Animal welfare has been of increasing interest to consumers and producers of animal products in Europe. Issues during transport affect both the wellbeing and the productivity of livestock. This study was conducted to analyze two practice-oriented transport variants of organically mixed-held white and brown pullets. No significant difference could be found between the transport variants. Instead, we discovered clear differences between the two genetic pullet lines.The welfare of two genetic lines of organic layer hen pullets—H&N Super Nick (HNS) and H&N Brown Nick (HNB)—was compared during two commercial transport variants of 15 flocks of mixed-reared birds. Birds were either transported overnight (with a break in travel), or were transported direct to the layer farm (without a break in travel). Samples of feces were collected non-invasively from 25 birds of each genetic line per flock for each transport variant before transportation to evaluate baseline values of glucocorticoid metabolites, and at 0 h, 3 h, 6 h, 10 h, 24 h, 34 h, 48 h, 58 h, and 72 h after the end of transportation, to measure transportation and translocation stress. We assessed the fear toward humans with the touch test before transportation, and we checked the birds’ body condition by scoring the plumage condition and the occurrence of injuries. Body weight before and weight loss after transportation were determined, and ambient temperature was measured before, during, and after transportation. Stress investigations showed no significant differences between the transport variants : ). Instead, we discovered differences between the pullet lines ). Weight loss was different between the transport variants ) and between the genetic lines, as HNB lost significantly less weight than HNS ). The World Organization for Animal Health provides a reference document  of interThe Swiss consumer assumes that organic livestock farming applies more species-appropriate animal husbandry corresponding to the animals’ natural living conditions, and thus provides better animal welfare than conventional farming practices . Animal Various stressors such as climate, environment, nutrition, physical, and social and physiological conditions are likely to influence welfare and performance . The preTo evaluate the stress response to the two transport variants, we measured corticosterone metabolites non-invasively in excretions of the pullets. Fecal corticosterone metabolites have previously been used as a reliable indicator of adrenocortical activity .The project was initiated by Switzerland’s largest organic egg supplier—hosberg AG in Rüti—and was supported by two other Swiss-based companies—Wüthrich Brüterei AG in Belp and Prodavi AG in Schötz. Participation in “LTK  Module 2: Training for Persons Responsible for Directing Animal Experiments” was required as a prerequisite for the intercantonal approval by the Swiss Cantonal Veterinary Office in Zurich, and the project was approved on 6 January 2016, under registration number ZH196/15. The study refers to Europe, with special emphasis on Switzerland.The study was conducted with organically mixed-held pullets of two genetic lines—H&N Super Nick (HNS) and H&N Brown Nick (HNB)—of a commercial breeder and distributor . Parent animals were imported to Switzerland and raised as organic laying hens. The experimental unit consisted of pullets and laying hens of 15 flocks, which were reared and kept according to the guidelines of Bio Suisse   on free-Temperature was measured with HOBO U10  inside of the stable at animal head height and during transportation inside of the plastic crates on the upper edge. For both transport variants, temperature was recorded during the whole investigation period every 10 min per flock. Means of minimum and maximum temperature values during the testing period (January until July) for Variant I ranged from 11.1 to 32.3 °C (rearing farm), 1.9 to 34.7 °C (transportation vehicle) and 3.8 to 34.1 °C (farm of laying hens) and for Variant II from 7.6 to 26.3 °C (rearing farm), −8.9 to 28.8 °C (transportation vehicle), and 6.1 to 26.2 °C (farm of laying hens). Animal husbandry varied according to the individual farmer’s management.To examine the effects of transportation and translocation on stress in each flock, corticosterone levels were measured non-invasively by extracting metabolites from bird droppings. For each sampling time point, 25 pullets of each genetic line were randomly caught from different tiers of the dimmed barn. To enable the collection of individual, spontaneously voided droppings, the pullets were placed separately in cleaned and disinfected plastic crates, and marked on their legs with a pen . Samples were collected within 1 h of the experimenter entering the barn according to Rettenbacher et al. , who fouv/v) methanol by shaking for 30 min on a multi-vortex  [In the laboratory, 0.5 g of each sample was suspended in 5 mL of 60%  . When a MO, USA) . The appMO, USA) ,23.The level of fear of humans is an important determinant of welfare of pullets and laying hens. Regular handling of pullets is fear reducing , and posThe body condition of the birds was evaluated by scoring the plumage and integuments before and after transportation, following feces sampling and the touch test. The assessment basis was the LayWel grading scheme  modifiedTo check minimum body weight, which is 1300 g for HNS and 1479 g for HNB at the age of 18 weeks , 50 numerically marked birds, 25 per line, were weighed during loading. To check a possible transport-related weight reduction due to water and feed withdrawal and “time in plastic crates,” we compared body weights before and after transportation (following sampling) for each hen. Results were compared with a control flock that was not transported and was kept overnight in the winter garden without access to water and feed but were free to move around; hens of the control flock were weighed in the evening (8:00 p.m.) and in the morning (7:00 a.m.). For evaluation, the weight of the same numerically marked bird was compared in each case. Weight determination was carried out with a BAT1 poultry scale . The 50 hens of the transport study were divided into four transport crates. To ensure a regular number of 16 birds per crate according to the Swiss Order on the Protection of Animals [For the statistical analysis, the relationships between the predictors  and the response variables  were analyzed simultaneously using mixed-effects models. The flock was modeled as an unstructured random effect for the model constant (intercept), and the transport variant and the layer line were modeled as ordinary fixed effects. For the continuous response baseline CM concentration, CM concentration after transport, difference in plumage score before and after transport, and transport weight, normal distributions were chosen as observation models. For the binary outcome return to baseline value after 72 h, a logistic regression model was used. Results from this analysis were expressed as odds ratios (OR). For baseline CM concentration, temporal progression was also considered by including time as an unstructured random effect . Data were analyzed by using the statistical programming language R . All ). Three flocks showed significant deviations from mean baseline values in Variant II: two flocks with significant above-average values (D2 and D7) and one with significantly lower values (D6). Any effect that crossed zero did not significantly deviate from the mean baseline value in this flock .The transit from the rearing farm to the farm of the laying hens resulted in higher mean concentrations of CM compared with the mean baseline values. The highest values were found immediately on arrival (0 h). The mean concentration at 0 h was 173 ng/g and 323 ng/g for Variant I and Variant II, respectively. CM concentrations decreased rapidly during the 0–6 h interval after transportation. Variant I showed an increase during the 6–12 h interval, followed by a steady decline. Values for Variant II were slightly increased at 24 h, 48 h, and 72 h, and slightly decreased at 34 h and 58 h, with the additional sampling times considering the circadian rhythm .We found no significant difference in CM concentrations between Variant I and Variant II, because the overall trend was similar, and confidence intervals overlapped strongly ) .Significant differences in CM concentrations were found once again between the layer lines. HNS had higher values than HNB ). Furthermore, considerable variations among flocks were found. Significant above-average values could be measured for one flock of Variant II (D7), significantly lower values for three flocks of Variant II , and one flock of Variant I (N4) during the 0–72 h interval. Any effect that crosses zero does not significantly deviate from the mean CM concentration in this flock .The ratio of CM concentrations after 72 h to CM baseline values showed that most CM concentrations did not return to baseline values in both transport variants . For botWith the touch test, we evaluated the hen–human relationship based on the approach and avoidance behavior of the birds between flocks. To evaluate whether this behavior was reflected in the measured CM concentrations, we compared CM concentrations between hens that stayed an arm length away from the examiner, and those that could be touched. An increase in CM concentration by one unit (1.0 ng/g) resulted in a significantly greater number of hens that could be touched ). In addition, a few differences in approach and avoidance behavior between flocks were found: One flock (D5) had significantly fewer hens that could be touched compared with three other flocks .The examined flocks of both transport variants showed an average plumage score of 24.62 ± 1.37 (mean ± SD) before and after transportation, indicating a good feather condition . Flocks D4 and D5 of Variant II had a better plumage score after transportation than before .Altogether, we found no significant differences in the plumage condition of the body areas scored with four degrees of severity before and after transportation, regardless of layer line, transport variant or flock, with one exception: HNB in comparison with HNS showed less plumage deterioration ) in Variant I, and in Variant II, greater deterioration ). The total plumage score, including those body areas scored with two forms of severity  apparently significantly improved after transportation compared with before transportation in Variant II ) but not in Variant I ). Integument injuries of body areas scored with three degrees of severity were not sufficiently variable in their distribution of characteristics, and only isolated injuries were found. The same applies for integument injuries of the eyelid (binary score). Both comb and head  were scored positive in 13% and 4% of the cases, respectively. We could find no major differences in integument injuries before and after transportation.Following the transit from the rearing farm to the farm of laying hens, the birds showed a weight loss of −2.9% ± 1.9% (mean ± SD). Comparing both transport variants, birds of Variant I lost significantly more weight ) than birds of Variant II. Regarding the layer lines, HNB lost significantly less weight than HNS ). Considering the transport variants, differences in weight loss between layer lines can solely be found for Variant II: HNS showed higher loss in weight (−2.38% ± 1.46%) compared with HNB (−1.3% ± 0.71%) ). Differences in relative weight losses between flocks hardly existed . None ofBirds of the control flock, which were not transported and were kept in the winter garden overnight, free to move around without access to food and water, showed a mean weight loss of −5.9% ). HNB hens of the control flocks lost significantly less weight ) than HNS hens ). Comparing the weights of all birds (study and control flocks) calculated as means, birds of the control flock showed on average a higher loss of −2.0% ) than birds of the study flocks. The target weight of the 18-week-old pullets, which is defined by the breeder and distributor H&N International, is set at 1300 g for HNS and 1479 g for HNB. It was not reached by all weighed hens: HNS hens weighed on average 1339 ± 102 g (mean ± SD), and HNB hens 1679 ± 156 g. With age included, no differences could be found within each layer line in reaching the target weight . The onlTo the best of our knowledge, this is the first study comparing two practice-oriented transport variants for pullets over a period of 72 h via fecal CM. The aim of the study was to evaluate which of the two examined transport variants resulted in less pronounced stress responses of the birds. Measurements of CM, a reliable indicator of stress , showed Baseline values of CM concentrations and values measured between 0 h and 72 h after transportation did not show significant differences between the two transport variants. Instead, we found significant differences between the two layer lines in both baseline values and values measured after transportation. However, other studies found similar baseline plasma corticosterone concentrations in brown and white layer lines ,40. One The relationship between animals and humans is an important aspect of animal welfare. Additional contact to humans can positively influence the hen–human relationship . StudiesThe examined flocks were in good condition before and after transportation, as measured by the use of the sum of the body parts that were individually scored for plumage condition and integument injuries . With reBirds lose weight overnight, even without transportation, and this has potential side effects such as increased corticosterone levels or heat stress, as results from our control flock show. Birds of the control flock were able to move around in the winter garden without access to food and water, matching the lack of these resources for transported birds. “Time in winter garden” for the control flock was 11 h, and this is thus based on the “time in plastic crates” of Variant I. Several studies describe a diurnal and seasonal weight fluctuation in wild birds (e.g., ,45,46,47Our findings prove that no significant differences exist between the two studied transport variants. This conclusion may be supported by further investigations. Considering the tested flocks, we can say that both transport variants exerted a similar level of stress on the birds. Significant differences between the two layer lines indicated that HNS hens would benefit from transportation in the short variant, whereas stress levels in HNB hens were similar in both variants. Nonetheless, we cannot say whether a longer time of transportation exerts more and longer lasting negative impacts than a shorter period of transportation. Future studies comparing weight development or egg production and egg weight between both transport variants could help to answer the remaining questions.


The main aim of the current investigation was to contemplate the impact of high-voltage electric field cold plasma (HVCP) on different quality characteristics  of carrot juice in correlation with thermal processing. A carrot juice (250 mL) sample sealed in pre-sterilized food-grade bottles, which placed between two dielectric quartz plates for HVCP treatment. The gap between the plates was 30 mm, and a stable and uniform plasma dielectric barrier discharge (DBD) generated for 3 and 4 min at 60, 70, and 80 kV. Air was used as a working gas during the DBD-based plasma treatment. The observed rise in temperature was 2–5 °C during the HVCP treatment. A water bath was used to carry out thermal treatment (100 °C for 5 min). The maximum inactivation of enzymes and microorganisms was achieved with thermal treatment and then with HVCP treatment at 70 kV for 4 min. However, maximum retention of coloring compounds, ascorbic acid, total phenols, flavonoids, and tannins was found following HVCP (70 kV for 4 min) treatment compared to thermal treatment. The °Brix, pH, and acidity remained unchanged irrespective of treatments. These findings suggest that HVCP treatment at 70 kV for 4 min may be a good alternative to thermal treatment, and it may successfully be applied in carrot juice production, resulting in reduced enzymes, lower microbial activity, and improved bioactive compounds. The prospects of overcoming the existing conventional physical and chemical methods for sterilization make it a novel and more economical technique to maintain food’s natural nourishment, composition, appearance, structure, and freshness. Daucus carota L.) is an important root vegetable with a pleasant taste, high nutritional value, and several benefits to human health due to its specific anti-anemic, anticancer, antioxidant, sedative, and healing characteristics [The carrot  non-thermal treatment is a new kind of non-thermal sterilization technique  that hasTherefore, high-voltage electric field cold plasma (HVCP) treatment can be beneficial, as it was found to stabilize wheat germ by inactivating lipase and lipoxygenase (LOX) enzymes, thereby extending the shelf life of wheat germs . PreviouMoreover, the findings of this study are expected to be beneficial for the solution of quality and safety issues, to attain maximum consumer satisfaction. It is especially important, as consumers are now more conscious about health and diet, and their demand for fresh food brought about increased interest in the mild processing technologies used.FolinCiocalteu (FC) reagent was bought from Shanghai RyonBiological Technology Co., Ltd., China. Catechin and ascorbic acid were provided by Shanghai Aladdin Bio-chem Technology Co., Ltd. Methanol, hydrogen peroxide, petroleum ether, hydrochloric acid, and n-hexane were provided by Nanjing Chem. Reagent . All the other chemicals used in the experiment were of analytical grade.Daucus carota cv Heitian-5) was bought from the local Suguo supermarket of Nanjing, China. For thermal treatment, good quality carrots (1 kg) were washed using tap water, peeled and then sliced manually to a thickness of approximately 2 cm, and diameter was 10 mm. The sliced carrots were blanched  in hot water at 100 °C for 5 min. The approximate ratio between the weight of vegetables and water was kept 1:2. Blanched carrots were cooled to room temperature by dipping in cold water, and then these slices were pressed to make juice by using Hurom slow juicer (Model# HU7WN3L). The fresh carrot juice was selected as the control without any treatment. The fresh carrot juice was subjected to HVCP as a design in the experiment.Raw material (Carrots: The dielectric barrier discharge (DBD) plasma system was used as a reaction cell. The apparatus was composed of an AC dielectric test set , high voltage wires, two circular aluminum electrodes (150 mm diameter), and dielectric barriers (2 mm polypropylene sheets). A high voltage power transformer (CTP-2000K) connected with the voltage regulator  was used to generate and provide power supply (0–80 kV) to upper and lower electrodes. Approximately, 250 mL of carrot juice sample was taken for the treatment of HVCP. The samples were packed in pre-sterilized food grade bottles and were placed between two dielectric quartz plates with a gap of 30 mm and treated at 60, 70, and 80 kV for 3 and 4 min with three-time repetitions and a 30-second break interval in every treatment. Stable and uniform plasma was generated; the air was used as a working gas during the HVCP treatment. The observed rise in temperature was measured by a digital thermometer (2–5 °C) during the HVCP treatment. The schematic diagram of the HVCP treatment for carrot juice has been illustrated in The method of  was usedThe PPO residual activity in treated and untreated carrot juice samples was determined by the method of . ChangesPME is measured as the amount of enzyme that releases 1 mmol of the carboxyl group in 60 s, as described by . A changKim’s method was used to determine the lipoxygenase activity in carrot juice . ChangesTotal carotenoid was measured in all the treatments by a method previously reported in  with minAll the samples were treated, and the control was tested to determine the effect of HVCP on lycopene contents. A method explained by  was usedreported  for lycoTM prep C18: 5 μm OBDTM, 150 mm × 19 mm, Waters, Ireland). The mobile phase was comprised of a mixture solution of acetonitrile-acetone-methanol , and the flow rate was adjusted to 0.80 mL/min. Commercially available β-carotene and lutein with different concentrations were used to draw a linear regression calibration curve.Briefly, the juice sample (25 mL) was poured into a separation funnel with an equal volume of acetone three times and filtered by a No.1 Whatman filter paper. The filter cake was re-extracted with methanol, and the extract was vigorously mixed with an equal volume of petroleum ether. The upper petroleum ether layer was dehydrated using anhydrous sodium sulfate, and after filtration, it was concentrated using a rotary evaporator at 30 °C. Then, we added 10 mL acetonitrile–methanol–acetone solution  and kept it at 18 °C in the dark until further analysis. The samples were filtered through a syringe filter . Filtered samples were fractionated using Waters Auto Purification high-performance liquid chromatography (HPLC) . The mobile phase consisted of a mixture solution of aqueous formic acid (A) with methanol (B) . We then injected 5 mL of filtrate sample into the column at a flow rate of 1 mL/minute. A linear biphasic gradient was used with 15–40% solvent B over 10 min, 40–50% over 15 min, 50–75% over 20 min, 75–90% over 25 min followed by a gradual column re-equilibration from 90–65% over 30 min, 65–40% over 35 min, 40–10% over 40 min. Samples were detected using a UV-VIS spectrophotometer at a wavelength of 320 nm, a commercially available chlorogenic acid was used as an external standard, and different concentrations of its solution (10–80 mg/mL) were used to draw a standard curve. Data were presented as mg of chlorogenic acid equivalent per milliliter of samples. Kahle method with minor modifications was used to determined chlorogenic acid . The ideTM prep C18: 5 μm OBDTM, 150 mm × 19 mm, Waters, Ireland). The mobile phase consisted of acetonitrile  with a 1 mL flow rate. A Cosmosil packed column of D-sugars (4.6×250 mm) was used. Commercially available sucrose, fructose, and glucose were used as external standards. Different concentrations of each solution standard were prepared. Sucrose, fructose, and glucose were used to draw a linear regression calibration curve. Data were analyzed as g of sucrose, fructose, and glucose equivalent per liter of sample.Sugar contents were determined by . The ideAmerican Public Health Association (1988)  describe2O2 to this mixture and heated at 200 °C in a microwave oven for 20 min with a one-minute rest after the first ten minutes for better acid digestion. The digested solution was transferred into a 50 mL volumetric flask and diluted up to the mark with pure water. The samples were tested using an inductively coupled plasma-optical emission spectrometer . Commercially available standards of each mineral were purchased and used as standards. All the measurements were conducted in triplicate. We followed the American Public Health Association (1988) described the method to determine mineral contents. 1mL of the carrot juice sample was digested with 7 mL of nitric acid solution  in a Teflon digestion vessel (TFM). All the conditions for the detection of minerals are given below in We added 1 mL of HTotal phenolic content was determined following the method described by . ElutionThe total flavonoid content was determined using the method described by . The absTannin contents were determined by the method of . The absBrix was measured by a hand refractometer  at room temperature (25 ± 2 °C). All the measurements were taken in triplicate, and water was used to wash prism of hand refractometer. A digital pH meter was used to measure changes in pH in carrot juice samples. Different concentration buffer solutions (pH = 4.0 and 7.0) were used for the calibration of the pH meter. 15–20 mL of each treatment sample was poured into a beaker, and we measured the changes of pH with a pH meter. All measurements were conducted in triplicate.The titratable acidity of the carrot juice samples was measured by the standard method of the Association of Official Analytical Chemists . BrieflyThe color was measured using a colorimeter  or greenness (−a*), and b* used to describe the level of yellowness (+b*) and blueness (−b*). A standard white plate  was used to calibrate the instrument. There are nine samples, and each piece was recorded three times.The method described in  was foll−1).Microbiological counts were assessed by , with slp < 0.05 the). Least significant difference (LSD) pair-wise comparison test was used to determine the level of significance between means. All the results were analyzed using the Statistical package for social science (SPSS), version 18.0 .The mean and standard deviation values of the results were derived. A complete randomized design (CRD) with one-way Analysis of variance (ANOVA) was applied to calculate the level of significance  treatment and followed by HVCP at 70 kV for 4 min . ResultsThe absorbance charts of the POD and LOX have been drawn to evaluate the impact of different treatments such as Control (Ck) TP, HVCP 60-3, HVCP 60-4, HVCP 70-3, HVCP 70-4, HVCP 80-3, and HVCP 80-4. PME and PPO were drawn by the means value of absorbance at a different time from 0 to 10 min. As given below, the time point enzyme activities chart has been explained in Clupea harengus), which tended to inhibit the formation of alkaline compounds in the early days of a storage period [Albertos has reported the ability of DBD toward reducing the protein decomposition in herring  on the sugar contents of the processed carrot juice was evaluated. It is depicted that there was a significant decrease in sugar content  in thermally processed samples when compared to HVCP and control groups . The obsAlthough a full biochemical mechanism that describes this increase is still unknown, it was reported previously that ionized nitrogen species reacts to breaking bonds between sugars and cell membranes. It could be attributed to the electrically charged species from the cold plasma, which may result in the electroporation of cell-matrix and alter the hydrophobic or hydrophilic nature of the membrane and promote the extraction ability . The result regarding the effect of high voltage cold plasma on the mineral profile  has been demonstrated in Therefore, an increase in Na, K, and P in all high voltage treated samples is also a solid reason to consider and verify the effect of high voltage cold plasma for the processing of carrot juice. The highest increase was observed in HVCP 70 kV for 4 min when compared to the control sample. Although, in the case of HVCP 60 kV for 4 min, less effect on the mineral profile was noticed. Moreover, a further increase in voltage from 70 kV has a negative impact on mineral contents, and this reduction was more pronounced in the case of Mg.The results of TP and other treatments of HVCP have been listed below . ResultsSimilar findings have been reported when sonication treatment was applied in comparison with thermal processing for apple and carrot juices ,36. ThisThe different treatment effects on the extraction and determination of phenolics have been explained in Similar findings had reported previously when an increase in phenolic compounds was observed, when carrot  Saqib etIncreased concentrations of different polyphenolic compounds such as (+)-catechin, (−)-epicatechin, epigallocatechin gallate, quercetin-3-galactoside, and ellagic acid were previously found in pasteurized strawberries . IncreasA scientist  has studWhereas, another researcher  Brandenb2 species may lead to the erosion of the epidermal layer of lettuce where flavonoids and other compounds accumulated in the central vacuoles of guard cells and epidermal cells are released. Moreover, the interactions of atmospheric plasma reactive species with secondary plant metabolites in lamb’s lettuce in  suggesteHowever, overexposure may result in a decrease in phenolic compounds. Once phenolic compounds are in their free form, they are more prone to be degraded by oxidative species on extensive exposure, thus leading to a decrease in quantity . The decThe different treatment effects on the determination of pH, °Brix titratable acidity, and changes in colors  of total carotenoids have been explained inNo significant effect was observed in pH, acidity, and °Brix after treatment with TP and HVCP. This study is under the previous report . The resAs a key important factor for any processing technology, no technology can be authenticated without significant success in reducing and controlling microbes during the processing. Therefore, this study also elucidated the effect of HVCP on microbial activities . Total pThis better reduction of microbial activities could be because of the biocidal effect of high voltage that inhibits the growth of microorganisms and enhance the stability and shelf life of the juices. It could be attributed to the production of reactive nitrogen and oxygen species (RONS) during the exposure of plasma generated atmosphere, as shown in − and NO2−), the treatment reduces microbial load and enhances the stability of carrot juice with better nutritional value. Due to this beneficial aspect, it is appropriate for industrial applications for heat-sensitive food items in which heat treatments lose nutrients. Moreover, HVCP treatment had a significant effect on the quality characteristics of carrot juice, such as color, acidity, and odor. Keeping all the above findings and also the certain benefits, i.e., simple and controllable equipment handling, and process operation compared to traditional processing and preservation techniques, we suggest that high voltage cold plasma may successfully be employed in the food industry.The findings of the recent work showed that HVCP processing has the potential for improving the quality and safety of carrot juice, and it may successfully be employed in beverage industries. Furthermore, the antimicrobial behavior of HVCP treatment has indicated that due to the presence of the reactive species and lethal interaction of hydrogen peroxide and acidified nitrites (NO


Cocaine has traditionally been the topical decongestant most frequently used for visualization of the surgical field in Endoscopic Sinus Surgery (ESS). Alternatives include xylometazoline, oxymetazoline, and epinephrine. The understanding of the safety profile of each agent is changing, as are the practices of Otolaryngologists-Head & Neck Surgeons. The objective of this study is to determine decongestant use practices in ESS across Canada, which has not previously been studied.A cross-sectional survey design using a 24-item electronic questionnaire was distributed to actively practicing members of the Canadian Society of Otolaryngology-Head and Neck Surgery via email. A French translated version of the survey was also available. Questions explored the respondents’ demographics and decongestion practices for ESS.Ninety-six surveys from otolaryngologists practicing in Canada were completed (19% response rate). The average time in practice was 16.5 years . Twenty-six (27%) of respondents use some form of cocaine solution for topical decongestion in ESS. Over a total of over 1500 combined practice-years, eight respondents (8%) personally experienced an adverse event that could be attributed to cocaine, including two mortalities. One cardiac even was directly attributable to the patients’ use of recreational cocaine in the immediate pre-operative period.The popularity of cocaine for topical decongestion in ESS in present-day Canada is less than in surveys from other countries. However, there are few reported adverse events with long-term consequences that are attributable to intraoperative cocaine. Considering the beneficial effects of cocaine for visualization and pain control, this change in practice warrants further investigation.The online version of this article (10.1186/s40463-019-0337-8) contains supplementary material, which is available to authorized users. Endoscopic Sinus Surgery (ESS) is a common procedure, widely regarded as the standard of care for chronic rhinosinusitis refractory to medical management. Decongestant medications minimize the engorgement of the nasal mucosa and facilitate hemostasis, which is crucial to optimizing visualization in nasal surgery. For over a century, the most popular drug for this purpose has been cocaine.Cocaine (benzoylmethylecgonine) is an alkaloid ester that provides topical analgesia, decongestion and hemostasis . These pA survey of American otolaryngologist – head and neck surgeons in 1977 found that 94% used cocaine in their procedures regularly, 35% use epinephrine with cocaine, and that 48% did not adhere to the recommended maximum dose of 200 mg of cocaine per patient . A repeaAn online questionnaire methodology was developed in consultation with the Heath Sciences Research Ethics Board for Western University . An email list of active members of the Canadian Society of Otolaryngology—Head and Neck Surgery (CSOHNS) was used to distribute the questionnaire in both English and French. Each member received by email a notification including an introductory note describing the nature of the study and a hyperlink to a short anonymous survey using the Qualtrics platform. A single reminder email was sent 6 weeks later. The survey remained open over 8 weeks. Participation was entirely voluntary. To satisfy the inclusion criteria, participants must have been practicing staff surgeons and active members of the CSOHNS. Potential participants in residency or fellowship training were excluded as they would not yet make the ultimate decision regarding which decongestant preparation would be used. Only responses from those who completed the survey in its entirety were used.The survey used a closed-question format asking about the physician’s use of cocaine and other decongestant drugs, their practices regarding local epinephrine injection, and adverse outcomes experienced. When necessary, questions included a space for comments. The survey included demographic questions about number of years in practice and practice type and location, as well as subspecialty training and training location. No compensation was offered to the participants, and no attempt was made to contact participants who did not return surveys. The survey is available online as Additional file The responses to each question were analyzed as proportions. The responses of different demographic groups were compared using Chi-squared tests. Short open text responses were analyzed descriptively. Descriptions of adverse events were screened for duplicate descriptions of the same event, using a combination of event descriptions themselves as well as demographic information.Ninety-six eligible otolaryngologists currently practicing in Canada returned the survey, representing a 19% response rate among eligible participants. Physicians from all 10 provinces responded. The average practice years per respondent was 16.5 with a standard deviation of 12.1 years and a range from 1 to 50 years. Figure Twenty-two respondents (23%) used cocaine for decongestion in ESS. Six respondents (6%) used Moffett’s Solution (cocaine + epinephrine), including 2 respondents (2%) who used both Moffett’s and isolated cocaine, giving a total of 26 respondents (27%) who used a cocaine preparation in ESS.Only 2 respondents reported using cocaine in pediatric patients, which represents 8% of the group of respondents who used cocaine. The other 24 respondents of this group (92% of respondents who use cocaine) reported that they avoided cocaine in pediatric patients.P = .037]). Cocaine usage also differed by province  used a 4% solution, and 3 respondents (12%) used a 10% solution. Among users of Moffett’s solution, 2 respondents (33%) used 1.2% cocaine with 1:10000 epinephrine, 2 respondents (33%) used 4% cocaine with 1:1000 epinephrine, 2 respondents (33%) used 4% cocaine with 1:10000 epinephrine, and 1 respondent (18%) also used 10% cocaine and 1:10000 epinephrine.Of those that used some form of cocaine in ESS, 14 respondents (54%) reported that their decision to use the agent was affected by the patient’s comorbidities, while 12 respondents (46%) did not change their use of the agent based on comorbidities. Some of the comorbidities respondents considered include allergy, coronary artery disease, arrhythmia, hypertension, and history of drug abuse. Only 2 respondents reported that they did not restrict dose of cocaine to 200 mg. Five respondents were unsure whether they dosed below 200 mg.Of all respondents who used cocaine, 4 15%) indicated that they personally experienced at least one adverse event that could be attributable to cocaine, in a combined total of 467 practice-years , followed by the poor availability of cocaine  (Table Sixty respondents (63%) used topical epinephrine for decongestion in ESS. Six respondents (6%) used Moffett’s Solution (cocaine + epinephrine), including 3 respondents (3%) who used both, giving a total of 63 respondents (66%) who used an epinephrine preparation in ESS Table .P = .015]) (Table Reported usage among the respondents is given in Table ]) Table . EpinephAmong the 60 respondents that utilized isolated topical epinephrine, the most common concentration used was 1:1000, with 53 respondents (88%).For locally injected decongestant, 85 respondents (88%) use epinephrine and lidocaine and 5 respondents (5%) use isolated epinephrine. The most popular concentration of injected epinephrine is 1:100000 , followed by 1:200000 . Eighty-four respondents (88%) inject trans-nasally and 10 respondents (10%) inject trans-orally, including 9 respondents who do both  reported their residency as an important factor and 19 respondents (20%) reported their fellowship training as an important factor. Evidence from the literature was a factor for 25 respondents (26%) , followed by Oxymetazoline  Table .This is the first investigation of Canadian otolaryngologists’ practices for nasal decongestion in ESS. Over the years there has been a trend of declining use of cocaine for nasal decongestion. In the United States, Long et al. repeated methodology from a 1977 survey 25 years later and found that cocaine use had significantly decreased, with only 65% having used it in the last 10 years compared to 92% in 1977 [Compared to the most recent data from other nations, the prevalence of cocaine administration among Canadian otolaryngologists’ 27%) is the lowest yet reported. A 2002 survey in Australia found 64% of otolaryngologists used cocaine in nasal surgery . A 2011 % is the The most common reason for not using cocaine in ESS was providers’ satisfaction with other available decongestants. The next most common reason for avoiding cocaine was restrictions in availability, including a lack of medical-grade cocaine suppliers in some cities in Canada.The safety of cocaine when used as recommended in nasal surgery has not been well investigated. The most common reported complications include arrhythmia, hypertension and cardiac arrest. Mortality is rare: in a survey of 360 otolaryngologists with a combined 3417 total practice-years, only one mortality possibly related to cocaine was reported . In our Interestingly, one of the reported events was in a patient who abused cocaine pre-operatively, and had a cardiac arrest after xylometazoline was administered. This serves as a reminder of the importance of screening for cocaine abuse before surgery, regardless of the decongestant used. Fifty-six percent of providers who use cocaine for ESS take into account patient comorbidities in their decision to use the drug. The factors that deter providers from using cocaine in certain patients include allergy, arrhythmia, hypertension, coronary artery disease, and a history of drug abuse. It is possible that our study overestimates the frequency of adverse events related to cocaine, as those who have had negative experiences may be more likely to respond to a survey about intraoperative cocaine use.In similar studies of otolaryngologists in other nations, a combination of cocaine and epinephrine (Moffett’s Solution) has proved popular, with a recent U.K. study reporting that 53% of respondents used it for nasal surgery . There iAlthough our response rate of 19% was less that most previous studies on this topic, it represents an above-average response rate for electronic surveys sent out to CSO-HNS members. The low completion rate may be partially due to the survey having no opt-out mechanism for respondents who have other sub-specialty expertise or do not perform sinus surgery.Our question “which of the following solutions do you use for decongestion of nasal mucosa?” captures current practices by respondents. Our results show that an unexpectedly low proportion of Canadian otolaryngologists currently use cocaine for ESS. To elucidate why this finding is different from previous studies, practice pattern surveys in the near future could be performed in other jurisdictions, especially the United States, the United Kingdom, and Australia, where previous data exists to see if a global shift in decongestant practices is present.This study shows that the decongestant practices of Canadian otolaryngologists for ESS differ significantly from those reported in other nations and in the past. Notably, the use of cocaine for decongestion is much lower than previous studies in other countries. Most respondents’ experience with cocaine did not include adverse events with long-term consequences, and use of cocaine with epinephrine (Moffett’s Solution) was not associated with any adverse events. Many practitioners have adopted the use of 1:1000 epinephrine, citing equivalency to cocaine with an improved safety profile as the primary reason. Regardless of the decongestant used, providers should make their choice based on patient factors.Additional file 1:Complete Online Survey - English version. (DOCX 25 kb)Additional file 2:Complete Online Survey - French version. (DOCX 27 kb)


Neoaortic regurgitation and root dilatation are common findings in patients with transposition after an arterial switch operation. The aim of this study was to describe the relation between neoaortic regurgitation long term after an arterial switch procedure, aortic root diameters, and surgical technique used. We also assessed the agreement of the neoaortic regurgitation grade and root diameters in different imaging modalities. For this retrospective study, we qualified 56 consecutive patients who, according to our institutional protocol, had a routine postoperative evaluation of more than 16 years with multimodality imaging studies. Neoaortic regurgitation was assessed by both transthoracic echocardiography and magnetic resonance imaging, and the root diameters obtained by echocardiography and tomography were compared to the reference values and associated with the presence of neoaortic insufficiency. Neoaortic insufficiency was present in 75% of examined patients; the vast majority of them had trace or mild regurgitation, and its qualitative evaluation was significantly different between echocardiography and magnetic resonance imaging. In our study group, the neoaortic valve and aortic sinus were larger in relation to the normal values, and they were significantly correlated with the presence of neoaortic insufficiency, but not with the surgical technique used. Values obtained by echocardiography and tomography correlated well but were significantly different. Transthoracic echocardiography has a tendency to overestimate the severity of regurgitation compared to magnetic resonance imaging. Neoaortic valve and sinus dilatation are significantly correlated with valve insufficiency, but in most cases of root dilatation, the valve remains competent. Neoaortic regurgitation (NeoAR) is a common sequela affecting patients with the transposition of the great arteries (TGA) after an arterial switch operation (ASO) . In mostBecause of the complex aortic root geometry, its detailed description is frequently difficult in echocardiography, especially in older patients. In our institution, as part of the routine follow-up protocol after an ASO for all patients who are older than 16 years, we perform standard transthoracic echocardiography (TTE), phase-contrast MRI, and coronary computed tomography (CT) angiography . This muThe aim of this study was to describe the relation between neoaortic regurgitation long term after an arterial switch procedure, aortic root diameters, and surgical technique used. We also assessed the agreement of the neoaortic regurgitation grade and root diameters in different imaging modalities.In our Institution between the years 1991 and 2018, 806 patients underwent an arterial switch operation. For this retrospective study, the initial cohort of 53 consecutive patients who had routine follow-up examinations late after an ASO by transthoracic echocardiography, MRI, and CT with a coronary artery evaluation and detailed measurements of the neoaortic root. Additionally, we included 3 patients who underwent all these studies earlier because of severe aortic regurgitation requiring precise assessment before surgical qualification. The study was approved by the institutional ethics board.The surgical technique was described previously , 6, herez-scores [All patients underwent a full TTE examination with an evaluation of NeoAR on a 5-grade scale  based on “eyeballing,” the diameter of the vena contracta, the ratio between the regurgitant jet and the left ventricular outflow tract (LVOT) diameter, reverse flow in the descending and abdominal aorta, the pressure half-time and the left ventricular diastolic diameter and volume. All studies yielded detailed measurements of the neoaortic root along the long parasternal axis (modified according to the anatomy of the ascending aorta) at the level of the hinge points of the valve cusps , aortic sinus, and sinotubular junction. All measurements were made according to the European Society of Cardiology (ESC) guidelines along the long parasternal axis, including measurements of the aortic annulus at peak systole and the aortic sinus and sinotubular junction at end-diastole . The meaz-scores .z-scores for the tomographic data [The CT examination of all patients provided a detailed description of the coronary anatomy with a major focus on the proximal parts, as well as a description of the aortic valve anatomy and aortic root measurements in two perpendicular planes at the level of the valve, aortic sinus, sinotubular junction, and mid-ascending aorta. All measurements were standardized to the patient height and width using the mean value of two perpendicular diameters and calculated hic data .All MRI studies provided the diastolic volume of the left ventricle and aortic valve regurgitant flow calculated from the velocity-encoded phase-contrast sequence  with measurements performed in diastole at the level of the NeoAoV perpendicular to the LVOT. We evaluated the quantitative regurgitant fraction and the qualitative neoaortic insufficiency on a 5-grade scale: none, trace (regurgitant fraction: 0–8%), mild (8.1–20%), moderate (20.1–40%), and severe (> 40%) .All results regarding NeoAR and aortic root diameters were correlated with potential risk factors, such as associated defects  or the surgical technique .U test and ANOVA Kruskal–Wallis test or Student’s t test and ANOVA. The test selection was based on the normality of the data distribution. To evaluate the statistical relation between qualitative datasets, the χ2 test or Fisher exact test was used. The agreement between diameters obtained by two different methods was assessed by correlation tests and paired tests (t test or Wilcoxon test). A p value less than 0.05 was considered statistically significant.Statistical analyses were performed using Statistica 13 software . Quantitative data are presented as the mean with the 95% confidence interval (95% CI) and standard deviation (SD) or the median and interquartile range  depending on the normality of the distribution. Qualitative data are presented as percentages. Associations between quantitative datasets were tested using Spearman’s or Pearson’s correlation test. Differences between the groups were assessed using the Mann–Whitney p < 0.001, Chi-square test, Fig. R = 0.62, p < 0.001, Spearman correlation test), but there were no statistically significant differences in the regurgitant fraction of the NeoAoV among patients with no, trace and mild insufficiency on echocardiography . However, the difference between these patients and those with moderate and severe insufficiency was statistically significant .The median age at the time of examinations was 19.8 years IQR 17.9–23 years). Neoaortic insufficiency was a common finding in our study group. On the basis of TTE, NeoAR was present in 75% of patients (42 out of 56). In most of the cases, it was trace or mild  and had no clinical significance. Moderate stenosis was present in 4 cases (7.1%), and 5 patients showed signs of severe stenosis (8.9%). Among this group most of the patients were examined routinely (53 patients), additionally 3 cases were qualified earlier for these studies because of severe neoaortic regurgitation. Comparing these data to the MRI results, regurgitation was found in 43 cases (76.8%) and we mostly found trace insufficiency ; mild insufficiency was found in 6 patients (10.7%), moderate was present only in 2 cases (3.6%); and 4 patients had confirmed severe regurgitation (7.1%). The differences between the qualitative assessments of neoaortic insufficiency by TTE and MRI were statistically significant (3 years. p = 0.019); in these patients, the regurgitant fraction calculated via MRI was significantly larger  than that in patients with tricuspid valve .The presence of neoaortic insufficiency was significantly correlated with bicuspid aortic valve  and the left ventricular end-diastolic volume indexed for body surface area .The regurgitant fraction obtained via MRI was significantly correlated with the left ventricular end-diastolic volume . In patients who developed regurgitation qualitatively estimated as more than trace , the valve diameter was significantly larger  than that in patients with no or trace insufficiency  . However, 9 out of 15 patients who had NeoAoV z-scores greater than 3 on TTE had no or trivial insufficiency on MRI. Among patients with regurgitant fractions, over 8% (12 patients), half had NeoAoV Z-scores less than 3, and 4 of them had NeoAoV z-scores less than 2.In our study group, the NeoAoV diameter obtained by TTE was usually larger than the normal values; the average z-score: 1.92, 95% CI 1.55 to 2.3, SD 1.4). Patients with an aortic regurgitant fraction greater than 8% had a larger valve annulus  than those without insufficiency  . The diameter of the NeoAoV measured on CT was significantly correlated with the MRI regurgitant fraction ; however, 7 out of 12 patients who had a NeoAoV CT z-score greater than 3 had no or trivial insufficiency on MRI. Among patients with a NeoAR regurgitant fraction greater than 8% (12 patients), seven had an aortic valve CT z-score less than 3, and 3 had an aortic valve z-score less than 2.The CT results were similar; the valve diameter was usually larger than the normal values . Both results correlated well , but the observed differences were statistically significant . A significantly dilated NeoAoV (z-score > 3) was diagnosed in 15 cases during TTE and in 12 cases during CT. Eight patients had a coherent diagnosis of dilated aortic valve by both modalities. In most cases, the difference was related to the difference in the measurements or a significantly asymmetrical valve described by CT.Although the z-score 1.95, 95% CI 1.58 to 2.31, SD 1.35). The neoaortic sinus was significantly wider in patients with NeoAR  than in those with no or trivial insufficiency  . In the group of patients with regurgitant fractions greater than 8% (12 patients), 6 had aortic sinus z-scores less than 3, and among them, 4 patients had z-scores less than 2. Eleven patients had a diagnosis of significant aortic sinus dilatation on TTE, but among them, 6 had only trace insufficiency detected via MRI.The average diameter of the aortic sinus on echocardiography was larger than would be expected in the normal population . Similar to the TTE findings, a larger sinus was observed in these patients, who had insufficiency with a regurgitant fraction greater than 8%  . Aortic sinus CT Z-scores significantly correlated with the NeoAoV regurgitant fraction obtained by MRI . In the group of patients with aortic sinus z-scores greater than 3 (16 patients), 10 patients had only trace insufficiency on MRI. In the group of patients with significant regurgitation, 6 patients had aortic sinus CT z-scores less than 3, and among them, 2 patients had aortic sinus z-scores in the normal range.The diameters of the aortic sinus determined by the CT examination were also larger than the reference values; the mean z-scores but also the diameters themselves were higher on CT than on TTE . The results of these two modalities correlated well ; however, the differences were statistically significant . Significantly dilated aortic sinus (z-score > 3) was diagnosed in 11 patients by TTE and in 16 patients by CT. Nine patients had a coherent diagnosis of dilated aortic valve via both modalities.In the case of the aortic sinus, not only the calculated z-scores for both CT (p = 0.031) and TTE (p = 0.014). Similarly, the intraoperatively confirmed significant discrepancy of the arterial valves also increased the aortic sinus z-scores calculated for the TTE (p = 0.014) and CT (p = 0.006) datasets.Among anomalies associated with TGA, in our cohort, the Taussig Bing anomaly was correlated with higher aortic sinus z-score 0.56; 95% CI 0.25 to 0.86; SD 1.12). The difference between the patients who developed NeoAR with a regurgitant fraction greater than 8% and those patients without significant insufficiency was not significantly different  , and the difference between patients with and without significant regurgitation was not statistically significant  . The sinotubular junction diameters obtained via TTE and CT correlated well ; however, the difference between the results was statistically significant ; the mean difference between the CT and TTE results was 2.08 mm .The average diameter of the sinotubular junction obtained by TTE was close to the reference values .Among the associated defects, aortic arch anomalies were correlated significantly with the smaller sinotubular junction CT Currently, NeoAoV regurgitation seems to be the most common complication after ASOs, its reason is multifactorial what implicates the different postoperative courses in different patients. The association of neoaortic insufficiency and root dilatation in this group of patients was previously described , 11, 12.The presented frequency of neoaortic valve insufficiency is quite high, but it is mostly a benign complication, as in the majority of cases, the regurgitant jet is usually trace or mild. In our dataset, TTE tended to overestimate the regurgitation grade, as shown in Fig. z-score > 3) was similar irrespective of the surgical approach. As both techniques in our institution were used by the same surgical team and the main operator (JJM), this is evidence that both techniques influence the root size and valve function in a similar way. Of course, there is a significant difference in the reported frequency of these complications between different centers using both the same and different surgical methods of coronary transfer. Therefore, the method of coronary transplantation is important, but in our opinion, with proper experience, one can benefit from the trap door technique without increasing the risk of root dilatation or neoaortic insufficiency [The surgical technique is frequently proposed as a potential risk factor for the development of NeoAR and aortic root dilatation , 14. In The root dilatation in this group of patients requires special attention not only because it may result in valve incompetence but also because of its impact on coronary arteries. Many patients with TGA have a left coronary artery placed more anteriorly in the aortic sinus, just below the pulmonary artery, with acute proximal angulation and a somewhat angulated proximal course with a tendency to reduce the cross-sectional area . LookingNeoaortic insufficiency is quite common in patients with transposition after arterial switch procedure, but is usually a benign complication. Transthoracic echocardiography has a tendency to overestimate the severity of regurgitation compared to MRI.Neoaortic valve and aortic sinus diameters in these group of patients are larger in relation to the normal population, and they are significantly associated with neoaortic insufficiency; however, not every case of significant regurgitation is related to root dilatation, and not every case of significant root dilatation is related to valve incompetence. The root diameters are changed similarly irrespective of the surgical technique used.


Introduction Vitamin D is key in maintaining muscle mass and bone structure. The purpose of this quality improvement project is to evaluate the current treatment of elderly patients who experience falls, educate providers on the importance of vitamin D, and measure the changes.One-third of people aged 65 years of age and older fall annually.MethodsWe obtained baseline data from the electronic medical records (EMR) of patients who had experienced falls from over a two-year period. We also surveyed providers from the departments of internal medicine (IM) and family medicine (FM) to evaluate fall treatment, educated providers on new protocols, reviewed EMRs of patients that had fallen and surveyed FM and IM providers after education.ResultsWe found that vitamin D supplementation and home health (HH) referral were marginally improved after education and that significant improvement was found in patients being referred to physical therapy (PT).ConclusionEstablishing a fall treatment protocol leads to more consistent care among FM and IM providers. Reviewing and updating of the protocol based on outcomes and subsequent research is recommended for improvement in patient care. Vitamin D is a fat-soluble vitamin that is converted in the liver to 25(OH)D (circulating form) and then in the kidney to 1,25-dihydroxyvitamin D (active form). Vitamin D helps with enterocyte differentiation, intestinal absorption of calcium, intestinal phosphate absorption, direct suppression of parathyroid hormone, regulation of osteoblast (bone-forming cells) function, parathyroid hormone (PTH)-induced osteoclast (bone-resorbing cells) activation, and bone resorption [One-third of people 65 years of age and older fall each year and many falls may result in a serious injury . SarcopeThere are three main ways to raise vitamin D levels: ingesting food with high D levels , exposure to the sunlight, or taking supplements. Current dietary recommendations are 1200 mg of Ca and 800 international units (IU) of vitamin D for postmenopausal women with osteoporosis. For all other adults, the dietary recommendations are 1000 mg of Ca and 600 IU of vitamin D [It has been recommended to have a minimum level of 25(OH)D concentrations of 30 ng/ml to minimize the risk of falls and fractures . A fall Multiple studies agree that supplementation with vitamin D is worthwhile to decrease the risk of falls and fractures, but the dosage requirements are inconsistent. For example, in a study by Zheng et al., there was an increased risk of falls for patients treated with high dosage and intermittent vtamin D when compared with the control p = 0.006) , which i , which The American Geriatrics Society (AGS) has attempted to clear some confusion for the vitamin D debate. AGS noted that serum concentrations of 25(OH)D <30 ng/ml have been associated with balance problems, impaired lower extremity function, high fall rates, low bone mineral density, and muscle weakness. In order to treat this issue, clinicians should recommend vitamin D supplementation of at least 1000 IU as well as Ca supplementation to community-dwelling older adults (≥65 years old) to reduce the risk of fractures and falls. Routine lab testing for 25(OH)D serum concentrations before supplementation is not necessary. If clinicians choose to monitor 25(OH)D, they are advised to test after four months of D3 supplementation to confirm that appropriate levels have been achieved. Clinicians should not recommend large bolus doses of D2 or D3 ≥300,000 IU . Despite the confusion of how and when to prescribe vitamin D, it was determined that examining how supplementation is utilized among the providers of internal medicine (IM) and family medicine (FM) was beneficial to standardize treatment. Our objectives were: (1) to review patient records of those who were at risk of falling, specifically vitamin D levels, vitamin D supplementation, referrals to therapy and frequency of falls; (2) prospectively survey providers to evaluate barriers to vitamin D supplementation and therapy in individuals at risk for falls; (3) establish a recommended patient care protocol and educate providers; (4) conduct a post-education review of records to see if therapy referrals and vitamin D supplementation are aligned with the patient care protocol.Part 1A retrospective chart review was performed to see how providers treated those who had fallen. Study participants were selected from Robert Packer Hospital (RPH), a 254-bed tertiary care teaching hospital in Sayre, Pennsylvania that serves the region of the Twin Tiers, the Northern Tier of Pennsylvania and the Southern Tier of New York State. RPH is part of the Guthrie Clinic (GC), a not-for-profit, integrated health care organization. A list of patients was selected whose providers had used a variant of the ICD-10 code for fall for their GC visit of FM or IM providers, from the period of January 8, 2016 to November 29, 2017. The patients were stratified according to demographics, body mass index (BMI), vitamin D and Ca levels, polypharmacy (defined as more than four medications), treatment chosen , and the cause of fall. The data was then analyzed for trends.Part 2A survey was designed and administered to providers from IM and FM, to evaluate how they treat fall victims and to understand possible barriers to implementing vitamin D supplementation and other treatment options, including referrals to therapy (Supplementary Text S1). Survey results were then combined and analyzed. The results of the survey along with the research done to date and education from an interdisciplinary team of professionals that treat fall victims were used to develop a patient care protocol for treatment which was then communicated to providers at grand rounds.Part 3Twelve months after grand rounds, a follow-up review of patient records who had fallen and a second survey of IM and FM providers was conducted to determine how well physical therapy referrals and vitamin D supplementation dosages aligned with the established protocol (Supplementary Text S2).Statistical analysis was completed using R statistical software program . In the paper, statistical significance was defined as a p-value of 0.05 or less.Part 1General CharacteristicsA total of 243 unique patient charts were examined who had fallen over the past two years, 65% were female, 35% were male. The average patient age was 79 years old. The average BMI was 29.66 (standard deviation=6.95), with frailty mentioned in only 3% of patients. The most common cause of falls was described as mechanical (73%). Physical therapy (PT) was recommended 33% of the time, and home health (HH) was recommended 12% of the time. Polypharmacy was found in 89% of the patients (Table Vitamin D LevelVitamin D levels were recorded in only 73% (n=177) of the patients. The average level of vitamin D was 37.54 ng/ml (SD=15.99). Of those 177 patients, levels below 30 ng/ml were seen in 61 patients (35%). For those 61 patients, only 57% (n=35) were on vitamin D supplementation. Part 2A survey was completed by a total of 43 providers in the IM and FM. About half of providers saw between 1-10 patients annually for falls, and 35% saw between 11-20 patients annually for the same. About 70% of providers believed vitamin D to be deficient at levels <30 ng/ml. About 61% of providers believed that vitamin D deficiency was a significant cause of falls in the elderly. Most believed that vitamin D supplementation was helpful in the prevention of falls, but less prescribed it for fall prevention  Table .Most providers did not think that calcium supplementation was important for prevention of falls, and they did not prescribe it for their patients (p = 0.0001) Table .After the completion of the education period, 176 patients were seen over a period of about six months. Most patients that were seen in the clinic who had fallen were female (72%). About 60% of falls were deemed to be mechanical in origin. Almost all (95%) of patients seen were on at least four medications. About 30% of patients had low vitamin D levels, but only 61% of those patients with low levels were being treated with vitamin D. HH was offered to patients about 8% of the time, and PT was offered about 50% of the time. In the IM department, the number of patients that were recommended for PT went from about 34% to about 55% (p = <0.0001).Healthcare providers entering the outpatient primary care environment will have many elderly patients who have either fallen or at risk of falling. Therefore, a consistent diagnosing and treatment approach for fall victims is important for good patient care. Two years of past patient records of fall victims that saw either a family or internal medicine doctor were reviewed to establish the current medical treatment approach. Treatment approaches used were inconsistent between providers. Some patients were placed on supplements, some obtained medication usage counseling, and some obtained referrals for either PT or HH. The diagnosis of why someone fell was not consistently documented. Therefore, the hospital implemented a patient care protocol for patients that had fallen.Pre-interventionMost elderly patients who are fall victims should be tested to measure if the amount of vitamin D in their system is adequate and receive either PT or HH for strengthening and balance. However, patient records revealed inconsistent treatment practices between providers:- Only 73% of patients had their vitamin D level measured.- Among the patients whose vitamin D level had been measured and found to be below the 30 ng/ml requirement, only 57% were placed on supplements.- Only 45% of patients were recommended to receive either PT (33%) or HH (12%).According to the survey results, most providers believed that PT/HH was helpful in managing patients with fall risk. Only 45% of patients were recommended due to the knowledge the provider has that some of their patients were unwilling to participate in therapy. Also, therapy follow-up would require the provider to spend time following the patient through the therapy process, taking time away from other patient care.Most providers interviewed in the survey believe that vitamin D deficiency increases the risk of falling in elderly patients and that supplements should be taken Table . This isBoth vitamin D and calcium work together in the body for bone health. Vitamin D helps in calcium absorption and builds skeletal health by bone mineralization. Thus, current recommendations from the American Geriatrics Society (AGS) have patients 65 years of age and older taking both vitamin D and calcium to help prevent osteoporosis and falls . HoweverEducationA multidisciplinary team consisting of an FM physician, an IM physician, a physical therapist, and an HH nurse presented at grand rounds. During this grand rounds, information on Vitamin D, calcium, and referrals was discussed. The IM physician discussed a patient, who had fallen, and all the medications that she was on. The risk of polypharmacy was emphasized. A physical therapist spoke of various treatment modalities that are helpful for patients with balance and deconditioning. The HH nurse showed an example of risk to a patient trying to navigate their house.The grand rounds event was well attended by a variety of healthcare professionals .Post-interventionA year after the education was completed, post-intervention started. The EMR was surveyed to observe the changes in patient care. Of the 176 patients seen by a provider after a fall, most patients were female (73%). Causation of falls was 59% mechanical, 22% risk of falls , 12.5% unknown, and 6% cardiovascular/neurological. Polypharmacy was evident again (as defined as >4 medications/supplements) in 95% of patients.- The percentage of patients that had their vitamin D levels drawn was 77.8% (137 patients). This was a slight improvement from the pre-intervention results of 73%.- Of patients whose vitamin D levels were low, 60% were on supplements (n=25), a small improvement from those prescribed supplements before training was done (57%).- The number of those referred to HH care remained about the same.- There was a significant increase (see Table The post-education survey was completed by 42 providers from FM and IM. About 95% of respondents considered vitamin D levels to be deficient at <20 ng/ml or <30 ng/ml. Two-thirds of respondents believed vitamin D deficiency to be a significant cause of falls. The providers who believe that vitamin D deficiency is a significant cause of falls prescribed vitamin D to their patients (p=0.0028, Table The study had some significant findings. Most providers only prescribe vitamin D supplements when necessary to raise a patient’s test results to the standard. However, supplements were not prescribed as a form of fall prevention for those who had acceptable levels of vitamin D present in their bloodstream. Conversely, most providers did not think calcium supplementation reduced the risk of fractures when people fell and did not educate their patients on the importance of calcium in their diets. IM providers increased the number of referrals to PT after the education while FM providers, who mostly absent from the session, did not. Otherwise, there were no statistically significant changes in patient care between pre-intervention and post-intervention surveys for FM and IM providers.There may be an opportunity for a quality improvement project to address education on referrals of fall victims to PT within the FM program. A future study could review the patient medical records to determine the usefulness of PT in reducing falls.Elderly people are more prone to fall as they age. This can increase a person’s morbidity and mortality rate. It is important to have an established process in place when caring for patients who have fallen. This study attempted to establish a process for evaluating fall victims. Vitamin D with calcium supplementation has been shown to be significant in decreasing fall risk for patients. PT and HH are important adjuncts for decreasing falls. Further research and education are required to unify how providers care for patients that have fallen.


P = 0.040). The beta-diversity was significantly different among the three groups (P = 0.043), between the lower and middle 2Q groups (P = 0.029), and between the lower and upper groups (P = 0.026). Bacteroides eggerthii showed a positive correlation with NLR (q = 0.015). The diversity and composition of the gut microbiome were different between the NLR groups. Particularly, patients with a lower NLR had a greater diversity of gut microbiota.Gut microbiota and blood neutrophil-to-lymphocyte ratio (NLR) are associated with systemic inflammation; however, data on the association between gut microbiota and NLR are lacking. We investigated the association between gut microbiota and NLR. A total of 1,309 subjects who had available data on NLR and 16 S rRNA sequencing of gut microbiota were included in this study. They were grouped according to NLR quartile (Q) as follows: lower Q , middle 2Q  and upper Q . The diversity and composition of the human gut microbiota in the groups were calculated. The phylogenetic diversity of gut microbiota in the lower group was significantly higher than in the middle 2Q group ( Because the composition of gut microbiota is affected by multiple factors, such as host genetics, diet, geographic location, environment, early microbial exposure, and use of medication5, the diversity and abundance of the gut microbiota greatly differ between healthy individuals. However, functional metabolic pathways remain relatively consistent despite variations in the microbiota6. The crucial role of gut microbiota consists of its association with development and maintenance of the human immune system via metabolism8. Recently, several studies have reported that the gut microbiota influences the pathogenesis of immune-mediated inflammatory diseases such as inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, and ankylosing spondylitis9.The human intestinal tract contains a varied and complex microbiotic environment that consists of more than 1,000 different species whose DNA encode the proteins for 3 million microbiomes11. NLR is not only highly correlated with the prognosis of cancer patients, but it is also correlated with the prognosis of multiple diseases including inflammatory disease, cardiovascular disease, and tuberculosis19. Patients with an elevated NLR show a relatively decreased number of lymphocytes and an increased number of neutrophils, suggesting that cell-mediated immunity is impaired and systemic inflammation is increased in inflammatory processes20. Although Forget et al. reported that the normal value of NLR ranged from 0.78 to 3.53 in the healthy population21, the range of normal NLR is still controversial due to limited evidence that subjects with a normal NLR range have similar immunity and inflammatory statuses.Neutrophil-to-lymphocyte ratio (NLR), which is calculated by dividing the absolute count of neutrophils by the number of lymphocytes in the complete blood count, is a simply-measured and reproducible biomarker used to evaluate systemic inflammationWe hypothesized that the composition and diversity of human gut microbiota are different depending on the range of NLR since both gut microbiota and NLR are affected by systemic inflammation and immunity in healthy individuals. The purpose of our study is to investigate the association between NLR and gut microbiome in a large-scale population.3/mm3 [lower Q] vs. 5.7 103/mm3 [middle 2Q] vs. 6.5 103/mm3 [upper Q], P < 0.001) and the proportion of neutrophils were significantly higher in the upper Q group than in the lower Q and middle 2Q groups , whereas the proportions of lymphocytes , eosinophils , basophils , and monocytes  were higher in the lower Q group compared with upper Q and middle 2Q groups. C-reactive protein (CRP) in the upper group was also significantly higher than in the other groups . Differences in comorbidities and nutritional intake were not identified between the three groups , 328 (25.1%), 653 (49.9%), and 328 (25.1%) were classified as the lower Q, middle 2Q, and upper Q groups, respectively (Table P = 0.222)We made additional comparisons between the lower Q and higher 3Q groups (Supplement Table P = 0.216), PD , evenness , and Shannon’s index   in the post hoc test. These results indicate that richness, including phylogenetic diversity, was different among the NLR groups, but evenness was not.The alpha diversity of gut microbial taxa between the lower Q, middle 2Q, and upper Q groups did not show statistically significant differences in observed OTU  and observed OTU  compared with the higher 3Q group ; between the lower Q and upper Q groups (P = 0.029); and between the lower Q and middle 2Q groups . In weighted UniFrac-based beta diversity, no significant differences were revealed among the three groups (P = 0.455) or within each of the two groups  was positively correlated with NLR  and negative correlation  with NLR, respectively  and middle 2Q groups  and showed a marginal trend toward decrease compared with the middle 2Q group  and middle 2Q groups  is slightly lower compared with other medical conditions, ranging from 2 to 328. Our study demonstrated a subtle difference in beta diversity between the lower and upper 3Q groups. Considering that we divided the NLR groups based on a cut-off of 1.25, which was considered a normal value in previous studies, the composition of the microbiota might be different depending on the NLR, even within the normal range. In addition, these subtle differences might be due to the healthy population.NLR can be used as a prognostic marker in multiple diseases29; however, it is difficult to interpret because the cause of inflammation is not well discriminated. On the other hand, because NLR represents the function of lymphocyte, it can more accurately reflect both the inflammatory response and the immune state31. Therefore, the NLR can most sensitively reflect the microbiome changes caused by external factors, such as immune systems or inflammatory responses.NLR and CRP can be used as markers of systemic inflammation in various medical settings. CRP is an acute-phase protein produced in the hepatocytes, exposed to the inflammatory cytokines and tumor necrosis factor. CRP is rapidly increasing in response to inflammation and used as a marker reflecting prognosis and disease severity in various inflammatory situations including infection, trauma, and tumor33. In conclusion, even within the normal range, the lower is the NLR, the lower is the risk for inflammatory disease, which is similar to the findings that the lower is the blood glucose or blood pressure, the lower is the risk of diabetes mellitus or cardiovascular-related mortality, respectively35.The alpha diversity indices were also higher in the lower Q group than in the upper 3Q group. These findings suggest that, even within the normal rage of NRL, alpha diversity  of gut microbiota decreases as NLR increases. We also found that the abundance of several gut microorganisms had a linear correlation with NLR in the healthy population. This is consistent with previous reports that the activity scores of several diseases have a linear correlation with NLRB. eggerthii is a less commonly isolated species of Bacteroide, which is a genus of Gram-negative, anaerobic, non-spore-forming bacteria that is part of the normal human gastrointestinal flora38. Using in vivo mouse models, Dziarski et al. indicated that an abundance of B. eggerthii is associated with dextran sulfate sodium-induced colitis39. In addition, several reports have suggested that changes in abundance of Bacteroide are observed in subjects with IBD, including patients with Crohn’s disease and ulcerative colitis42. On the other hand, NLR is a biomarker of disease activity and prognosis in patients with IBD27. Considering previous reports indicating the relationships between colitis and NLR and between colitis and B. eggerthii, our study showed a significant association between NLR and B. eggerthii. Therefore, there is likely a link among NLR, B. eggerthii, and intestinal inflammation.Biophilia spp. are Gram-negative, anaerobic, urease-positive, bile-resistant bacteria associated with an animal-based protein and high-saturated fat diet, and they promote T helper type 1 (Th1)-mediated immunity43. The most frequently isolated species of Biophilia is B. wadsworthia, and although it is found in < 0.1% of the normal human gastrointestinal flora, it is found in abundance in infectious conditions such as colitis, perforation, and abscesses44. Devkota et al. demonstrated that B. wadsworthia induced colitis in IBD-prone interleukin (IL)-10 mice by activating Th1-mediated colonic inflammation45. We identified a lower abundance of Biophilia in the lower Q NLR group than in the higher 3Q group. Considering that NLR is a marker of prognosis and severity of IBD, an elevated abundance of B. eggerthii and genus Biophilia might be associated with the status of bowel inflammation, and NLR could reflect these microbiota changes, even though our subjects were relatively healthy.Dialister, which showed an increasing trend of abundance in the higher Q3 NLR group, has been associated with irritable bowel syndrome47. Organisms of the genus Prevotella, considered to have a beneficial role due to its association with a plant-rich diet48, showed a decreased quantity in the higher Q3 NLR group. These results suggest that NLR decreases as the gut microbiota changes within a beneficial environment. Furthermore, since NLR is related to the prognosis of various medical conditions23, it is suggested that small changes can reflect the early progression of disease.Our results suggest that several organisms of the gut microbiota differ in abundance between the lower Q and higher Q3 groups . The genus Our study has several limitations. First, this was a single-center, retrospective, cross-sectional study, and it is unable to provide a causal relationship between gut microbiota and NLR. Second, we only included a relatively young and healthy population, and data on subjects with disease are limited. Third, the clinical parameters such as symptoms or diagnosis were not acquired because we used health check-up materials, not medical records. Instead, data on medical, past, family, and medication history from the self-reported questionnaire were used. Some subjects tend to misreport or forget to include their history. However, this is the largest population-based study that demonstrated the association between the gut microbiome and NLR, showing differences in the diversity and abundance of bacteria between NLR groups.This study investigated the association between the gut microbiota and NLR in a large healthy population. The diversity of the gut microbiota increased in subjects with a lower NLR. Furthermore, a higher NLR was associated with increased abundance of IBD-related gut microbiota and decreased abundance of beneficial bacteria. The findings of the present study highlight the role of NLR as a marker of intestinal inflammation because it reflects changes in the gut microbiota. Further long-term chronological studies are needed to determine the mechanism of the gut microbiota’s influence on NLR.49. Among them, subjects who met the following criteria were excluded: 1) Subjects who received antibiotics within six weeks of enrollment or lipid-lowering drugs or probiotics within four weeks of enrollment due to the medication’s influence on gut microbiota (n = 141); 2) Subjects who did not have NLR data obtained during the physical examination (n = 5); and 3) Subjects whose fecal samples contained < 1,000 sequences per sample (n = 8). Finally, 1,309 subjects were included for analysis.A total of 1,463 Korean men and women between the ages of 25 and 78 years with a comprehensive annual or biennial physical examination between June 2014 and September 2014 at Kangbuk Samsung Hospital Healthcare Screening Center in the Republic of Korea were initially screened . After explaining the nature and possible consequences of the study, we obtained written informed consent from all study participants. All applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during this research.49. Amplified genomic DNA was obtained using fusion primers targeting the variable V3 and V4 regions of the 16 S rRNA genes with indexing barcodes. The Illumina Miseq platform  was pooled for sequencing all samples according to the manufacturer’s specifications51.Fecal samples were frozen at −20 °C immediately after collection and stored at −70 °C within 24 hours. Within one month of receiving the samples, the MO Bio PowerSoil® DNA Isolation Kit  was used for DNA extraction from the fecal samples according to the manufacturer’s instructions. For amplification and sequencing of the DNA to analyze the bacterial communities, the methods described in a previous study were usedhttps://qiime2.org)52 was performed to generate unique sequence variants by filtering low quality samples and chimera. Since unique grouping sequences produce the “operational taxonomic units (OTUs)” from DADA2, they are regarded as 100% OTU and are typically referred to as sequence variants. The Feature Table was generated from the QIIME2 software, and it was the equivalent of the biom table and the representational sequence file. Almost identical (99%) sequence which was homology to an optimized version of the gene from the GreenGenes database (version 13.8) containing the V3-V4 region to detect taxonomies, mapped the sequences.The DADA2 pipeline of the QIIME2 package 55, respectively. For measuring beta diversity, unweighted and weighted UniFrac56 values were calculated to determine the dissimilarity between groups. Diversity between the NLR groups was compared using pairwise PERMANOVA57. A P-value < 0.05 was considered statistically significant.The values of NLR were transformed using the natural logarithm (ln) to construct a normal distribution. After transformation, we divided the subjects into three groups according to NLR quartile (Q): lower Q (the lowest 25% of the NLR range), middle 2Q (from the next lowest 25% of the NLR range to the second highest 25% of the NLR range), and upper Q (the highest 25% of the NLR range). We also compared the lower Q to the higher 3Q, which included the middle 2Q and upper Q groups (the highest 75% of the NLR range) to investigate various aspects of the microbiota. All basic statistical analyses were performed with SPSS version 24.0 . QIIME2 (version 2018.04) was utilized for exploratory and differential microbial composition analyseshttps://huttenhower.sph.harvard.edu/maaslin)58 of RStudio (version 0.98.983). Confounding variables -adjusted coefficients (CE) were estimated using MaAslin. All analyses of MaAslin were conducted using the default options. The FDR (Benjamini-Hochberg) method was used to adjust multiple comparisons on each phylogenetic level. A q-value < 0.05 was considered statistically significant.Correlation and comparison between the abundance of taxa and NLR were calculated using the Multivariate Association with Linear Models (MaAsLin) software package (Supplementary Information


In topsoil, their contents of forest lands and croplands  are higher than those of other land uses . The pH values range from 4.2 to 6.1 in topsoil, and with increase in soil depth, they tend to increase and then decrease. Soil carbon, nitrogen and the C/N (TC/TN ratio) are negatively correlated with soil pH, demonstrating that relatively low pH benefits the accumulation of organic matter. Most soil samples are considered as sandy loam and silt loam from the percentages of clay, silt and sand. For soil profiles below 50 cm, the TOC and TON average contents of soil samples which contain more clay and silt are higher than those of other soil samples.Soil carbon and nitrogen are essential factors for agricultural production and climate changes. A total of 106 soil samples from three agricultural lands (including two rice fields and one sugarcane field) and four non-agricultural lands  in the Mun River Basin were collected to determine soil carbon, nitrogen, soil pH, soil particle sizes and explore the influence of pH and soil texture on soil C and N. The results show that total organic carbon (TOC) and nitrogen (TON) contents in topsoil (TOC: 2.78 ~ 18.83 g kg Soil holds more than three times as much carbon as the atmosphere and terrestrial vegetation, thus playing an important role in global climate change and agricultural production . It is wAccording to statistical data , ThailanTherefore, the aims of this study are as follows: (1) to determine the vertical distribution characteristics of soil C, N, C/N, pH and soil particle sizes; (2) to recognize the difference between these properties based on different land uses; (3) to explore the influence of pH and soil texture on soil C and N.2  and occupies an area of 82,000 km2 . There a2 . The Mun2 . Soil or2 .The Mun River Basin is mainly occupied by clastic sedimentary rocks of Mesozoic continental red beds known as Khorat Group, which consists of siltstone, sandstone, conglomeritic sandstone and shale . For exaSamples  were collected from seven soil profiles, including three agricultural lands  and four non-agricultural lands . It should be noted that sampling point TS4 is located in a rice field which was abandoned for 2 years. Weeds and trees of the wasteland (where TS5 is located) were burned in preparation for farming. These soil profiles were chosen to explore soil C, N, pH and soil texture in agricultural lands to compare with those in non-agricultural lands . Soil saAfter the removal of the plant residue, roots and stones, soil samples were ball milled to pass a 200-mesh sieve to make them homogenized with a grinding machine Retsch MM400 . Total carbon (TC) and total nitrogen (TN) were measured with an elemental analyzer  whose precision is C ± 0.1% and N ± 0.02%. The mixture of 1M KCl and 0.5M HCl was used to eliminate inorganic carbon and inorganic nitrogen . After bCorrelation analysis was conducted using SPSS 20  and all figures are produced with OriginPro 9.0 software and CorelDRAW Graphics Suite 2018.−1, TS7: 13.56 g kg−1) are similar with those of croplands . The TC contents are relatively lower at sampling points TS4, TS5 and TS6, in the range of 3.26–8.68 g kg−1. Soil TN, TOC, TON contents have similar distribution characteristics. One exception is TS7 has relatively lower TON content, just 0.56 g kg−1. Total inorganic carbon contents at TS4 and TS6 are much lower compared with those at other sampling points, while TIN contents at TS2 and TS4 are much lower compared with those at other sampling points.As shown in After the soil particle sizes are obtained, all soil particles are classified into three groups  according to the soil classification system used in America . PercentThe correlation coefficients between pH and other soil properties at different sampling points are shown in It has been reported that the effects of land-use and vegetation are eliminated when soil depth reaches 50 cm . The TOC+) and thus the pH values would not be too low in that layer. In addition, there are some iron manganese nodules existing in the other soil profiles. The positive peaks of pH values in the middle section of soil profiles may be explained by the existence of these iron manganese nodules.Soil pH is an important soil chemical property which controls many soil properties and it is affected by climate, soil buffering system, plants, etc. . In thisThe C/N ratio can estimate the quality of soil organic matter, especially in the process of decomposition and nitrification . RecentlSoil TOC and TON are important soil properties influenced by various kinds of factors. Most soil samples are sandy loam and silt loam, which are rich in silt and sand. The TOC and TON average contents of samples from sampling point TS1 where soil is rich in silt and clay are much higher than those from TS5 and TS6 where soil is rich in sand. Therefore, on the condition that other factors are excluded, the silt and clay contents are positively correlated with TOC and TON contents. y(NO3−) and NHx(NH4+), which can exert different impacts on soil chemical reactions (+. Meanwhile, soil pH is controlled by different buffering systems whose effects on pH may be overlapped (+, causing the changes of soil acidity (4+ ion and NO3− ion pose different impacts on soil acidity (3− ion lowers soil pH by causing the leaching of Ca and Mg and reducing their concentrations (4+ acidizes soil by exchanging base cations directly (Soil inorganic carbon is mainly stored in the residue of parent rocks or minerals that derive from the preservation or formation process of carbonates . Soil ineactions . At someeactions . Carbonaerlapped , which e acidity . In term acidity . Specifitrations , while Ndirectly . These pWeeds and trees on the wasteland where sampling point TS5 is located were burned to prepare for cultivation. This is a slash-and-burn farming method which is common in local areas. Fire is a traditional tool to open “new land” for agriculture when the existing land lost its fertility and “the old” land will be abandoned for growing plants and replenishing soil fertility . HoweverIn the Mun River Basin, TOC and TON contents in topsoil of agricultural lands and forest lands are higher than those of other kinds of lands. Vertically, distributions of TOC and TON contents in the soil profiles are influenced by soil texture significantly. Specifically, the soil containing more silt and clay has higher TOC and TON contents because clay and silt particles have bigger specific surface areas to absorb and protect organic matter. Soil C, N and C/N ratio tend to be negatively correlated with soil pH in most soil profiles, indicating the close relationship between soil pH and soil C and N.10.7717/peerj.7880/supp-1Supplemental Information 1Click here for additional data file.