Energy and protein levels in dairy cow diets to recover milk ethanol stability.

The objective of this study was to evaluate the effect of energy and protein in the diet on the recovery of milk ethanol stability (MES) induced by feed restriction. Twelve Holstein and Holstein x Jersey crossbred cows with an average of 146 ± 50 d in milk, 575.4 ± 70 kg of body weight, and 18.93 ± 5.46 kg/d of milk yield were distributed in a 3x3 Latin square design with 3 treatments and 3 experimental periods. Each experimental period lasted 24 d, comprising 3 phases: a 13-d adaptation phase (100E+100P), a 4-d induction phase for milk ethanol instability (50E+50P), and a 7-d recovery phase for MES (3 treatments). The 3 treatments during the recovery phase consisted of 3 diets aiming to meet the requirements of energy and protein (100E+100P), only energy (100E+50P), or only protein (50E+100P). The diet during the adaptation and induction phases was common for all cows. The energy and protein levels to meet each cow's requirements were based on the group average. Restriction of energy and protein reduced dry matter, crude protein, and total digestive nutrient intake for cows fed 100E+50P and 50E+100P. The lowest body weight was observed for cows fed 50E+100P, with no difference for body condition score. During the induction phase, MES "was" reduced by 9 percentage units. Cows fed 100E+100P recovered MES in the first days of the recovery phase, while 100E+50P slightly improved MES, and 50E+100P had a constant decrease in MES. Cows fed 100E+50P and 50E+100P produced, respectively, 3.6 and 5.9 kg less milk than those fed 100E+100P. The 50E+100P treatment exhibited the highest milk fat content and somatic cell score, along with the lowest milk lactose content. Protein content was higher in the 100E+100P treatment. Cows fed 50E+100P showed higher serum albumin levels compared with those on the 100E+100P treatment, not differing from the 100E+50P treatment. We concluded that the complete recovery of MES in cows with feed restrictions is possible only by supplying both the energy and protein requirements in the cows' diet. However, restricting energy intake poses a greater limitation on MES recovery compared with restricting protein.

Vaginal laser therapy for GSM/VVA: where we stand now - a review by the EUGA Working Group on Laser.

Vulvovaginal atrophy (VVA) is a chronic progressive condition that involves the genital and lower urinary tracts, related to the decrease of serum estrogenic levels when menopause occurs. The definition of genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing and publicly acceptable term than VVA. Due to the chronic progressive trend of GSM, symptoms tend to reappear after the cessation of therapy, and frequently long-term treatment is required. First-line therapies include vulvar and vaginal lubricant or moisturizers, and, in the case of failure, low-dose vaginal estrogens are the preferred pharmacological therapy. Populations of patients, such as breast cancer (BC) survivors, are affected by iatrogenic GSM symptoms with concerns about the use of hormonal therapies. The non-ablative erbium:YAG laser and the fractional microablative CO2 vaginal laser are the two main lasers evaluated for GSM treatment. The aim of this comprehensive review is to report the efficacy and safety of Er:YAG and CO2 vaginal lasers for GSM treatment. Vaginal laser therapy has been demonstrated to be effective in restoring vaginal health, improving VVA symptoms and sexual function. The data suggest that both Er:YAG and CO2 vaginal lasers are safe energy-based therapeutic options for management of VVA and/or GSM symptoms in postmenopausal women and BC survivors.

Effects of turmeric extract supplementation on the lipid and lipoprotein subfraction profile in hemodialysis patients: A randomised, double-blind, crossover and controlled trial.

Dyslipidemia is common in patients with chronic kidney disease. Curcumin, a bioactive polyphenol from Curcuma longa, can improve lipid profile. This study aims to analyze the effects of Curcuma Longa extract supplementation on lipid profile and lipoprotein subfractions in hemodialysis (HD) patients. This is a longitudinal, double-blind, washout-period randomized clinical trial. The patients were randomized into two groups: the curcumin group (n = 10) (orange and carrot juice with 2.5 g of Curcuma Longa extract) and the control group (n = 11) (juice without curcumin) 3x/w during HD sessions for 3 months. After the washout period, patients continued the supplementation as a crossover for the same period. The lipid profile was measured using enzymatic assays. The high-density lipoprotein and low-density lipoprotein subfractions analyses were performed using LipoprintTM. In the curcumin group, the triglyceride values tended to decrease with a different triglyceride variation between the pre and post-intervention for the control and curcumin groups of 38.5 (19.8) mg/dL (p = 0.06). There was no statistical difference in the others parameters. In conclusion, Curcuma longa extract may be a good nutritional strategy to reduce triglyceride plasma levels in hemodialysis patients, but it seems ineffective for the other parameter.

Short Report: Choline plasma levels are related to Nrf2 transcriptional expression in chronic kidney disease?

BACKGROUND & AIMS: Choline is an amine osmolyte with antioxidant potential. A limited number of studies have implied that choline modulates the nuclear factor-erythroid 2-related factor 2 (Nrf 2) pathway, a major cytoprotectant system. However, there are no data regarding such an interaction in patients with chronic kidney disease (CKD). This cross-sectional pilot study therefore aimed to evaluate the possible relationship between choline plasma levels and transcriptional expression of Nrf2 in patients with CKD on hemodialysis (HD). METHODS: This study was performed in 24 HD patients [54 ± 10 years, 14 men, BMI 26.4 ± 4.5 kg/m2]. Choline plasma levels were measured by LC-MS/MS. Nrf2 mRNA expression was measured by real-time quantitative polymerase chain reaction (rt-PCR) in isolated peripheral blood mononuclear cells (PBMC). RESULTS: We used Pearson's correlation (rho) to determine the correlations with Nrf 2 expression and observed a positive correlation between choline plasma levels and Nrf2 (rho = 0.56, P = 0.004). CONCLUSIONS: This finding suggests that choline may play a role in Nrf2 expression in CKD.

Conservative management of intravesical erosion of a synthetic mid-urethral sling for the treatment of stress urinary incontinence, based on patient preference: A case report.

BACKGROUND: Intravesical mesh erosion is an uncommon late complication of placement of a synthetic mid-urethral sling (MUS) for the treatment of stress urinary incontinence, and only a few cases have been reported. Optimal management remains controversial, though there is a tendency toward surgical removal through a variety of routes. However, surgical removal comes with its own risks and is not necessarily associated with an improvement in symptoms. We, herein present the first case of a conservatively managed intravesical mesh erosion following MUS placement. CASE: Nine years after insertion of a tension-free vaginal tape (TVT), a patient presented with persistent lower abdominal pain and dysuria. Flexible cystoscopy demonstrated an erosion of the tape through the bladder wall. The patient declined surgical intervention at the time. Therefore, she was commenced on regular methenamine hippurate and vaginal oestrogen, and kept under surveillance with regular cystoscopies. Her symptoms responded to this treatment and 6 years later remained well controlled on this regime. CONCLUSION: This case demonstrates that conservative management may be a safe and appropriate option for patients who decline surgical excision of mesh erosion.

Can pelvic organ prolapse in postmenopausal women be treated with laser therapy?

PURPOSE: This study aims to assess the effectiveness of the non-ablative photothermal erbium laser (Er:YAG laser) for managing anterior and/or posterior vaginal compartment prolapse. METHODS: A randomized, single-blind, 1:1 trial was performed comparing Er:YAG laser treatment to watchful waiting in postmenopausal women with symptomatic cystocele and/or rectocele stage 2 or 3 who opted to undergo surgery due to bothersome prolapse symptoms. Three Er:YAG laser treatments at monthly intervals were applied for the Er:YAG laser group, while there was no treatment for the watchful-waiting group. The primary outcome was the proportion of patients with stage 0 or 1 following laser treatment, while secondary outcomes included the Pelvic Organ Prolapse Quantification System (POP-Q points), Pelvic Floor Distress Inventory Questionnaire short-form, Pelvic Floor Impact Questionnaire short-form, and Patients Global Impression of Improvement (PGI-I). All outcomes were evaluated at baseline and 4 months post baseline. RESULTS: Thirty women (15 vs. 15) were eligible to be included. No participants (0%) in either group had POP-Q stage 0 or 1 at 4 months. Moreover, no change was present in the secondary outcomes. In the PGI-I, 2/15 (14%) and 0/15 (0%) participants declared much better/very much better in the laser and watchful-waiting group, respectively. CONCLUSIONS: The findings of this study do not support use of the intravaginal Er:YAG laser for treatment of the anterior/posterior vaginal wall. Clinical trial identification number: NCT03714607.

Intestinal alkaline phosphatase modulation by food components: predictive, preventive, and personalized strategies for novel treatment options in chronic kidney disease.

Alkaline phosphatase (AP) is a ubiquitous membrane-bound glycoprotein that catalyzes phosphate monoesters' hydrolysis from organic compounds, an essential process in cell signaling. Four AP isozymes have been described in humans, placental AP, germ cell AP, tissue nonspecific AP, and intestinal AP (IAP). IAP plays a crucial role in gut microbial homeostasis, nutrient uptake, and local and systemic inflammation, and its dysfunction is associated with persistent inflammatory disorders. AP is a strong predictor of mortality in the general population and patients with cardiovascular and chronic kidney disease (CKD). However, little is known about IAP modulation and its possible consequences in CKD, a disease characterized by gut microbiota imbalance and persistent low-grade inflammation. Mitigating inflammation and dysbiosis can prevent cardiovascular complications in patients with CKD, and monitoring factors such as IAP can be useful for predicting those complications. Here, we review IAP's role and the results of nutritional interventions targeting IAP in experimental models to prevent alterations in the gut microbiota, which could be a possible target of predictive, preventive, personalized medicine (PPPM) to avoid CKD complications. Microbiota and some nutrients may activate IAP, which seems to have a beneficial impact on health; however, data on CKD remains scarce.

A direct comparison of women's perceptions and acceptability of micronised progesterone and medroxyprogesterone acetate in combination with transdermal oestradiol in the management of young postmenopausal women, under 45 years of age.

OBJECTIVE: To assess the acceptability and perception of postmenopausal women, to two different hormone replacement therapy regimens, in relation to the control of their symptoms and development of adverse effects. STUDY DESIGN: Prospectively recruited postmenopausal women, <45 years, were randomised to one of two treatment arms for 12-months: cyclical micronised progesterone or medroxyprogesterone acetate in combination with transdermal oestradiol. A self-reported questionnaire with matrix rating scales was completed and repeated after 3, 6 and 12-months. MAIN OUTCOME MEASURES: Symptom control and development of adverse effects. RESULTS: Seventy-one individuals were screened, with baseline data available for 67 subjects. A total of 190 questionnaires were returned. The most commonly reported symptoms were low energy levels, vasomotor symptoms and sexual dysfunction. The prevalence of adverse effects ranged between 57.89 and 87.50%, with a reduction seen in the transdermal oestradiol + micronised progesterone arm (73.91% at 3-months, decreasing to 57.89% at 12-months; p = 0.33), compared to the transdermal oestradiol + medroxyprogesterone acetate arm (76.92% at 3-months, increasing to 87.50% at 12-months; p = 0.69). The main reported adverse effects were bloating, weight change and psychological symptoms. A significant difference was documented between the groups after set intervals, with a greater proportion reporting breast tenderness after 3-months (p = 0.01), lower numbers reporting mood swings at 6-months (p = 0.01) and irritability at 12-months (p = 0.03) in the transdermal oestradiol + micronised progesterone arm compared to the transdermal oestradiol + medroxyprogesterone acetate arm. CONCLUSIONS: The acceptability of both regimens was high despite adverse effects, but tolerability of transdermal oestradiol combined with micronised progesterone appeared to be better with fewer women reporting psychological concerns.

Comportamento de vacas da raça Holandesa em ordenha robotizada / Behaviour of Holstein cows in robotic milking

O objetivo do trabalho foi avaliar o comportamento ingestivo de concentrado e de ordenha de vacas em lactação em sistema de ordenha robotizada (SOR) conforme a paridade. O experimento foi realizado de março a junho de 2014, em Castro, PR, com vacas da raça Holandesa, confinadas em free stall, ordenhadas automaticamente e classificadas de acordo com a ordem de parto (1, 2 e +3 partos). Os dados foram extraídos do software de gerenciamento, sendo consideradas as atividades de um dia por mês (24h), por quatro meses, no dia seguinte após a realização do controle leiteiro oficial. Os dados foram analisados por técnicas de análise multivariada (análise fatorial, canônica e de agrupamento), utilizando-se o pacote computacional SAS. O comportamento ingestivo de concentrado influenciou toda a atividade das vacas no SOR, sendo fundamental para o desempenho dos animais nesse sistema. A ordem de parto não influenciou o comportamento na ordenha, somente o comportamento ingestivo, devido à dominância social das vacas multíparas. As vacas mais produtivas apresentaram um comportamento ingestivo mais agressivo. Conclui-se que a ordem de parto influencia o comportamento ingestivo de concentrado, porém não interfere no comportamento de ordenha de vacas com maior paridade. No SOR, primíparas devem ser manejadas em grupo específico.(AU)

The aim of this study was to assess the ingestive behavior of concentrate and milking of dairy cows in automatic milking system (AMS) according to parity. The experiment was conducted from March to June 2014, in Castro, PR, with Holstein cows housed in a free stall, milked automatically, and classified according to the lactation order (1, 2 and +3 lactations). Data were extracted from the management software, considering the activities of one day a month (24 hours) for four months, the day after the official milk production control. The data were analyzed by multivariate analysis (factorial analysis, canonical and cluster), using the statistical package SAS. The ingestive behavior of concentrate influenced the entire activity of the cows in the AMS, being a fundamental factor in the performance of animals in this system. Parity did not influence the milking behavior, only the ingestive behavior, due to the social dominance of multiparous cows. High-yielding cows had a more aggressive ingestive behavior. It was concluded that parity influenced the ingestive behavior of concentrate, but does not interfere in milking behavior in cows with higher parity. In the AMS, primiparous should be managed in a specific group.(AU)

Perfil metabólico de vacas Holandês e mestiças Holandês x Jersey no periparto / Metabolic profile of Holstein and crossbred Holstein x Jersey cows in the peripartum

O objetivo do presente trabalho foi determinar e comparar o perfil metabólico de vacas Holandês (H) e mestiças Holandês x Jersey (HxJ) no periparto. Avaliaram-se 24 vacas, sendo 11 vacas Holandês e 13 mestiças Holandês x Jersey. Semanalmente, coletou-se sangue para a determinação das concentrações séricas de glicose, beta-hidroxibutirato (BHB), proteína total, albumina, aspartato aminotransferase (AST), creatinoquinase (CK), cálcio total, cálcio iônico, magnésio, fósforo inorgânico e colesterol. Avaliou-se também o peso vivo e o escore de condição corporal (ECC). Os dados foram submetidos à análise de variância com medidas repetidas no tempo. As vacas Holandês apresentaram maior peso vivo. Não houve diferença entre os grupamentos genéticos para ECC. Foi observada tendência de maiores concentrações séricas de BHB, AST e maior concentração de cálcio iônico em vacas mestiças Holandês x Jersey. Vacas mestiças Holandês x Jersey e Holandês apresentaram perfil energético similar durante o período de transição pré e pós-parto na maioria dos indicadores, com exceção do cálcio, que foi maior nas vacas mestiças, e do fósforo, que foi superior nas vacas Holandês.(AU)

The aim of this study was to determine and compare the metabolic profile of Holstein (H) and crossbred Holstein x Jersey (HxJ) on peripartum. For this, 24 cows were evaluated, 11 Holstein and 13 crossbreeds Holstein x Jersey. Weekly, venous blood sample were collected to determine concentration of glucose, beta-hydroxybutyrate (BHBA), total protein, albumin, aspartate aminotransferase (AST), creatine kinase (CK), total calcium, ionic calcium, magnesium, inorganic phosphorus and cholesterol. Body weight (BW) and body condition score (BCS) were also evaluated. The data were submitted to analysis of variance with repeated measures in time. Holstein cows presented higher BW, however, there was no difference for BCS in compare to crossbreed Holstein x Jersey cows. Tendency for higher serum concentrations of BHBA, AST and higher concentration of ionic calcium was observed in crossbreed cows in comparison to the Holstein. The energetic profile during the pre and postpartum transition period is similar for both genetic groups with higher concentrations of BHBA on the first week of lactation, however, with a tendency of higher serum concentrations of BHBA for crossbreed cows. Higher concentrations of ionic calcium were observed in crossbreed cows and higher concentrations of phosphorus in Holstein cows on peripartum. Holstein and Holtein x Jersey crossbreed cows have a similar energy profile during the pre and postpartum transition period in most of the indicators, except for calcium that was higher in crossbred cows and higher phosphorus in Holstein cows.(AU)

Managing overactive bladder.

Overactive bladder (OAB) is a common and distressing condition which is known to increase with age and has a significant effect on quality of life. Whilst OAB is a symptomatic diagnosis, many patients will require basic investigations prior to initiating the appropriate management. This article will review the initial clinical assessment and management of women complaining of OAB including conservative measures and drug therapy, and will also focus on the role of estrogen. In addition, the management of refractory OAB will also be discussed including more invasive strategies such as neuromodulation, Botulinum Toxin, and reconstructive surgery.

Rationale and design for fractional microablative CO2 laser versus photothermal non-ablative erbium:YAG laser for the management of genitourinary syndrome of menopause: a non-inferiority, single-blind randomized controlled trial.

Genitourinary syndrome of menopause (GSM) is a common condition affecting up to 50% of postmenopausal women and up to 70% of postmenopausal breast cancer survivors. GSM is a chronic condition with a significant impact on sexual health and quality of life. The mainstay of treatment has been with symptomatic relief using topical emollients or lubricants. Second-line treatment is with topical vaginal estrogens to restore the physiology of the vaginal epithelium. For some, the latter is not suitable or acceptable. Newer treatments with ospemifene and vaginal lasers have now been introduced. The two main types of laser currently used for the treatment of GSM are the fractional microablative CO2 laser and the non-ablative photothermal erbium:YAG laser. We present a study protocol for a multicenter, prospective, non-inferiority, single-blinded, randomized controlled trial comparing the fractional microablative CO2 laser versus the photothermal non-ablative erbium:YAG laser for the management of GSM. We will recruit 88 postmenopausal women across two sites who will be randomized to one of the two laser groups. Participants will all have GSM symptoms and a Vaginal Health Index Score < 15. All participants will receive an active treatment. Each participant will receive three applications of vaginal laser 1 month apart and will be followed up at 1 month, 6 months, and 12 months. Our primary outcomes will look at all changes of GSM symptoms (dryness, dyspareunia, itching, burning, dysuria, frequency, urgency), urinary incontinence (if present), and overall sexual satisfaction. Both subjective and objective means will be used to assess participants. The findings of this trial have the potential to allow clinicians and women suffering from GSM to make an informed decision when opting for a specific laser type. The trial will add to the current growing body of evidence for the safe use of vaginal lasers in GSM as an alternative treatment. We hope this trial will provide robust and long-term data for the safe use of both lasers.

Rendimento industrial, eficiência de fabricação e características físico-químicas de queijo colonial produzido de leite com dois níveis de células somáticas / Industrial yield, manufacturing efficiency and physical and chemical characteristics of colonial cheese produced from milk with two levels of somatic cells

Com base em dois níveis de contagem de células somáticas (CCS) do leite utilizado como matéria-prima, determinou-se influência no rendimento e na eficiência de fabricação do queijo colonial, em escala industrial. Os dois níveis de CCS foram formados do leite captado pela indústria, baixa CCS (<500.000 células/mL) e alta CCS (≥500.000 células/mL), sendo produzidos sete lotes de queijo para cada nível. O rendimento foi avaliado com rendimento simples (litros de leite/kg de queijo produzido) e rendimento seco (litros de leite/kg de sólidos totais de queijo produzido). A eficiência de fabricação do queijo foi avaliada por meio das perdas de sólidos no soro de queijo. Mediante análises multivariadas, demonstrou-se a relação entre altas CCS e a diminuição no rendimento simples e seco de queijo colonial, que apresentou também menor eficiência de fabricação, sem alterar a composição do queijo. Além disso, determinaram-se dados relativos às características físico-químicas de queijo colonial, o qual ainda não possui um regulamento técnico de identidade e qualidade. Conclui-se que a qualidade do leite tem influência direta na produção dos queijos e que, ao utilizar matéria-prima com alta CCS, a indústria assume os prejuízos do menor rendimento e da menor eficiência de fabricação dos queijos coloniais.(AU)

From two somatic cells count levels (SCC) of the milk used as raw material, the influence on the yield and cheese-making efficiency of colonial cheese was determined on an industrial scale. Both SCC levels were formed from milk received by the industry, being low SCC (<500.000 cells/mL) and high SCC (≥500.000 cells/mL), and seven batches of cheese were produced for each level. The yield was evaluated as simple yield (liters of milk/kg of cheese produced) and dry yield (liters of milk/kg of total solids of cheese produced). The cheese-making efficiency was evaluated by the loss of solids in cheese whey. Multivariate analysis showed a relationship between high SCC and decrease in simple and dry colonial cheese yield, which also had lower manufacturing efficiency, without altering the composition of the cheese. Moreover, data on the physical and chemical characteristics of colonial cheese were determined, that does not have Technical Regulation of Identity and Quality. We conclude that the quality of milk has a direct influence on the production of cheeses and, when using raw materials with high SCC, the industry takes the costs of worsening in performance and manufacturing efficiency in colonial cheese.(AU)

Influência da profundidade do úbere na limpeza dos tetos e na saúde da glândula mamária em ordenha robótica / Influence of udder depth on cleaning teats and health of the mammary gland in robotic milking

O objetivo deste trabalho foi avaliar a influência da profundidade do úbere sobre a limpeza de tetos e a saúde da glândula mamária. O experimento foi desenvolvido no período de março a junho de 2014, em Castro, PR. Foram utilizadas 20 vacas da raça Holandesa confinadas em free stall e ordenhadas em sistema de ordenha robotizada (SOR). As vacas foram divididas em quatro grupos com cinco animais cada (duas primíparas e três multíparas), com base na distância do piso do úbere em relação ao jarrete (úbere profundo, normal, pequeno e raso). Os dados, registrados eletronicamente, foram coletados mensalmente, por quatro meses, referentes à semana do controle leiteiro oficial. Para avaliar a efetividade da limpeza dos tetos, foram feitos swabs de dois tetos contralaterais (anterior direito e posterior esquerdo) antes e após a limpeza automática, bem como foram esfregadas toalhas umedecidas, uma vez, ao redor dos outros tetos. Uma amostra de leite foi coletada por vaca para determinar a contagem de células somáticas (CCS). Na análise multivariada, foi observada relação da profundidade do úbere com a limpeza de tetos avaliada por meio do escore de limpeza de tetos com toalhas umedecidas (ELTT). Os úberes levemente acima do jarrete (normal) apresentaram menor CCS e contagem bacteriana total (CBT) dos tetos. Os úberes rasos apresentaram maior diferença no ELTT. As vacas com úberes profundo e raso apresentaram menor efetividade na limpeza de tetos e na saúde da glândula mamária. Vacas com úbere normal apresentaram conformação e sanidade da glândula mamária e contaminação de tetos mais adequadas à ordenha robótica. Em fazendas que pretendem introduzir o SOR, é recomendado selecionar vacas com úbere com profundidade um pouco acima do jarrete. O impacto do SOR na CBT dos tetos está relacionado à condição de limpeza deles na pré-ordenha e das instalações. Portanto, a condição de ambiência das vacas é fundamental para a saúde da glândula mamária e a obtenção de um leite com alta qualidade.(AU)

The aim of this study was to assess the influence of the depth of the udder on cleaning of teats and health of the mammary gland. The experiment was developed in the period spanning from March to June 2014, in Castro, PR. Twenty Holstein cows confined in free stall and milked in an automatic milking system (AMS) were used. The cows were divided into 4 groups with five animals (2 primiparous and 3 multiparous) based on the depth of the udder (udder depth: normal, small, and shallow). The electronically recorded data were collected monthly for four months, referring to the week of the official production milk control. To evaluate the effectiveness of cleaning teats, two contralateral teats were swabbed (right front quarter and left rear) before and after the automatic cleaning and once moistened towels were scrubbed around the other teats. A sample of milk was collected per cow to determine the somatic cell count (SCC). In the multivariate analysis relation of the udder depth with the teat cleaning was observed and evaluated through the teat cleaning with moistened towels score (TCTS). Udders slightly above the hocks (normal) had lower SCC and total bacterial count (TBC) of the teats. Shallow udders showed greater difference in TCTS. Cows with deep and shallow udders show less effective teat cleaning and health of the mammary gland. Cows with normal udders presented mammary gland conformation and health and contamination of teats most appropriate for robotic milking. On farms intending to introduce AMS it is recommended to select cows with udder depth which is a little above the hock. The impact of AMS on the TBC of the teats is related to the condition of cleaning of the teats pre-milking and housing conditions. Therefore, the condition of ambience of the cows is fundamental for the health of the mammary gland and obtaining high quality milk.(AU)

Does resistance exercise performed during dialysis modulate Nrf2 and NF-κB in patients with chronic kidney disease?

Studies have shown that nuclear factor erythroid 2-related factor 2 (Nrf2) can be modulated by physical exercise. However, the impact of resistance exercise has never been investigated in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the effects of resistance exercise programs on the expression of transcription factors Nrf2 and nuclear factor κB (NF-κB) in CKD patients on hemodialysis (HD). Patients on an HD program were randomly assigned to an exercise group of 25 patients (54.5% women, aged 45.7±15.2years and time on dialysis=71.2±45.5months) or a control group of 19 patients who had no exercise intervention (61.5% women, aged 42.5±13.5years and time on dialysis=70.1±49.9months). A strength exercise program was performed 3 times a week during the HD sessions. Peripheral blood mononuclear cells were isolated and processed for the expression of Nrf2 and NF-κB by quantitative real-time polymerase chain reaction 3months before and after the exercise program. Using an enzyme-linked immunosorbent assay, the activity of glutathione peroxidase (GPx) as well as the products of high-sensitivity C-reactive protein and nitric oxide (NO) were assessed. Nrf2 expression (ranging from 0.86±0.4 to 1.76±0.8) and GPx activity were significantly increased after exercise intervention. In the exercise group, no difference in the levels of NO was observed; however, there was a significant reduction in the control group. In conclusion, these data suggest that resistance exercises seem to be capable of inducing Nrf2 activation in CKD patients on HD.

Is there an association between aspects of the metabolic syndrome and overactive bladder? A prospective cohort study in women with lower urinary tract symptoms.

OBJECTIVE: The aim of our study was to determine whether there is a link between aspects of the metabolic syndrome (MetS) and overactive bladder (OAB) in women with lower urinary tract symptoms (LUTS). STUDY DESIGN: A single-centre prospective study. We evaluated a cohort of consecutive women with LUTS attending a tertiary referral urodynamic clinic from October 2012 to January 2015. Obesity, diabetes, hypertension and dyslipidaemia were used as markers of MetS. OAB and detrusor overactivity (DO) were defined according to the International Urogynaecological Association/International Continence Society terminology. RESULTS: Eight hundred and forty women were enrolled. Three hundred and eight (36.6%) had normal weight, 260 (31%) were overweight and 272 (32.4%) obese. We identified 168 women (20%) with hypertension, 64 (7.6%) with diabetes mellitus, and 98 (11.7%) with dyslipidaemia. Seven hundred and four (83.8%) women were diagnosed symptomatically with OAB and 305 (36.3%) were diagnosed urodynamically with DO. Obesity (p<0.001) was the only independent predictor for OAB (OR 1.09, 95% CI 1.05-1.13) and DO (OR 1.06, 95% CI 1.03-1.08), respectively. CONCLUSION: Our study demonstrates a correlation between obesity and OAB/DO in female patients. However, other components of MetS do not appear to be associated with either OAB and DO. Weight reduction should be strongly recommended in women with OAB.

Drug therapy for overactive bladder.

Overactive bladder is a syndrome with a significant worldwide prevalence and economic impact on health resources. With ageing populations, the health burden of this condition that is more common in older people, is likely to increase. Following conservative therapies, medical management of overactive bladder is the mainstay of treatment, usually with antimuscarinic therapy. However, adherence is poor either due to adverse events or lack of efficacy of therapy. There have been recent developments that include a ß3-adrenoreceptor agonist and intradetrusor botulinum toxin, both of which are increasingly supported by a robust evidence base. Additionally there are emerging combination therapies and novel target agents that aim to treat this troubling syndrome. Alternative modes of delivery for existing therapies are also being explored with a view to improving adherence and efficacy. This article aims to outline the evidence base for existing and novel therapies as well as inform readers of emerging therapeutic options.

Risk factors for the occurrence of new and chronic cases of subclinical mastitis in dairy herds in southern Brazil.

The aim of this research was to evaluate the risk factors for new and chronic subclinical intramammary infections (IMI) using the monthly somatic cells count of dairy cows. The study took place at 30 dairy herds with approximately 1,700 cows in lactation. Data characterizing the dairy farms and their milking management were obtained from a survey questionnaire. The somatic cells count values from 2 consecutive months were used to classify cows as either healthy or with new or chronic infections. A chi-squared test was used in the analysis of subclinical IMI to evaluate associations between each independent variable, followed by logistic regression to estimate the risk of a new infection in healthy cows and of chronic infection in cows with new infections. Factors increasing the odds ratio of a cow developing a new case of subclinical mastitis were (1) cows with more than 3 lactations, (2) cows with a mean hyperkeratosis score above 3, (3) cows with the udder below the hock, (4) cows with very dirty udders, and (5) milking of infected animals before healthy cows. Factors increasing the risk of a subclinical chronic infection compared with new cases of subclinical mastitis were (1) a lack of regular maintenance of milking machinery, (2) cows over 100 d in lactation, and (3) cows with the udder on or below the hock. The risk factors identified in this study can be used in IMI control programs to reduce the frequency of new and chronic cases of subclinical mastitis.

Sexual function after urinary incontinence surgery.

UNLABELLED: Urinary incontinence (UI) affects between 42 and 71% of women. Sexual dysfunction is prevalent in the general population, but in women with UI, the prevalence is greater (42-56%). This review assesses the effects of urinary continence surgery on the sexual function of women with UI. Stress UI is surgically mostly managed via Burch colposuspension or a mid-urethral sling. These operations are as effective as each other with regards to maintaining or improving in sexual function. One of the main risks of these operations are that urgency UI (UUI) may be exacerbated or arise de novo and this has been shown to decrease sexual function. Severe refractory UUI requires complex surgery, such as percutaneous sacral nerve stimulation (SNS) then augmentation cystoplasty or urinary diversion. SNS may improve sexual function by direct action on the pudendal nerve as well as improving incontinence. Urinary diversion and augmentation cystoplasty are procedures of last resort in women who are refractory to all other UUI treatments. The majority of women report no change or improvement in sexual function as the urinary diversion negates the requirement for incontinence pads and indwelling catheters. Deteriorated sexual function has also been described in up to 37.5%. Thirty percent of women undergoing urinary diversion would have liked more 'sexological' counselling. CONCLUSION: The majority of women enjoy maintained or improved sexual function after surgical treatment of UI. It is important to ensure women have appropriate pre-operative assessment and counselling so they may be advised of the risks of failed surgery including deteriorated sexual function.