Engl 2018 Jul;100(6):436-442

Department of Endocrine and Thyroid Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital , London , UK.

Introduction Parathyroidectomy is considered to be a safe procedure with low morbidity. However, while this is true for primary hyperparathyroidism, whether it applies to tertiary disease is not so well documented. The aim of this study was to assess the morbidity of surgery for tertiary hyperparathyroidism compared with primary disease and to establish whether there are predictive factors for poor outcomes. Methods Data for patients subjected to parathyroidectomy during the period 2007-2015 were retrospectively analysed from a prospectively collected database. Patient age, sex, American Society of Anesthesiologists (ASA) score, renal status, extent of operation and indications for surgery were examined. The complication and mortality rate were compared and independent predictors of outcome were examined. Results A total of 1079 patients were scheduled for a parathyroidectomy during the study period of whom 158 for renal related hyperparathyroidism (renal group) and 921 for primary disease (non-renal group). There was a significantly higher complication rate in the renal parathyroid group, including a higher mortality (1.3% vs 0.1%, P = 0.011), overall complication rate (7.0% vs 2.3%, P = 0.001), surgery related complication rate (4.4% vs 1.7%, P = 0.03) and systemic complication rate (2.5% vs 0.4%, P = 0.005). In patients with ASA score ≤ 2 reoperative surgery (OR 9.25, 95% confidence interval, CI 1.41-60.75), male sex (OR 4.12, 95% CI 1.46-11.63) and renal impairment were (OR 5.86, 95% CI 1.65-20.78) were predictors of worse outcomes. In patients with ASA score ≥3 renal impairment, in addition to other variables, were not predictors of complications. Conclusions Parathyroidectomy in renal-related disease is associated with a significantly higher risk of morbidity and mortality compared with primary hyperparathyroidism.
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http://dx.doi.org/10.1308/rcsann.2018.0032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111922PMC
July 2018

Pregnancy after Whipple procedure: a new case and review of the literature.

J Matern Fetal Neonatal Med 2020 Jan 22;33(2):344-348. Epub 2018 Jul 22.

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.

Whipple procedure is a complex operation usually performed to treat periampullary neoplasms. There are only four case reports of five pregnancies after Whipple procedure, with limited evidence about how to manage pregnancy after this surgery. A 28-year-old gravida 5 Para 2022 presented to our hospital at 20 weeks with worsening depression. She had a history of Whipple for a solid pseudopapillary neoplasm of the pancreas followed by two pregnancies. In the first, she underwent successful induction of labor at 38 weeks for pregestational diabetes. In her second pregnancy, she had multiple admissions for diabetic ketoacidosis. She was scheduled for induction of labor at 35 weeks but given unstable lie, underwent cesarean delivery. Women with a history of Whipple procedure generally have successful pregnancies with the most common antenatal complications including diabetes mellitus, abdominal pain and pancreatitis/cholangitis.
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http://dx.doi.org/10.1080/14767058.2018.1488959DOI Listing
January 2020

Undiagnosed Primary Hyperparathyroidism and Recurrent Miscarriage: The First Prospective Pilot Study.

World J Surg 2018 03;42(3):639-645

Department of Endocrine and Thyroid Surgery, Hammersmith Hospital, Imperial College London, London, UK.

Background: Primary hyperparathyroidism (pHPT) in pregnancy is reported to be associated with significant maternal and foetal complications and an up to threefold increase in the risk of miscarriage. However, the true incidence of pHPT in pregnancy, complete and miscarried, is unknown and there are no data on the prevalence of undiagnosed pHPT in recurrent miscarriage (RM) (≥3 consecutive miscarriages under 24-week gestation). This is the first prospective study aiming to establish the prevalence of undiagnosed pHPT in RM.

Methods: Following UK National ethics committee approval, women who had experienced 3 or more consecutive miscarriages were recruited from a nationwide RM clinic. Serum corrected calcium, phosphate, PTH and vitamin D were evaluated. Patients with raised serum calcium and/or PTH were recalled for confirmatory tests. Power calculations suggested that a minimum of 272 patients were required to demonstrate a clinically significant incidence of pHPT.

Results: Three hundred women were recruited, median age 35 years (range 19-42). Eleven patients had incomplete data, leaving 289 patients suitable for analysis; 50/289 patients (17%) with abnormal tests were recalled. The prevalence of vitamin D deficiency (<25 nmol/l) and insufficiency (25-75 nmol/l) was 8.7 and 67.8%, respectively. One patient was diagnosed with pHPT (0.34%) and underwent successful parathyroidectomy.

Conclusions: The prevalence of undiagnosed pHPT (0.34%) in RM in this study appears to be many times greater than the 0.05% expected in this age group. The findings of this pilot study merit follow-up with a larger-scale study. Routine serum calcium estimation is not currently undertaken in RM and should be considered.
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http://dx.doi.org/10.1007/s00268-017-4395-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5801386PMC
March 2018

Diagnosis, management, histology and genetics of sporadic primary hyperparathyroidism: old knowledge with new tricks.

Endocr Connect 2018 Feb 12;7(2):R56-R68. Epub 2018 Jan 12.

Department of Thyroid and Endocrine SurgeryImperial College London, London, UK.

Primary hyperparathyroidism (pHPT) is a common endocrinopathy resulting from inappropriately high PTH secretion. It usually results from the presence of a single gland adenoma, multiple gland hyperplasia or rarely parathyroid carcinoma. All these conditions require different management, and it is important to be able to differentiate the underlined pathology, in order for the clinicians to provide the best therapeutic approach. Elucidation of the genetic background of each of these clinical entities would be of great interest. However, the molecular factors that control parathyroid tumorigenesis are poorly understood. There are data implicating the existence of specific genetic pathways involved in the emergence of parathyroid tumorigenesis. The main focus of the present study is to present the current optimal diagnostic and management protocols for pHPT as well as to review the literature regarding all molecular and genetic pathways that are to be involved in the pathophysiology of sporadic pHPT.
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http://dx.doi.org/10.1530/EC-17-0283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5801557PMC
February 2018

Quality of life in differentiated thyroid cancer.

Int J Surg 2018 Feb 26;50:133-136. Epub 2017 Dec 26.

Imperial College Healthcare NHS Foundation Trust, London, UK.

Background: The incidence of thyroid cancer has increased significantly over the last ten years and conversely the mortality has decreased. With 85% of patients with thyroid cancer surviving for ten years or longer it is increasingly important to study the quality of life in these patients and identify which aspects of the patients' health and wellbeing could be improved.

Methods: During the first UK patient-doctor thyroid cancer forum, patient attendees filled in an anonymized questionnaire. Patients with a diagnosis of differentiated thyroid cancer were studied, and patients less than 6 months from diagnosis were excluded. The questionnaire included demographic data, the EQ-5D-3L validated tool, information on post-operative outcomes; scar satisfaction, use of calcium supplements >6months post-operatively, vocal cord palsy, anti-depressant use and psychological counselling.

Results: 82 completed questionnaires were used for the study. The median age at diagnosis was 42 years (range 18-72), and there was a female:male ratio of 6:1. EQ-5D utility health scores: the mean weighted health outcome of the average population in the UK is 0.86 (SD 0.23). Our group had a significantly lower quality of life compared to the average UK population, with a mean weighted health outcome of 0.776 (SD 0.26, p value < .0004).

Conclusion: This study assesses quality of life in a group of self-selected patients who attended the patient-doctor thyroid cancer forum and, although accepting there is a sampling bias, the conference provided an opportunity to assess the quality of life of patients with differentiated thyroid cancer. The study has found that the average quality of life in this group of patients is lower than that of the UK population, and lower than that of patients with breast, colorectal and prostate cancer. A large number of these patients suffer with fatigue, and depression requiring anti-depressants and/or counselling.
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http://dx.doi.org/10.1016/j.ijsu.2017.12.014DOI Listing
February 2018

Effect of textured insoles on postural control during static upright posture following lower limb muscle fatigue.

J Sports Med Phys Fitness 2019 Feb 15;59(2):246-252. Epub 2017 Dec 15.

Department of Systems Medicine, School of Human Movement Sciences, Tor Vergata University, Rome, Italy.

Background: The purpose of this study was to assess the effects of textured insoles on static upright posture before and after lower limb muscle fatigue. Textured insoles used contained small and non-deformable pebbles of various sizes that are able to stimulate a major number of mechanoreceptors. It was inserted inside footwear.

Methods: Ten healthy young adults participated in the study (mean age 26.1±3.07 years). They were asked to stand on a force platform in four sensory states: vision, no vision, with and without natural plantar stimulation. For each sensory state the subjects underwent a single 30-second trial in pre-fatigue and post-fatigue conditions. Muscle fatigue was induced by 60 seconds of continuous jumping. Center of pressure displacement, sway velocity, antero-posterior and medio-lateral sway velocity were measured using force platform.

Results: Textured insoles had a stabilizing effect on balance compared to control insoles. Textured insoles significantly reduced CoPDISP and VA/P levels in closed eyes pre-fatigue condition. Post-fatigue all postural parameters improved in both vision and no vision conditions.

Conclusions: Textured insoles with rigid stimulation significantly improved CoPDISP, independently of vision, supplying relevant and complete sensory information and improving balance in fatigue conditions.
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http://dx.doi.org/10.23736/S0022-4707.17.08029-XDOI Listing
February 2019

Correction to: Breast cancer metastases to the thyroid gland - An uncommon sentinel for diffuse metastatic disease: A case report and literature review.

J Med Case Rep 2017 10 6;11(1):288. Epub 2017 Oct 6.

Department of Thyroid & Endocrine Surgery, Hammersmith Hospital, Imperial College Hospitals NHS Trust, London, W12 0HS, UK.

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http://dx.doi.org/10.1186/s13256-017-1478-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389167PMC
October 2017

Breast cancer metastases to the thyroid gland - an uncommon sentinel for diffuse metastatic disease: a case report and review of the literature.

J Med Case Rep 2017 Sep 22;11(1):269. Epub 2017 Sep 22.

Department of Thyroid & Endocrine Surgery, Hammersmith Hospital, Imperial College Hospitals NHS Trust, London, W12 0HS, UK.

Background: Metastases to the thyroid are rare. The most common primary cancer to metastasize to the thyroid is renal cell carcinoma, followed by malignancies of the gastrointestinal tract, lungs, and skin, with breast cancer metastases to the thyroid being rare. Overall, the outcomes in malignancies that have metastasized to the thyroid are poor. There are no prospective studies addressing the role of surgery in metastatic disease of the thyroid. Isolated thyroidectomy has been proposed as a local disease control option to palliate and prevent the potential morbidity of tumor extension related to the airway. Here, we present a case of a patient with breast cancer metastases to the thyroid gland and discuss the role of thyroidectomy in the context of the current literature.

Case Presentation: A 62-year-old Afro-Caribbean woman was diagnosed as having bilateral breast carcinoma in 2004, for which she underwent bilateral mastectomy. The pathology revealed multifocal disease on the right, T2N0(0/20)M0 grade 1 and 2 invasive ductal carcinoma, and on the left side, T3N1(2/18)M0 grade 1 invasive ductal carcinoma. Surgery was followed by adjuvant chemotherapy and regional radiotherapy. The disease was under control on hormonal therapy until 2016, when she developed cervical lymphadenopathy. The fine-needle aspiration cytology of the thyroid was reported as papillary thyroid cancer; and the fine-needle biopsy of the left lateral nodal disease was more suggestive of breast malignancy. She underwent a total thyroidectomy and a clearance of the central compartment lymph nodes and a biopsy of the lateral nodal disease. The histopathological analysis was consistent with metastatic breast cancer in the thyroid and lymph nodes with no evidence of a primary thyroid malignancy.

Conclusions: A past history of a malignancy elsewhere should raise the index of suspicion of metastatic disease in patients presenting with thyroid lumps with or without cervical lymphadenopathy. Detection of metastases to the thyroid generally indicates poor prognosis, obviating the need of surgery in an already compromised patient. An empirical thyroidectomy should be considered in select patients for local disease control.
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http://dx.doi.org/10.1186/s13256-017-1441-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5609028PMC
September 2017

Dietary supplementation with dried olive pomace in dairy cows modifies the composition of fatty acids and the aromatic profile in milk and related cheese.

J Dairy Sci 2017 Nov 23;100(11):8658-8669. Epub 2017 Aug 23.

Facoltà di Bioscienze e Tecnologie Agroalimentari ed Ambientali, Università di Teramo, Teramo, Italy, 64100. Electronic address:

This study aimed to evaluate the effect of dietary integration of dried olive pomace (DOP), a by-product of olive oil separation, on nutritional and aromatic properties of milk and cheese. Twenty dairy cows were divided into 2 groups that were balanced for milk yield, parity, and days in milk. The control group was fed a conventional diet (20 kg of dry matter/head per day), whereas the experimental group (EG) received the conventional diet supplemented with DOP as 10% of dry matter. During the trial, milk yield was recorded and the samples of milk, cheese, total mixed rations, and DOP were collected and analyzed to determine the chemical-nutritional composition and aromatic profile. Atherogenic and thrombogenic indices were calculated on the basis of the fatty acid (FA) profile of milk and cheese. Data were analyzed according to the mixed model for milk yield and chemical composition, including cows nested within treatment as a random effect, whereas the general linear model was used for the analysis of cheese parameters. Differences were assessed by Tukey's test. The EG diet had a lower content of palmitic, stearic, and linoleic acids and a higher level of oleic acid compared with the control. Dietary DOP integration did not affect milk yield and composition with the exception of protein content, which was greater in EG and significantly affected by diet and period. Instead, period was found to be significant for fat and casein in both groups. Dietary supplementation with DOP modified the FA profile of milk and cheese. There was a decrease in short- and medium-chain FA, but significance was achieved only for palmitic acid. The stearic, isomer trans of oleic (in particular vaccenic acid), oleic, and isomer trans of linoleic acids significantly increased. Monounsaturated FA increased in EG milk and cheese and saturated FA were significantly lower, whereas no difference was marked between the groups regarding level of polyunsaturated FA. Supplementation with DOP reduced atherogenic and thrombogenic indices and increased conjugated linoleic acid in both milk and cheese. The free fatty acids, ketones, lactones, esters, and phenylalanine catabolites were increased in raw milk, whereas only leucine metabolism was affected by diet in pasteurized milk cheese at both 1 and 30 d of ripening. The present results pointed out that DOP supplementation may improve the nutritional and nutraceutical properties and modify the aroma of milk and derived cheese.
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http://dx.doi.org/10.3168/jds.2017-12899DOI Listing
November 2017

Acute changes in neuromuscular activity in vertical jump and flexibility after exposure to whole body vibration.

Medicine (Baltimore) 2017 Aug;96(33):e7629

Movement Science Institute Department of Systems Medicine, Faculty of Medicine and Surgery, Tor Vergata University of Rome Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University Clinical Laboratory of Experimental Medicine, Fondazione Santa Lucia IRCCS I.R.C.C.S. San Raffaele Pisana, Rome, Italy.

This study was aimed to investigate the neuromuscular activity after 10 minutes of exposure to a whole body vibration (WBV) session.Twenty male young adults (24.8 ± 2.5 year olds) were randomized and divided into 2 groups: the vibration group (VG) was exposed to 10 minutes of WBV at 35 Hz; performed 10 minutes of WBV at 35 Hz (displacement = 5 mm; magnitude = 5 g); the nonvibrated group (NVG) was the placebo group that maintained the same position on the plate but without exposure to any type of vibration. Subjects were evaluated with counter movement jump (CMJ) and muscular flexibility by means of electromyographic (EMG) analysis recorded on the vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), and gastrocnemius lateralis (LG).The 10 minutes of WBV showed an increase in muscular flexibility, associated with a decrease of EMG activity in BF (P < .01) and jump height. The latter was associated with a reduction of EMGs activity in BF (P < .01). The control group did not show any significant difference in all considered parameters.These results support the hypothesis that 10 minutes of WBV had effects on flexibility and explosive strength performance influencing neuromuscular behavior through inhibitor effects on antagonist muscles more than the stretch reflex activity on agonist muscles.
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http://dx.doi.org/10.1097/MD.0000000000007629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571681PMC
August 2017
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