A second iron injection administered to piglets during lactation improves hemoglobin concentration, growth performance, and carcass characteristics at slaughter.

An experiment was conducted to evaluate the effects of a second injection of iron dextran administered on days 6 to 8 of age. A total of 144 crossbred pigs (equal barrows and gilts; initial age 6 to 8 d; initial body weight [BW] = 2.86 ± 0.01 kg) were assigned to either the control (CON) or an added-injection treatment (+Fe). Pigs were paired by sex and BW within a litter and randomly assigned to the iron treatment within each pair. All pigs had received an initial intramuscular (IM) injection of iron dextran (200 mg Fe) <24 h after birth. Pigs assigned to the +Fe treatment received a second IM injection of iron dextran (200 mg Fe) on days 6 to 8. All pigs were weaned at 22 to 25 d, housed 6 pigs/pen, and received a common corn-soybean meal diet. BW and feed disappearance were recorded every 2 wk. Hemoglobin (Hb) concentrations were measured at birth, initiation of experiment (days 6 to 8), weaning, and the end of the nursery and end of the study. At the end of the study, 1 pig/pen (n = 12 pigs/treatment), closest to the pen mean was selected and slaughtered for carcass characteristic measures. The individual pig served as the experimental unit for BW, Hb, average daily gain (ADG), and carcass characteristic data whereas the pen served as the experimental unit for average daily feed intake, and gain/feed ratio data. The +Fe pigs had a greater Hb at weaning (13.1 vs. 10.7 g/dL, respectively; P < 0.01) and end of the nursery (12.1 vs. 11.7 g/dL, respectively; P = 0.01) compared to CON pigs. During the finisher period, +Fe pigs had a greater ADG (0.94 vs. 0.91 kg, respectively; P = 0.05) compared to CON pigs. Overall, pigs receiving the second iron injection had an ~4% increase in ADG (P = 0.04) from weaning to the end of study. The cumulative improvement in ADG from weaning to the end of study observed for +Fe group resulted in +Fe pigs having a heavier BW at the end of the study (~3 kg; P = 0.04). Following slaughter, +Fe pigs had ~7.2% heavier trimmed loin (P = 0.04) compared to the CON pigs. In conclusion, administering a second iron injection resulted in greater Hb at weaning and the end of the nursery as well as improved growth performance from weaning to the end of study weight and increased carcass weight at slaughter.

The study aimed to evaluate the effects of a second iron dextran injection administered to piglets before weaning on hemoglobin concentration (Hb), growth performance, and carcass measures. Treatments included: a single iron injection administered within 24 h after birth (CON) and two iron injections (+Fe), one administered within 24 h after birth followed by a second iron injection administered 6 to 8 d after birth. Administering a second iron injection before weaning resulted in increased Hb at weaning and the end of the nursery period. Furthermore, pigs receiving a second iron injection had a greater average daily gain from weaning to final market weight which resulted in a final bodyweight difference of ~3 kg. The increased slaughter weight observed for pigs receiving a second iron injection was associated with an increase in trimmed loin yield. In the current study, providing a second iron injection before weaning was a practical method to improve weaning Hb in early life and resulted in a faster overall growth from weaning to the end of the study.

Effects of multiple vitamin E levels and two fat sources in diets for swine fed to heavy slaughter weight of 150 kg: II. Tissue fatty acid profile, vitamin E concentrations, immune capacity, and antioxidant capacity of plasma and tissue.

The study objective was to evaluate the effect of two fat sources and graded levels of vitamin E (VE) supplementation on tissue fatty acid profile, VE concentrations, immune capacity, and antioxidant capacity of plasma and tissues of pigs at heavy slaughter weight (150 kg). A total of 48 individually-fed pigs (24 barrows, 24 gilts; 28.44 ±â€…2.69 kg) were randomly assigned to eight dietary treatments in a 2 × 4 factorial arrangement. The two fat treatments were either 5% tallow (TW) or 5% distiller's corn-oil (DCO). The VE treatments included four levels of α-tocopheryl-acetate (11, 40, 100, and 200 ppm). Compared to pigs fed the DCO diet, pigs fed the TW diet had greater SFA (C14, C16, and C18; P < 0.05) and MUFAs (C14:1, C16:1, C18:1, and C20:1; P < 0.05), lower PUFA (C18:2n-6, C18:3n-3, C20:2, C20:3, and C20:4; P < 0.05) and iodine value in the backfat and belly fat. Increasing dietary VE supplementation level increased α- and total tocopherol concentrations in plasma (linear and quadratic, P < 0.05), liver, and loin muscle (linear, P < 0.06), superoxide dismutase activity (quadratic, P < 0.05), but decreased γ-tocopherol concentrations in liver (linear, P = 0.06), plasma, and loin muscle (quadratic, P < 0.07), and decreased liver glutathione disulfide (GSSG; linear, P = 0.07) and malondialdehyde (MDA) content (quadratic, P < 0.05). There was an interaction between fat sources and dietary VE supplementation level on the concentration of α-tocopherol in the loin muscle (P < 0.05) wherein a greater increase was observed in the TW treatment than the DCO treatment with the increasing dietary VE supplementation level. In conclusion, dietary FA composition in TW and DCO affected the composition of most FA in backfat, belly fat, and liver while increasing VE supplementation level did not significantly alter the FA profile in these tissues. Increasing dietary VE supplementation level increased tocopherol concentrations in plasma, liver and loin muscle, and improved antioxidant capacity while tocopherol concentrations in plasma, liver and loin muscle in the TW treatment increased more than they did in the DCO treatment.

Effects of multiple vitamin E levels and two fat sources in diets for swine fed to heavy slaughter weight of 150 kg: I. Growth performance, lean growth, organ size, carcass characteristics, primal cuts, and pork quality.

The study objective was to evaluate the effect of two fat source and graded levels of vitamin E (VE) supplementation on growth performance, carcass characteristics, and meat quality of pigs at heavy slaughter weight (150 kg). A total of 48 individually-fed pigs (24 barrows, 24 gilts; 28.44  ±â€…2.69 kg) were blocked by sex and weight and randomly assigned to eight dietary treatments in a 2 × 4 factorial arrangement. Fat treatments were 5% tallow (TW) and distiller's corn-oil (DCO) in the diets. The VE treatments included four levels of α-tocopheryl-acetate (11, 40, 100, and 200 ppm). Growth performance, carcass traits, organ weight, primal cuts, and pork quality were measured. Increasing dietary VE supplementation levels linearly increased overall Average daily gain (ADG) and average daily feed intake (P < 0.05), with an interaction between fat sources and VE supplementation levels on cumulative ADG (P < 0.05) during phases 1 and 3 (28 to 100 kg) and 1 to 4 (28 to125 kg) wherein ADG in the pigs fed the DCO diet, but not the TW diet, increased with increasing dietary VE supplementation level. A similar interaction was observed in 24 h pH and picnic shoulder (P < 0.05). No notable effect of fat source was observed in growth performance. With increasing dietary VE supplementation levels, there were quadratic responses in pork pH at 45 min and 24 h postmortem with the highest value in 40 and 100 ppm of VE levels while TBARS values on day 7 postmortem decreased linearly (P < 0.05). Compared with the TW diet, the DCO diet resulted in greater TBARS values during 7 postmortem (P < 0.05; day 5, P = 0.09). These results demonstrated that increasing dietary VE supplementation level could enhance growth rate and feed intake and reduce lipid peroxidation of pork whereas the diet containing DCO as a fat source could negatively affect pork shelf-life and carcass characteristics and that increasing VE supplementation level had no notable interaction with fat sources for carcass characteristics.

Effects of dietary vitamin E and fat supplementation in growing-finishing swine fed to a heavy slaughter weight of 150 kg: II. Tissue fatty acid profile, vitamin E concentrations, and antioxidant capacity of plasma and tissue.

The study aimed to assess the effects of vitamin E (VE) supplementation and fat source on fatty acid (FA) composition, VE concentrations, and antioxidant capacity in plasma and tissues of pigs fed to a heavy slaughter weight (150 kg). A total of 64 pigs (32 barrows, 32 gilts; 28.41 ±â€…0.83 kg) were blocked by sex and weight, and randomly assigned to one of eight dietary treatments (n = 8 per treatment) in a 4 × 2 factorial arrangement. Fat sources included corn starch (CS), 5% tallow (TW), 5% distiller's corn oil (DCO), and 5% coconut oil (CN); VE supplementation levels were 11 and 200 ppm. Five-phase diets were formulated to meet requirement estimates of NRC (2012) and fed to pigs for each period of 25 kg from 25 to 150 kg. Increasing VE supplementation level increased C16:1 (P < 0.05) content but decreased C20:0 (P < 0.05) content in backfat and belly fat, while in liver, it increased C17:0 (P < 0.05) but decreased C18:0 (P < 0.05). Compared to the pigs fed the CS diet, the pigs fed the CN diet had greater (P < 0.05) content of total saturated FA, the pigs fed the DCO diet had greater (P < 0.05) content of total polyunsaturated FA content and iodine value, and the pigs fed the TW diet had greater (P < 0.05) content of total monounsaturated FA in backfat, belly fat, and liver. Plasma VE concentrations increased linearly (P < 0.05) with increasing length of feeding but faster (P < 0.05) in the pigs fed the CN and TW diets compared with the CS and DCO diets within the 200 ppm VE level; the pigs fed the DCO diet had the highest plasma VE concentrations (P < 0.05) from Phase 2 to Phase 5 within the 11 ppm VE level. The VE concentrations in liver and loin muscle (P < 0.05) increased with increasing dietary VE level from 11 to 200 ppm, but it was not affected by dietary fat source. There was no effect of VE supplementation and fat source on antioxidant capacity in plasma and liver except that pigs fed the DCO diet had greater liver SOD activity (P < 0.05) than the pigs fed the CN diet. In conclusion, dietary VE supplementation did not affect FA profile in backfat, belly fat, and liver consistently, while dietary FA composition with different fat sources affected much of the FA profile in backfat, belly fat, and liver. The higher level of VE supplementation increased liver and muscle VE concentrations and dietary fat sources affected plasma VE concentrations differently (P < 0.05), wherein the TW and CN diets increased the VE absorption greater than the DCO diet.

The study evaluated vitamin E (VE) supplementation and fat source on fatty acid (FA) composition and VE concentrations in pigs. Three fat sources with distinctive fatty acid profiles were used; VE levels were 11 (the requirement estimate) and 200 (a high level to assure any responses could be seen) ppm. Increasing VE affected very few FA in tissues. Compared with the control pigs, pigs fed the coconut oil diet had greater content of saturated FA, pigs fed the distiller's corn oil diet had greater content of polyunsaturated FA content, and pigs fed the tallow diet had greater content of monounsaturated FA in tissues. Plasma VE increased with increasing length of feeding but faster in pigs fed the coconut oil and tallow diets compared with the control and distiller's corn oil diets when the 200 ppm VE level was fed; pigs fed the distiller's corn oil diet had the highest plasma VE concentrations when the 11 ppm VE level was fed. In conclusion, dietary VE did not affect FA profile in backfat, belly fat, and liver consistently, while different dietary fat sources affected much of the FA profile in tissues. The higher level of VE, as expected, increased liver and muscle VE concentrations.

Effects of dietary vitamin E and fat supplementation in growing-finishing swine fed to a heavy slaughter weight of 150 kg: I. Growth performance, lean growth, organ size, carcass characteristics, primal cuts, and pork quality.

The study aimed to assess the effect of vitamin E (VE) supplementation and fat source on growth performance, lean growth, organ size, carcass characteristics, and pork quality of pigs at a heavy slaughter weight of 150 kg. A total of 64 pigs (32 barrows and 32 gilts; 28.41 ± 0.83 kg) were blocked by sex and body weight, and randomly assigned to one of eight dietary treatments (n = 8 per treatment) in a 4 × 2 factorial arrangement with main effects of fat source (corn starch [CS; no fat added], 5% tallow [TW], 5% distiller's corn oil [DCO], and 5% coconut oil [CN]) and VE supplementation level (11 and 200 ppm). Five-phase diets were formulated to meet requirement estimates of NRC and fed to pigs with each period of 25 kg from 25 to 150 kg. Increasing dietary VE supplementation from 11 to 200 ppm tended to increase average daily gain (ADG) in phase 5 (P = 0.08), and gain to feed ratio (G/F) in phase 4 (P = 0.06) and phase 5 (P = 0.06) resulting in increased G/F in the overall period (P = 0.10). Compared with the pigs fed the CS diet in the overall period, the pigs fed DCO diets had greater ADG (P < 0.05), the pigs fed the TW and CN diets had lower average daily feed intake (P < 0.05), and the pigs fed the fat-added diets had greater G/F (P < 0.05). Belly firmness was greatest in the pigs fed the CN diet and lowest in those fed the DCO diet (P < 0.05). Increasing dietary VE level from 11 to 200 ppm increased absolute and relative liver weight, absolute ham yield (P < 0.05), and tended to increase the relative yield of picnic shoulder (P = 0.07) and ham (P = 0.06) and the pigs fed the corn oil diet tended to have greater belly yield (P = 0.08) than the other fat treatments. Increasing dietary VE level increased 45-min pH and ΔpH at slaughter but decreased a* value, chroma (P < 0.10), and belly depth (P < 0.05). However, no effects of VE supplementation and fat source were observed on the other carcass traits and meat quality measurements. In conclusion, increasing dietary VE level from 11 to 200 ppm slightly increased growth rate and feed efficiency in the late finishing periods, and the addition of fat increased feed efficiency and backfat thickness, decreased lean content, and altered belly firmness. While there were some effects of VE supplementation and fat source observed on organ weight, primal cuts, carcass traits, and meat quality, there was no strong evidence that VE supplementation and fat source materially affected these measurements except for belly firmness.

The study aimed to assess the effect of vitamin E (VE) supplementation and fat source on growth performance, carcass characteristics, and pork quality of pigs slaughtered at 150 kg. Fat sources included corn starch (no fat added), or 5% tallow, distiller's corn oil (DCO), or coconut oil (CN); VE supplementation levels were 11 and 200 ppm. Increasing dietary VE from 11 to 200 ppm tended to increase the efficiency of conversion of feed to body weight gain for the overall study period. The pigs fed the DCO diet had greater backfat depth at slaughter. Belly (from which bacon is made) firmness was greatest in the pigs fed the CN diet and lowest in those fed the DCO diet. In conclusion, increasing dietary VE levels from 11 to 200 ppm slightly increased growth rate and feed efficiency, and the addition of fat increased feed efficiency and backfat thickness, decreased lean muscle content, and altered belly firmness. While there were some effects of VE supplementation and fat source, there was no strong evidence that VE supplementation and fat source materially affected these measurements except for belly firmness.

Assessment of visceral organ growth in pigs from birth through 150 kg.

Visceral organs (VO) are essential for their role in the metabolism and distribution of consumed nutrients as well as other life functions in animals. Two experiments were conducted to assess the natural longitudinal changes that the VO undergo from birth through 150 kg body weight (BW). In Experiment 1, a total of 96 crossbred pigs were euthanized at birth (pre-suckle), d 1, 2, 3, 5, 7, 14, 21 (weaning), 22, 23, 24, 26, 28, 42, 49, and 63 of age. In Experiment 2, a total of 48 crossbred pigs were euthanized at 30, 50, 75, 100, 125, and 150 kg of BW. The absolute weight of VO, and the volume and length of the gastrointestinal tract (GIT) were measured. In both experiments, the absolute weight of VO, GIT length, and their volume increased (linear, quadratic, and/or cubic, P < 0.05) as BW and age increased. In Experiment 1, the relative weight of VO (liver, kidney, heart, and lung) decreased after initially increasing within the first week of life (linear, quadratic, and/or cubic, P < 0.05), whereas the relative weight of all VO decreased as BW increased in Experiment 2 (linear and/or quadratic, P < 0.05). The relative length of small intestine decreased and that of large intestine increased as age increased in Experiment 1 (linear and quadratic, P < 0.05), whereas the relative length of the small and large intestine in Experiment 2 were relatively constant at 80% and 20% of the total length of the intestine, respectively. As age and BW increased, the relative volume of the large intestine to the total volume of the GIT increased (linear and/or quadratic, P < 0.05), while the relative volume of the small intestine decreased (linear and/or quadratic, P < 0.05). In conclusion, results showed that both absolute and relative measurements (weight, volume, and length) of VO were dependent on the BW (age) of the pig.

End-of-Life Care: Medical Aid in Dying.

Medical aid in dying (MAID) is a practice in which a physician provides a competent adult with a terminal illness with a prescription for a lethal dose of a drug at the request of the patient, which the patient intends to use to end his or her life. MAID currently is legal in nine states and the District of Columbia. The most common concerns leading to requests for MAID include loss of autonomy, loss of ability to participate in activities that make life enjoyable, and loss of dignity. MAID remains controversial. Physicians can choose not to participate in MAID and many are prohibited from participating by their employers. Family physicians should have the knowledge and skills to respond to inquiries about MAID in a compassionate, patient-centered manner. Clinicians should be familiar with the legal status of MAID in the state in which they practice, understand eligibility requirements for participation, have access to resources to support patients and clinicians, and be able to apply various communication strategies to MAID discussions. A thoughtful exploration of what led the patient to inquire about MAID will allow the physician to better understand and respond to patient concerns regarding the final months of life.

Polyphosphate and myofibrillar protein extract promote transglutaminase-mediated enhancements of rheological and textural properties of PSE pork meat batters.

The objective of this study was to improve the rheological (storage modulus G'; phase angle δ) and textural (hardness; breaking force) properties of nitrite-cured sausage batters prepared from pale, soft, exudative (PSE) pork with microbial transglutaminase (TG) using isolated myofibrillar protein (MP) or MP extracted by sodium tripolyphosphate (TPP) as substrates. While TG alone significantly enhanced G', δ and hardness, its combination with TPP was more pronounced as these product quality parameters were increased to the level equal to that of the counterpart batter made from normal (red, firm, non-exudative, RFN) pork. The addition of MP had negligible such effect on TG functions. Cooking loss of TG-treated RFN and PSE meat with TPP was minimal but the batters were less bright (L*) than other treatments. Redness (a*) was variable between treatments. Therefore, texture-related properties of comminuted PSE meat products can be restored to the RFN level by TG cross-linking of protein that is extracted by TPP.

Adult patients with respiratory syncytial virus infection: impact of solid organ and hematopoietic stem cell transplantation on outcomes.

BACKGROUND: Respiratory syncytial virus (RSV) is a common community-acquired pathogen responsible for a substantial disease burden in adults. We investigated the outcomes after RSV infection in hospitalized adults over a 3-year period. METHODS: This single-center, retrospective study identified 174 patients hospitalized with RSV upper or lower respiratory tract infection (LRTI) between January 1, 2009 and June 30, 2012. Clinical data were extracted from medical records. The primary outcome analyzed was all-cause mortality, defined as death during the index hospital admission. Subjects were divided into 3 groups for comparison: hematopoietic stem cell transplant (HSCT) patients, solid organ transplant (SOT) patients, and non-transplant patients. RESULTS: In our study, 41/174 (23.6%) were HSCT recipients and 28/174 (16.1%) were SOT recipients. Twelve of 174 (6.9%) died. Death occurred in 2/41 (4.9%) HSCT and 3/28 (10.7%) SOT recipients, compared to 7/106 (6.6%) non-transplant patients. When compared to the non-transplant cohort, HSCT and SOT were not found to be significant risk factors for mortality (P = 0.685 and 0.645, respectively). In multivariate logistic regression, age >60 was associated with mortality (P = 0.019), while lymphopenia on admission trended toward an association with death (P = 0.054). HSCT patients were less likely to be admitted to an intensive care unit (odds ratio [OR] 0.26, P = 0.04), but were significantly more likely to receive ribavirin therapy (OR 11.62, P < 0.0001). CONCLUSION: Adults hospitalized with RSV LRTI are at significant risk of mortality, and this risk may be increased in patients age >60 or with lymphopenia on admission. This study did not identify any significant increased mortality or morbidity associated with RSV infection in immune suppressed transplant recipients vs. patients who had not received a transplant.

Setting the One Health agenda and the human-companion animal bond.

"One Health", also called "One Medicine", began as an initiative advocating greater integration of human and animal medicine, in the 1800s. This concept has recently come to prominence, driven by the recognition that 75% of the newly emerging infectious diseases will arise from animal reservoirs, and that successful control and prevention will require a coordinated human medical and veterinary approach. Consequently, many One Health discussions have centered on the surveillance of animals in order to anticipate the potential emergence of new zoonotic diseases. An area that has been given only cursory mention, are the many ways that small companion animals benefit individual, community and possibly world health. The goal of this paper is to briefly review some of the evidenced-based data concerning the benefits of having companion animals in our lives, focusing on four major areas; cancer, heart disease, autism spectrum disorder (ASD), and the potential positive economic effects of the human-companion animal bond on One Health. Heart disease and cancer are the two leading causes of morbidity and mortality in the world, while ASD is a growing concern, not only for its individual effects, but also for its effect on family units, educational institutions, and its social implications for the community. In addition, these diseases can greatly affect the national and global cost of healthcare, as well as the economic output of a nation. It is therefore important to include and build on the concept of the Human-Animal Bond (HAB) as it relates to healthcare in these areas.

UL54 foscarnet mutation in an hematopoietic stem cell transplant recipient with cytomegalovirus disease.

We present a case of foscarnet (FOS) resistance arising from a UL54 mutation after a short duration of FOS exposure, which has not been previously described in a stem cell transplant recipient, to our knowledge. We discuss the use of FOS to treat other viral infections and the implications this may have for the development of resistance mutations and treatment of cytomegalovirus disease.

Disseminated Nocardia paucivorans infection in an immunocompetent host.

Nocardia paucivorans is a recently discovered species that has been shown to have a predilection for CNS involvement in cases of disseminated infection. We present a 50-year-old man with one year of weight loss admitted to the hospital with cough and confusion. Imaging revealed pulmonary and iliopsoas masses as well as innumerable ring-enhancing brain lesions. N. paucivorans was eventually identified in a subcarinal lymph node biopsy. The diagnosis was expedited by utilizing 16s rRNA gene sequencing on the biopsy tissue, resulting in species-level identification several weeks prior to culture positivity. He was treated with 12 months of parenteral and oral antibiotics, with resolution of pulmonary and brain lesions on repeat imaging.

Acquired hypogammaglobulinemia in HIV-positive subjects after liver transplantation.

INTRODUCTION: As more solid organ transplantations are performed in patients infected with human immunodeficiency virus (HIV), post-transplant complications in this population are becoming better defined. METHODS: Using serum samples from the Solid Organ Transplantation in HIV: Multi-Site Study, we studied the epidemiology of acquired hypogammaglobulinemia (HGG) after liver transplantation (LT) in 79 HIV-infected individuals with a median CD4 count at enrollment of 288 (interquartile range 200-423) cells/µL. Quantitative immunoglobulin G (IgG) levels before and after LT were measured, with moderate and severe HGG defined as IgG 350-500 mg/dL and <350 mg/dL, respectively. Incidence, risk factors, and associated outcomes of moderate or worse HGG were evaluated using Kaplan-Meier estimator and proportional hazards (PH) models. RESULTS: The 1-year cumulative incidence of moderate or worse HGG was 12% (95% confidence interval [CI]: 6-22%); no new cases were observed between years 1 and 2. In a multivariate PH model, higher pre-transplant model for end-stage liver disease score (P = 0.04) and treated acute rejection (P = 0.04) were both identified as significant predictors of moderate or worse HGG. There was a strong association of IgG levels <500 mg/dL with non-opportunistic serious infection (hazard ratio [95% CI]: 3.5 [1.1-10.6]; P = 0.03) and mortality (3.2 [1.1-9.4]; P = 0.04). These associations held after adjustment for important determinants of infection and survival among the entire cohort. CONCLUSION: These results suggest that a proportion of HIV-positive LT recipients will develop clinically significant HGG after transplantation.

A multicenter evaluation of pandemic influenza A/H1N1 in hematopoietic stem cell transplant recipients.

BACKGROUND: Hematopoietic stem cell transplant (HSCT) recipients have increased morbidity from respiratory viral infections. Pandemic influenza A - A(H1N1)/pdm09 - in 2009-2010 was associated with increased severity of illness in patients with underlying co-morbidities including HSCT, but the factors that contribute to severe disease in HSCT patients are not well characterized. METHODS: We conducted a multicenter review of microbiologically proven influenza A(H1N1)pdm09 in the HSCT population between April 2009 and April 2010 to determine factors that are associated with severe disease. RESULTS: We identified 37 adult patients (26 allogeneic and 11 autologous HSCT recipients). Median time from transplant to diagnosis was 411 days (range 4 days-14.9 years). Three cases were hospital acquired. Twenty-eight of 37 (75.7%) had confirmed A(H1N1)pdm09. Presumed viral lower respiratory tract infection was present in 12/37 (32.4%) patients. Antiviral therapy was given to 33/37 (89%) patients, primarily oseltamivir (n = 24) and oseltamivir before or after another antiviral (n = 8). Excluding those with nosocomial A(H1N1)pdm09, 18/34 (52.9%) were hospitalized and 6 (33%) required admission to an intensive care unit. Mortality within 30 and 60 days of symptom onset was 7/37 (18.9%) and 11/37 (29.7%), respectively. Factors associated with mortality included nosocomial acquisition (P = 0.023), receipt of mycophenolate mofetil (P = 0.001), or antilymphocyte antibody (P = 0.005) within the past 6 months, reduced-intensity conditioning (P = 0.027), and bacteremia (P = 0.021). CONCLUSIONS: A(H1N1)pdm09 infection was particularly severe in HSCT recipients, specifically among those receiving augmented immunosuppression for graft-versus-host disease. The high mortality of the nosocomial cases highlights the need for strict infection-control measures in hospitals during influenza outbreaks.

Severe plantar hyperhidrosis: an effective surgical solution.

Severe palmoplantar hyperhidrosis both affects activities of daily living and diminishes quality of life. This study evaluated overall safety and efficacy of endoscopic lumbar sympathectomy (ELS) using a clamping method in a large series of consecutive patients. Patient data were routinely entered into a prospectively designed database. Plantar sweating was graded as cured, improved, or unchanged. ELS (using 5-mm titanium clips) was performed in 154 patients, 68.2 per cent at the third lumbar vertebrae and 31.8 per cent at the fourth lumbar vertebrae. Follow-up averaged 15 months and ranged up to 4.7 years. Anhidrosis was achieved in 97.4 per cent of patients with the remainder reporting major reduction in symptoms. All patients were discharged home within 24 hours of surgery, requiring only oral analgesics, if any. There were two surgical complications (lymphatic leak and misidentification of genitofemoral nerve for sympathetic nerve). Six early patients required conversion to an open surgical procedure. Partial recurrence, usually mild, occurred in 4.5 per cent with 2.6 per cent requiring revision surgery. Severe plantar hyperhidrosis can be safely and effectively treated by endoscopic lumbar sympathectomy using the clamping method. It can be accomplished on an outpatient basis with low morbidity, complete resolution of symptoms, and a significant improvement in quality of life.

Using palliative care in progressive neuromuscular disease to maximize quality of life.

This article discusses the role of palliative care in the treatment pathway of patients with progressive neuromuscular disease (NDM), including amyotrophic lateral sclerosis and Duchenne muscular dystrophy (DMD). People with severe NMDs like DMD are now living much longer, well in to adulthood. This makes them suitable for the medical model of palliative care. Yet palliative medicine is a new area, especially for "adults" with DMD. Strategies for identifying the most effective modalities to alleviate suffering in patients with an NMD receiving palliative services and creating best practice standards in pain and symptom management for this patient population are discussed.

Consumption of a high-salt diet by ewes during pregnancy alters nephrogenesis in 5-month-old offspring.

Maternal nutrition during pregnancy can affect kidney development in the foetus, which may lead to adverse consequences in the mature kidney. It was expected that high-salt intake by pregnant ewes would lead to a reduction in foetal glomerular number but that the ovine kidney would adapt to maintain homoeostasis, in part by increasing the size of each glomerulus. Merino ewes that were fed either a control (1.5% NaCl) or high-salt (10.5% NaCl) diet during pregnancy, as well as their 5-month-old offspring, were subjected to a dietary salt challenge, and glomerular number and size and sodium excretion were measured. The high-salt offspring had 20% fewer glomeruli compared with the control offspring (P < 0.001), but they also had larger glomerular radii compared with the control offspring (P < 0.001). Consequently, the cross-sectional area of glomeruli was 18% larger in the high-salt offspring than in the control offspring (P < 0.05). There was no difference in the daily urinary sodium excretion between the two offspring groups (P > 0.05), although the high-salt offspring produced urine with a higher concentration of sodium. Our results demonstrated that maternal high-salt intake during pregnancy affected foetal nephrogenesis, altering glomerular number at birth. However, the ability to concentrate and excrete salt was not compromised, which indicates that the kidney was able to adapt to the reduction in the number of glomeruli.

Risk assessment of porcine reproductive and respiratory syndrome virus (PRRSV) transmission via somatic cell nuclear transfer (SCNT) embryo production using oocytes from commercial abattoirs.

Somatic cell nuclear transfer (SCNT) technology has become a powerful tool for reproductive biology to preserve and propagate valuable genetics for livestock. Embryo production through SCNT involves enucleation of the oocyte and insertion of a somatic donor cell into the oocyte. These procedures lead to a few small openings on the zona pellucida that may elevate risk of viral infection for the produced SCNT embryos. The oocytes used for SCNT are mainly obtained from abattoirs where viral contamination is almost inevitable. Therefore, a systematic evaluation of risk of disease transmission through SCNT embryo production is necessary prior large scale implementation of this technology in the livestock industry. The objective of the current study was to evaluate the risk of disease transmission via SCNT embryo production and transfer by testing for the presence of porcine reproductive and respiratory syndrome virus (PRRSV) throughout the process of SCNT embryo production. The presence of PRRSV in each step of SCNT embryo production, from donor cells to pre-implantation SCNT embryo culture, was carefully examined using a real-time PCR assay with a sensitivity of five copies per-reaction. All 114 donor cell lines derived from pig skin tissue over a period of 7 years in our facility tested negative for PRRSV. Out of the 68 pooled follicular fluid samples collected from 736 ovaries, only four (5.9%) were positive indicating a small amount of viral molecule present in the oocyte donor population. All 801 Day 7 SCNT embryos produced in four separate trials and over 11,571 washed oocytes obtained in 67 batches over 10 months tested negative. These oocytes were collected from multiple abattoirs processing animals from areas with high density of pig population and correspond to a donor population of over 5828 individuals. These results indicate that the oocytes from abattoirs were free of PRRSV infection and therefore could be safely used for in vitro embryo production. Additionally, the established SCNT embryo production system, including donor cell testing, oocytes decontamination, and pathogen free embryo reconstruction and culturing, bears no risk of PRRSV transmission.

The influence of MHC and immunoglobulins a and e on host resistance to gastrointestinal nematodes in sheep.

Gastrointestinal nematode parasites in farmed animals are of particular importance due to their effects on production. In Australia, it is estimated that the direct and indirect effects of parasite infestation cost the animal production industries hundreds of millions of dollars each year. The main factors considered by immunologists when studying gastrointestinal nematode infections are the effects the host's response has on the parasite, which immunological components are responsible for these effects, genetic factors involved in controlling immunological responses, and the interactions between these forming an interconnecting multilevel relationship. In this paper, we describe the roles of immunoglobulins, in particular IgA and IgE, and the major histocompatibility complex in resistance to gastrointestinal parasites in sheep. We also draw evidence from other animal models to support the involvement of these immune components. Finally, we examine how IgA and IgE exert their influence and how methods may be developed to manage susceptible animals.

Predictive validity of a non-induced mouse model of compulsive-like behavior.

A key to advancing the understanding of obsessive-compulsive disorder (OCD)-like symptoms is the development of spontaneous animal models. Over 55 generations of bidirectional selection for nest-building behavior in house mice, Mus musculus, resulted in a 40-fold difference in the amount of cotton used for a nest in high (BIG) and low (SMALL) selected lines. The nesting behavior of BIG mice appears to be compulsive-like and has initial face validity as an animal model for OCD in humans. Compulsive-like digging behavior was assessed; BIG male mice buried about three times as many marbles as SMALL male mice, strengthening face validity. Using the open field and elevated plus maze, SMALL male mice showed higher levels of anxiety/fear-like behavior than BIG male mice, indicating that compulsive-like and not anxiety-like behavior was measured. To establish predictive validity, chronic (4 weeks) oral administration of fluoxetine (30, 50 and 100mg/kg/day) and clomipramine (80 mg/kg/day), both effective in treating OCD, significantly reduced compulsive-like nest-building behavior in BIG male mice. Compulsive-like digging behavior was also significantly reduced by chronic oral fluoxetine (30 and 80 mg/kg/day) treatment in BIG male mice. General locomotor activity was not affected by chronic oral fluoxetine (30 and 80 mg/kg/day) treatment; chronic oral treatment with desipramine (30 mg/kg/day), an antidepressant not effective in treating OCD, had no effect on nesting behavior of BIG male mice, strengthening predictive validity. Together, the results indicate that these mice have good face and predictive validity as a non-induced mouse model of compulsive-like behavior relevant to OCD.