Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic

Background: This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic. Methods: We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients’ location by World Bank income groups (high [HIC], upper-middle [UMIC], and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality. Results: Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37–5.74) compared to HIC. Conclusions: The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors

Alternative sources of Omega-3 oils for Barramundi, Lates calcarifer, aquaculture

Fish oil (FO) is the major source of dietary lipid in carnivorous fish feeds including barramundi, Lates calcarifer, which is widely farmed in Asia and Australia. However, recent increases in FO prices, increased demand and the foreseen inability of wild fisheries to meet future requirements have created a need for cheaper and more sustainable alternatives. Vegetable oils (VO) can be produced in sufficient quantities to meet the growing aquaculture demand, although they lack the long-chain (‚Äöv¢‚Ä¢C20) polyunsaturated fatty acids (LC-PUFA) beneficial to human consumers. Some VO like rapeseed oil (RO), echium oil from Echium plantagineum (EO) and linseed oil (LO) have high levels of n-3 and n-6 short-chain (‚Äöv¢¬ßC18) PUFA that can accumulate or be converted into LC-PUFA by some fish species, although generally at low efficiency, and not to docosahexaenoic acid. In a series of comparative and factorial experiments, I investigated the growth and lipid changes of barramundi fed different dietary oils: FO, RO, LO and EO over conditions covering: a range of salinities and temperatures, subject to immunity stress or supplemented with plant-derived bioactive ingredients. In general, growth performance parameters were comparable for FO and VO treatments, and resulted in accumulation of VO-derived n-3 and n-6 PUFA. Salinity has no direct effect on growth or lipid metabolism regardless of the dietary lipid source. Endogenous conversion by barramundi of dietary PUFA into LC-PUFA is limited by more than one ratelimiting step and there is a preference for incorporation of LC-PUFA into the polar lipid fraction rather than neutral lipid. The growth of barramundi slowed at sub-optimal (20¬¨‚àûC) temperature compared to optimal (30¬¨‚àûC) temperature. PUFA from dietary VO deposits in muscle and are maintained under rapid temperature decreases. In contrast, excess LC-PUFA from FO depleted faster than occurs in VO fed fish. The production of pro-inflammatory eicosanoids in fish fed FO was lower than for fish fed VO following bacterial infection. EO significantly suppressed the production of the pro-inflammatory mediators compared to RO. Sesamin, a lignan in sesame seed, enhanced the conversion of dietary PUFA into LC-PUFA for the n-3 series rather than n-6 in early juvenile barramundi. However, sesamin had negative impact on fish growth at this early life-stage. Barramundi fed on VO are a rich source of LC-PUFA precursors, ˜í¬±-linolenic and stearidonic acid, and grow well under the different environmental conditions that are typical of outdoor barramundi farms. The use of terrestrial VO containing the LC-PUFA precursors and plant-derived bioactive compounds show promise for use in barramundi aquafeed in terms of fish growth and health as either partial or complete alternatives for FO. However, using currently available VO, high content of the n -3 LC-PUFA is not achieved

Alternative sources of Omega-3 oils for Barramundi, Lates calcarifer, aquaculture

Fish oil (FO) is the major source of dietary lipid in carnivorous fish feeds including barramundi, Lates calcarifer, which is widely farmed in Asia and Australia. However, recent increases in FO prices, increased demand and the foreseen inability of wild fisheries to meet future requirements have created a need for cheaper and more sustainable alternatives. Vegetable oils (VO) can be produced in sufficient quantities to meet the growing aquaculture demand, although they lack the long-chain (‚Äöv¢‚Ä¢C20) polyunsaturated fatty acids (LC-PUFA) beneficial to human consumers. Some VO like rapeseed oil (RO), echium oil from Echium plantagineum (EO) and linseed oil (LO) have high levels of n-3 and n-6 short-chain (‚Äöv¢¬ßC18) PUFA that can accumulate or be converted into LC-PUFA by some fish species, although generally at low efficiency, and not to docosahexaenoic acid. In a series of comparative and factorial experiments, I investigated the growth and lipid changes of barramundi fed different dietary oils: FO, RO, LO and EO over conditions covering: a range of salinities and temperatures, subject to immunity stress or supplemented with plant-derived bioactive ingredients. In general, growth performance parameters were comparable for FO and VO treatments, and resulted in accumulation of VO-derived n-3 and n-6 PUFA. Salinity has no direct effect on growth or lipid metabolism regardless of the dietary lipid source. Endogenous conversion by barramundi of dietary PUFA into LC-PUFA is limited by more than one ratelimiting step and there is a preference for incorporation of LC-PUFA into the polar lipid fraction rather than neutral lipid. The growth of barramundi slowed at sub-optimal (20¬¨‚àûC) temperature compared to optimal (30¬¨‚àûC) temperature. PUFA from dietary VO deposits in muscle and are maintained under rapid temperature decreases. In contrast, excess LC-PUFA from FO depleted faster than occurs in VO fed fish. The production of pro-inflammatory eicosanoids in fish fed FO was lower than for fish fed VO following bacterial infection. EO significantly suppressed the production of the pro-inflammatory mediators compared to RO. Sesamin, a lignan in sesame seed, enhanced the conversion of dietary PUFA into LC-PUFA for the n-3 series rather than n-6 in early juvenile barramundi. However, sesamin had negative impact on fish growth at this early life-stage. Barramundi fed on VO are a rich source of LC-PUFA precursors, ˜í¬±-linolenic and stearidonic acid, and grow well under the different environmental conditions that are typical of outdoor barramundi farms. The use of terrestrial VO containing the LC-PUFA precursors and plant-derived bioactive compounds show promise for use in barramundi aquafeed in terms of fish growth and health as either partial or complete alternatives for FO. However, using currently available VO, high content of the n -3 LC-PUFA is not achieved

Replacing dietary fish oil with Echium oil enriched barramundi with C18 PUFA rather than long-chain PUFA

Vegetable oils (VO) are sustainable sources for replacement of fish oil (FO) in aquafeeds. However, VO lacks the health-benefitting n-3 long-chain (≥ C20) polyunsaturated fatty acids (n-3 LC-PUFA) and potentially compromise farmed fish flesh quality for consumers. In a factorial experiment, barramundi (Lates calcarifer) were grown in either freshwater or seawater and fed on three diets containing different oil sources: FO; stearidonic acid (SDA, 18:4n-3) rich oil from Echium plantagineum (EO); or rapeseed oil (RO). RO and FO-fed fish grew faster than the EO treatment and all three dietary treatments were not affected by salinity. A fatty acid mass balance showed that feeding barramundi on EO diet bypassed the first rate-limiting step in n-3 LC-PUFA biosynthesis. However, the fish did not accumulate high EPA or DHA content. Total PUFA, mainly of the n-3 series and dominated by ALA (18:3n-3) and SDA, in the whole body of EO fish was higher than for the FO and RO treatments. The n-3:n-6 ratio in EO treatment was less than for FO, but exceeded that in RO-fed fish. FA apparent metabolism as derived from the fatty acid mass balance fluxes showed comparable kinetics for key enzymes, indicating limited efficiency for LC-PUFA biosynthesis from their C18 dietary precursors in barramundi fed EO or RO containing diets. Fish digested dietary FA and accumulated them efficiently regardless of the salinity. These findings establish a more comprehensive understanding for FA metabolism in barramundi fed different dietary lipids and at extremes of the species wide salinity range. Based on the observed levels of accumulation, EO-fed barramundi are a potentially rich source of ALA and SDA for human consumptio

Sesamin modulation of lipid class and fatty acid profile in early juvenile teleost, Lates calcarifer, fed different dietary oils

Sesamin, a major sesame seed lignan, has diverse biological functions including the modulation of molecular actions in lipid metabolic pathways and reducing cholesterol levels. Vertebrates have different capacities to biosynthesize long-chain PUFA from dietary precursors and sesamin can enhance the biosynthesis of ALA to EPA and DHA in marine teleost. Early juvenile barramundi, Lates calcarifer, were fed for two weeks on diets rich in ALA or SDA derived from linseed or Echium plantagineum, respectively. Both diets contained phytosterols and less cholesterol compared with a standard fish oil-based diet. The growth rates were reduced in the animals receiving sesamin regardless of the dietary oil. However, the relative levels of n-3 LC-PUFA in total lipid, but not the phospholipid, increased in the whole body by up to 25% in animals fed on sesamin with ALA or SDA. Sesamin reduced the relative levels of triacylglycerols and increased polar lipid, and did not affect the relative composition of phospholipid subclasses or sterols. Sesamin is a potent modulator for LC-PUFA biosynthesis in animals, but probably will have more effective impact at advanced ages. By modulating certain lipid metabolic pathways, sesamin has probably disrupted the body growth and development of organs and tissues in early juvenile barramundi

Coping with sub-optimal water temperature: Modifications in fatty acid profile of barramundi as influenced by dietary lipid

Metabolic responses to sub-optimal temperature deplete lipid depots, remodel membrane lipid and alter the fatty acid profile in the whole body and tissues of ectothermic vertebrates including fish. The magnitude of these changes may depend on dietary history including oil sources with different fatty acid compositions. Barramundi, Lates calcarifer (Perciformes, Latidae), a tropical ectothermic fish, was fed on diets either rich in dietary long-chain (≥C20) polyunsaturated fatty acids (LC-PUFA) from fish oil, rich in stearidonic and γ-linolenic acid (SDA and GLA, respectively) from Echium plantagineum, or rapeseed oil deficient in LC-PUFA. Following 5 weeks at the optimum temperature of 30 °C when growth rates were comparable amongst dietary treatments, water temperature was dropped to 20 °C for 1 week for half of the animals and maintained at 30 °C for the other half. Decreased temperature increased the liver and skeletal muscle content of LC-PUFA in fish fed on echium oil compared with rapeseed oil, while dietary LC-PUFA depots in fish oil fed-fish depleted rapidly in theweek of sub-optimal temperature. The lipid unsaturation index of cellular membrane in the liver and muscle increased under low temperature at the same rate regardless of dietary oil. Therefore, rapid exposure of an ectothermic vertebrate to a lower and sub-optimal temperature caused significant modulation in fatty acid composition.We propose that the tolerance of barramundi, a representative of tropical farmed fish, to sub-optimal temperature will be enhanced when fatty acid substrates closer to the LC-PUFA are available in their diet

Dietary oil modulates fatty acid profile in disease challenged barramundi

There are interactions between fish lipid profile and their health and physiology. Fatty acids (FA) are required for normal growth and development and are important in immunity modulation and disease resistance. The n-3 and n-6 long-chain polyunsaturated fatty acids (LC-PUFA) affect immune response partly by affecting cytokine secretion and pro-inflammatory factors. Using plant oils, such as Echium plantagineum oil (EO), instead of fish oil (FO) in barramundi feed formulations may be useful as EO has potential to provide a precursor for synthesis of LC-PUFA. However, the immune system could be impaired as a result of changing the FA profile of fish fed on alternate oils. We therefore investigated the changes of FA depots in disease challenged barramundi fed on EO instead of FO on bacterial infection. Worldwide, bacterial infection with Streptococcus iniae is responsible for significant mortalities of warm water aquaculture species including barramundi. Fingerlings (50¬±2g) were kept at 30¬∞C, 15 ppt salinity, 24 h light photoperiod and fed one of three dietary treatments differing only in their lipid source: FO, EO and canola oil (CO). Following 5 weeks, fish were challenged with S. iniae (1-2√v=105 cfu/ml bathing exposure) causing sub-acute infection. FA profiles in muscle were compared in initial fish and after one week of challenging when fish showed signs of recovery. Feed intake dropped initially in infected fish and was paired with the control group which remained intact. Similar growth ratios were observed in all dietary treatments during the experiment as well as equal mortality rates following the bacterial infection, with EO-fed fish retaining SFA, MUFA, n-3 and n-6 PUFA depots better than FO and CO. When compared with the control group, fish fed alternatives to FO showed a comparable ratio of utilising n-3 and n-6 LC-PUFA depots while challenged and sustained the n-3: n-6 ratio through the infection period. These findings indicate efficient growth, survival and lipid metabolism in barramundi fed on plant oils as alternatives to FO with capacity to sustain flesh quality in unfavorable production conditions such as when bacterial infection occurs