Chinook Regional Hospital

<bold>Background:</bold> Type 1 respiratory failure is hypoxia with PaO₂ < 60mmHg without hypercapnia in patients with respiratory distress. To elucidate the impact of hypoxic respiratory failure in severe COPD, we examined ventilation and respiratory muscle function during sustained hypoxia. <bold>Methods:</bold> Fine-wire EMG was implanted in parasternal intercostal (PARA) muscles of severe COPD (N=7, FEV₁ 0.87L 32%pred). We measured airflow, SpO₂, ETCO₂ and PARA EMG activity during room air followed by 20 min isocapnic hypoxia (SpO₂ ~80%). We report 4 min room air (BASE), sustained hypoxia: 2 min after reaching SpO₂ 80% (PEAK) and final 4 min (PLATEAU), and 4 min room air (RECOVERY). <bold>Results:</bold> Minute ventilation (V_I) increased from BASE-PEAK then decreased to PLATEAU (p<0.01). Changes in V_I were related to tidal volume and mean inspiratory flow (p<0.05), without changes in respiratory timing. Peak PARA EMG showed marked increase from BASE-PEAK followed by significant decline with sustained hypoxia (p<0.05). <bold>Conclusions:</bold> In severe COPD, hypoxic respiratory failure elicited a transient and fleeting ventilatory pattern with marked depression in breathing with sustained hypoxia. Significant recruitment of chest wall muscle was noted during acute hypoxia, however, abated in a temporal manner with sustained desaturation. Loss of ventilation and chest wall respiratory muscles poses a risk of hypoxic respiratory deterioration in severe COPD. <fig><object-id>erj;64/suppl_68/PA1668/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

Pharmacologic management of mental health illnesses in patients receiving dialysis is complex and lacking data. Our objective was to synthesize published data for the treatment of depression, bipolar and related disorders, schizophrenia or psychotic disorders, and anxiety disorders in adults receiving hemodialysis or peritoneal dialysis. We undertook a scoping review, searching the following databases: Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Scopus, and Web of Science. Data on patients who received only short-term dialysis, a kidney transplant, or non-pharmacologic treatments were excluded. Seventy-three articles were included: 41 focused on depression, 16 on bipolar disorder, 13 on schizophrenia and psychotic disorders, 1 on anxiety disorders, and 2 addressing multiple mental health illnesses. The majority of depression studies reported on selective serotonin reuptake inhibitors (SSRIs) as a treatment. Sertraline had the most supporting data with use of doses from 25 to 200 mg daily. Among the remaining SSRIs, escitalopram, citalopram, and fluoxetine were studied in controlled trials, whereas paroxetine and fluvoxamine were described in smaller reports and observational trials. There are limited published data on other classes of antidepressants and on pharmacological management of anxiety. Data on treatment for patients with bipolar disorder or schizophrenia and related disorders are limited to case reports. Over half of the studies included were case reports, thus limiting conclusions. More robust data are required to establish effect sizes of pharmacological treatments prior to providing specific recommendations for their use in treating mental health illnesses in patients receiving dialysis.

The development of novel antimicrobial technologies for the food industry represents an important strategy to improve food safety. Antimicrobial photodynamic disinfection (aPDD) is a method that can inactivate microbes without the use of harsh chemicals. aPDD involves the administration of a non-toxic, light-sensitive substance, known as a photosensitizer, followed by exposure to visible light at a specific wavelength. The objective of this study was to screen the antimicrobial photodynamic efficacy of 32 food-safe pigments tested as candidate photosensitizers (PSs) against pathogenic and food-spoilage bacterial suspensions as well as biofilms grown on relevant food contact surfaces. This screening evaluated the minimum bactericidal concentration (MBC), minimum biofilm eradication concentration (MBEC), and colony forming unit (CFU) reduction against Salmonella enterica, methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas fragi, and Brochothrix thermosphacta. Based on multiple characteristics, including solubility and the ability to reduce the biofilms by at least 3 log10 CFU/sample, 4 out of the 32 PSs were selected for further optimization against S. enterica and MRSA, including sunset yellow, curcumin, riboflavin-5′-phosphate (R-5-P), and erythrosin B. Optimized factors included the PS concentration, irradiance, and time of light exposure. Finally, 0.1% w/v R-5-P, irradiated with a 445 nm LED at 55.5 J/cm2, yielded a “max kill” (upwards of 3 to 7 log10 CFU/sample) against S. enterica and MRSA biofilms grown on metallic food contact surfaces, proving its potential for industrial applications. Overall, the aPDD method shows substantial promise as an alternative to existing disinfection technologies used in the food processing industry.

Acquired perforating dermatoses (APD) encompass a group of skin conditions distinguished by transepidermal elimination of dermal components. Acquired reactive perforating collagenosis (ARPC), a subtype of APD, has been reported most commonly in association with diabetes mellitus, chronic renal failure, and medications. In this report, we identify a novel case of ARPC secondary to Cabozantinib treatment.

Abstract Depending on the year, during the winter months, cattle begin to rub bare patches on their skin due to pruritus which leads to concern from cattle producers, especially the purebred breeders. Upon further investigation by veterinarians, the cause is not always caused by lice, as many may think. This study aimed to provide insight into the cause and potential prevention/treatment of pruritic beef cattle in western Canada by examining herds that met the study’s criteria of having more than 30% of the herd exhibiting pruritus. Seven herds were examined in the winter of 2023: one from Manitoba, two from Saskatchewan, and four from Alberta. Producers from each herd completed a detailed survey on treatments, nutrition, and environmental conditions and provided feed, water, and bedding samples. Within each herd, five cattle considered non-pruritic, and ten cattle considered pruritic by visual appraisal were enrolled for standard data collection consisting of documentation and photos of skin lesions localized to pruritic areas, general health clinical exam, lice exam/collection, mite exam/collection of hairs, skin hydration (corneometer), blood chemistry and vitamin/minerals, and kidney/liver enzymes for mycotoxins. A subset of the group (1 non-pruritic and 4 pruritic) was selected for advanced data collection, including dermal hypersensitivity (grass, alfalfa, grain, weeds, and molds) measured by swelling score and infrared camera temperature measurement compared with positive and negative controls, skin punch biopsies for eosinophils (IgE) and liver biopsies for copper levels. Only 21/101 cattle had lice (18 animals &amp;lt; 10 lice per 6.5 cm2). No significant correlation was observed between cattle with lice and being pruritic (P &amp;gt; 0.05). Dermal hypersensitivity was very low across both pruritic and non-pruritic cattle and was not different (P &amp;gt; 0.05). Skin hydration readings within animals comparing pruritic and non-pruritic areas on their body showed only one herd having significantly (P &amp;lt; 0.05) drier skin on pruritic locations compared with normal locations. Vitamin A, E, and copper blood analysis showed no significant difference between pruritic and non-pruritic cattle. However, liver biopsy copper levels were (P = 0.01) less in pruritic than non-pruritic cattle. Results suggest that the cause of pruritic cattle is not necessarily a result of intense lice infestations but rather multifactorial in nature, and a decision tree for producers and veterinarians should be developed to aid in determining the correct course of action to alleviate pruritic cattle in the field.

Simple SummaryPrescribed examination of enterohemorrhagic Escherichia coli (EHEC) O157:H7 microbiota–host interactions in the gastrointestinal tract of cattle is technically difficult due in part to the high cost of conducting research with cattle, the genetic heterogeneity among animals, the logistic challenges of obtaining prescribed samples, and the variability in the structure of the enteric microbiota among individuals. Thus, our overarching goal was to develop a prescribed enteric colonization model utilizing germ-free mice inoculated with individual bovine EHEC O157:H7 strains representing the primary genetic lineages of the pathogen. Moreover, we utilized the colonization model with or without stress induced via the administration of corticosterone to examine the ability of commensal E. coli strains to outcompete EHEC O157:H7 in vivo. A bovine strain of EHEC O157:H7 that incited reduced pathologic changes was identified, and the administration of 18 commensal E. coli strains isolated from cattle effectively reduced densities of the pathogen, and ameliorated histopathologic changes and markers of inflammation. Although stress has been identified as a factor affecting colonization success, we observed that physiological stress did not benefit enteric colonization by EHEC O157:H7. Despite its limitations, the defined microbiota murine enteric colonization model developed may prove useful for identifying mechanisms and mitigation strategies for subsequent validation in cattle.Cattle are a primary reservoir of enterohemorrhagic Escherichia coli (EHEC) O157:H7. Currently, there are no effective methods of eliminating this important zoonotic pathogen from cattle, and colonization resistance in relation to EHEC O157:H7 in cattle is poorly understood. We developed a gnotobiotic EHEC O157:H7 murine model to examine aspects of the cattle pathogen–microbiota interaction, and to investigate competitive suppression of EHEC O157:H7 by 18 phylogenetically distinct commensal E. coli strains of bovine origin. As stress has been suggested to influence enteric colonization by EHEC O157:H7 in cattle, corticosterone administration (±) to incite a physiological stress response was included as an experimental variable. Colonization of the intestinal tract (IT) of mice by the bovine EHEC O157:H7 strain, FRIK-2001, mimicked characteristics of bovine IT colonization. In this regard, FRIK-2001 successfully colonized the IT and temporally incited minimal impacts on the host relative to other EHEC O157:H7 strains, including on the renal metabolome. The presence of the commensal E. coli strains decreased EHEC O157:H7 densities in the cecum, proximal colon, and distal colon. Moreover, histopathologic changes and inflammation markers were reduced in the distal colon of mice inoculated with commensal E. coli strains (both propagated separately and communally). Although stress induction affected the behavior of mice, it did not influence EHEC O157:H7 densities or disease. These findings support the use of a gnotobiotic murine model of enteric bovine EHEC O157:H7 colonization to better understand pathogen–host–microbiota interactions toward the development of effective on-farm mitigations for EHEC O157:H7 in cattle, including the identification of bacteria capable of competitively colonizing the IT.

Autosomal dominant polycystic kidney disease (ADPKD) is the leading genetic cause of end stage renal disease characterized by progressive expansion of kidney cysts. To better understand the cell types and states driving ADPKD progression, we analyze eight ADPKD and five healthy human kidney samples, generating single cell multiomic atlas consisting of ~100,000 single nucleus transcriptomes and ~50,000 single nucleus epigenomes. Activation of proinflammatory, profibrotic signaling pathways are driven by proximal tubular cells with a failed repair transcriptomic signature, proinflammatory fibroblasts and collecting duct cells. We identify GPRC5A as a marker for cyst-lining collecting duct cells that exhibits increased transcription factor binding motif availability for NF-κB, TEAD, CREB and retinoic acid receptors. We identify and validate a distal enhancer regulating GPRC5A expression containing these motifs. This single cell multiomic analysis of human ADPKD reveals previously unrecognized cellular heterogeneity and provides a foundation to develop better diagnostic and therapeutic approaches.

Simple SummaryCastration is among the most common management procedures performed in the dairy and beef cattle industries. Despite the widely accepted benefits of castration, all castration methods produce pain and distress. While slower than other approaches, castration by banding is simple, inexpensive, and produces fewer complications. We have therefore focused the present study on developing herd-level pain mitigation during banded castration. Because lidocaine is effective at reducing pain and can be delivered topically, we have formulated lidocaine-loaded castration bands (LLBs) to deliver local pain relief to calves and bulls during banded castration. Laboratory results indicated a rapid release of lidocaine for the first 30 min, followed by a slow release for at least 48 h. Field studies indicated that, for both lidocaine delivery into tissues and pain mitigation, LLBs performed at least as well as standard lidocaine injections in the short term and outperformed lidocaine injections in the long term. LLBs delivered therapeutic quantities of lidocaine into scrotal tissues over a period of at least seven days in cattle. This approach would provide long-term pain mitigation to the animals and, by avoiding surgery or the administration of injections, would also decrease the time and handling costs for the producer.Castration is among the most common management procedures performed in the dairy and beef cattle industries and is mainly performed by surgery or elastic banding. Despite the various benefits of castration, all methods produce pain and distress. Castration by banding is simple, inexpensive, produces fewer complications, and can be performed in a high-throughput manner. Because lidocaine, a local anesthetic, can be delivered to trauma sites topically, we have formulated lidocaine-loaded castration bands (LLBs) to deliver local pain relief to calves during banded castration. The initial lidocaine content of three band types developed was between 80 and 200 mg per band. The transfer kinetics of lidocaine into tissue was determined in vitro, indicating a rapid release for the first 30 min, followed by a slow release lasting at least 48 h. Furthermore, the lidocaine delivery and pain mitigation effects of these LLBs were compared to standard lidocaine injections in vivo. Field studies indicated that LLBs performed at least as well as lidocaine injections for short-term lidocaine delivery into tissues and pain mitigation. Moreover, LLBs significantly outperformed lidocaine injections for long-term delivery and pain mitigation. The concentrations of lidocaine in the LLB-treated tissue samples were generally in the range of 0.5–3.5 mg of lidocaine per gram of tissue and were overall highest after 6 h. Lidocaine-loaded elastration bands deliver therapeutic quantities of lidocaine into scrotal tissues over a period of at least seven days in cattle. This approach would provide long-term pain mitigation to the animals and, by avoiding surgery or the administration of injections, would also decrease the time and handling costs for the producer.

To describe a systems-level baseline evaluation of central intake (CI) and triage systems in arthritis care within Alberta, Canada. The specific objectives were to (1) describe a process for systems evaluation for the provision of arthritis care; (2) report the findings of the evaluation for different clinical sites that provide arthritis care; and (3) identify opportunities for improving appropriate and timely access based on the findings of the evaluation. The study used a convergent mixed methods design. Surveys and semistructured interviews were the main data collection methods. Participants were recruited through 2 rheumatology clinics and 1 hip and knee clinic providing CI and triage, and included patients, referring physicians, specialists, and clinic staff who experienced CI processes. A total of 237 surveys were completed by patients (n = 169), referring physicians (n = 50), and specialists (n = 18). Interviews (n = 25) with care providers and patients provided insights to the survey data. Over 95% of referring physicians agreed that the current process of CI was satisfactory. Referring physicians and specialists reported issues with the referral process and perceived support in care for wait-listed patients. Patients reported positive experiences with access and navigation of arthritis care services but expressed concerns around communication and receiving minimal support for self-management of their arthritis before and after receiving specialist care. This baseline evaluation of CI and triage for arthritis care indicates satisfaction with the service, but areas that require further consideration are referral completion, timely waiting lists, and further supporting patients to self-manage their arthritis.