Carolinas Hospital System

Abstract Objectively selecting genotypes using genomic predictions for multiple traits warrants more empirical research. This study investigated how deployment of genomic prediction within the Clemson sorghum [ Sorghum bicolor (L.) Moench] breeding program would help to develop hybrids adapted to the eastern United States. Note that 9 years (2016–2024) of data collected on 1790 F 1 hybrids for grain yield, anthracnose resistance, days to anthesis, plant height, and test weight were used to calculate best linear unbiased estimates. Hybrid phenotypic data, in conjunction with genotype data for 1835 parents (983 R‐lines and 852 B‐lines), were used to train and test genomic prediction models. A model with general combining ability (GCA) effects only and a second with GCA and specific combining ability effects were used to estimate the breeding value of new parents and specific hybrid combinations, respectively. Prediction accuracy ( r ) using three cross‐validation strategies found that mean accuracies were high for plant height and moderate for grain yield, anthracnose resistance, days to anthesis, and test weight. An independent culling method using genomic prediction values for plant height and anthracnose was implemented to retroactively select seed and pollinator parents for testcrossing and specific hybrid combinations of superior seed and pollinator parents. Genomic selection of new F 4:5 parents resulted in approximately half of the total families within each fertility pool having one or more progeny advance to testcrossing, thereby avoiding overrepresentation of just a few pedigrees at the testcross phenotyping stage. Meanwhile, removing hybrids predicted above a height threshold and with an unacceptable level of anthracnose resistance led to 514 retained hybrids that had a significantly higher observed grain yield than the mean yield of 381 discarded hybrids. This tandem genomic selection scheme can advance the regional adaptation of individual fertility pools to support sorghum hybrid development for the eastern United States.

BackgroundExercise intolerance is common among adults with heart failure (HF) and is a strong prognostic indicator. We examined maximal inspiratory pressure (MIP) as an indicator of maximal and submaximal exercise capacity in older HF patients.MethodsFifty‐one patients age ≥ 50 years with HF underwent MIP testing via the PrO2 device. Peak oxygen uptake (VO2), 6 min walk distance (6MWD), 30 s sit‐to‐stand test (STS), gait speed (GS), grip strength and lower extremity muscle strength [one‐repetition maximum (1RM)] were measured. Correlation and exploratory multiple regression analyses investigated relationships between MIP, left ventricular ejection fraction (LVEF), age, body mass index (BMI) and physical function. MIP was then stratified by median (64 cm H2O), and endpoints were compared between median groups.ResultsThe median age was 69 years [interquartile range (IQR): 66–73], and the median LVEF was 36.5% (IQR: 30%–45%). Regression identified MIP as an independent predictor for grip strength, 6MWD, 1RM weight and 30 s STS after adjustment for age, BMI and LVEF. MIP greater than the median (n = 25) independently predicted and reflected greater peak VO2 [14.2 (12.8–18.1) vs. 11.5 (9.7–13.0) mL/kg/min; P = 0.0007] as well as 6MWD, 1RM, 30 s STS and GS (all P < 0.05).ConclusionThe analysis demonstrates that MIP is a novel biometric for exercise tolerance in adults with HF. Assessments of MIP are safe and convenient, with the potential to enhance routine HF surveillance and provide novel biometrics to guide HF therapeutics.

To review management strategies, outcomes, and complications in cerebral aneurysm surgery in a low-volume aneurysm practice. Seventy-nine craniotomies to treat aneurysms were performed between June 1996 and November 1999. Patient management strategy is outlined, complications are assessed, and outcomes are described. Twenty-six patients underwent surgery to treat unruptured aneurysms. Forty-two patients presented with Hunt and Hess Grade 1 to 3 subarachnoid hemorrhage. Eleven patients presented with Grade 4 or 5 subarachnoid hemorrhage. Twenty-four patients (92.3%) with unruptured aneurysms experienced favorable outcomes. Of the patients with unruptured anterior circulation aneurysms, 96% achieved favorable recoveries. Thirty-eight patients (90.5%) with Grade 1 to 3 subarachnoid hemorrhage experienced favorable outcomes; four of these patients were moderately disabled. Among patients with Grade 1 to 3 subarachnoid hemorrhage, the mortality rate was 7.1%. Of patients with Grade 4 or 5 subarachnoid hemorrhage, five (45.5%) experienced favorable outcomes, but four of these patients were moderately disabled; two patients (18.2%) were severely disabled, and four patients (36.4%) died. Acceptable clinical outcomes can be achieved in lower-volume aneurysm practices. A multidisciplinary subspecialty approach with aggressive perioperative care, especially in the prevention and treatment of cerebral vasospasm, is important in obtaining these results. Close interaction with medical consultants and other subspecialists is necessary.

The purpose of this longitudinal study was to evaluate whether a loss of body fat during lactation between 4 and 20 wk postpartum increases the concentration of environmental contaminants in breast milk. We examined this relationship in two different cohorts of exclusively breastfeeding women: (1) California women with low exposure to contaminants (n = 10 whose weight was stable [mean change, 0.0 +/- 0.2 kg] and n = 11 who lost weight [mean loss, -4.1 +/- 0.4 kg]) and (2) Hispanic women (n = 30) who had recently immigrated to North Carolina, primarily from Mexico, and were presumed to have a higher prior exposure to contaminants. Breast milk samples were analyzed for hexachlorobenzene (HCB) and DDT and its related products. There was no significant relationship between change in body composition and change in milk contaminant concentrations in either California or North Carolina women. Concentrations of HCB were similar between the California and North Carolina women, but those of DDT and related products were higher in the North Carolina subjects. Results suggest that moderate weight loss in lactating women with low exposure to environmental contaminants does not increase contaminant concentration in breast milk.

PREVIEWFoot infections in patients with diabetes mellitus are among the most common bacterial infections encountered in clinical practice. Unfortunately, these infections and their sequelae are also the most common cause of disability and the reason for most hospital admissions among diabetic patients. This article outlines the factors to consider when choosing appropriate treatment for these patients and provides a practical approach to empirical antibiotic therapy.