Effects of complete substitution of dietary grain and protein sources with by-products on the production performance of mid-lactation dairy cows fed diets based on barley silage under heat-stress conditions.

This study evaluated the effects of replacing cereal grains and soybean meal with by-products (BY) on production performance, nutrient digestibility, ruminal fermentation, nutrient recovery, and eating and chewing behavior of moderate-producing dairy cows under heat-stress conditions. Twelve multiparous Holstein cows (116.7 ± 12.01 d in milk; 42.7 ± 5.06 kg/d milk yield; 665 ± 77 kg body weight; mean ± SD) were used in a replicated 3 × 3 Latin square with 28-d periods (21 d for diet adaptation and 7 d for sampling and data collection). Cows were fed a total mixed ration containing a 39.2:60.8 ratio of forage to concentrate throughout the experiment. All diets were formulated to be isoenergetic and isonitrogenous, with different concentrates. Diets were (1) control diet based on cereal grains (CON: ground corn and ground barley, plus soybean meal); (2) sugar-rich BY diet (S-BY-CM: beet pulp, citrus pulp, and liquid molasses, plus canola meal); and (3) cereal grain BY diet (CG-BY: rice bran, corn germ meal, wheat bran, barley sprout, and broken corn). Our results showed that replacing grains with BY increased neutral detergent fiber intake and digestibility but decreased starch intake, human-edible energy, and human-edible protein. Milk yield and dry matter intake (DMI) decreased more in cows fed the CG-BY diet compared with the other 2 treatments. In contrast, no significant differences were observed between the CON and S-BY-CM diets in terms of milk yield and DMI. The S-BY-CM diet increased energy-corrected milk production compared with the CG-BY diet (36.2 vs. 34.3 kg/d), but CG-BY enhanced feed conversion efficiency compared with the other 2 treatments. Although the S-BY-CM diet prolonged the eating and sorting of small particles, neither of the dietary treatments affected chewing activity or ruminal pH 4 h after feeding. Furthermore, both diets containing BY contributed to an increase in milk fat content in comparison to the CON group. Additionally, the CG-BY and S-BY-CM diets demonstrated better performance than the CON diet in terms of human-edible feed conversion efficiency for protein and energy. The results indicated that S-BY-CM can completely replace barley and corn grain in the diet of mid-lactating dairy cows exposed to heat-stress conditions without any negative effect on production and ruminal pH. However, the inclusion of CG-BY did impair DMI, milk yield, and digestibility of nutrients and is not recommended during heat-stress conditions.

Association between impedance to blood flow in umbilical arteries and infant survival in twin-to-twin transfusion syndrome.

OBJECTIVE: To evaluate infant survival according to the Doppler pattern of impedance to blood flow in the umbilical arteries (UAs) prior to laser surgery, in pregnancies with twin-to-twin transfusion syndrome (TTTS). METHODS: This was a retrospective study of women with a monochorionic diamniotic twin pregnancy who underwent laser surgery for TTTS between January 2012 and May 2018 at a single institution. Absolute intertwin difference in UA pulsatility index (DUAPI) was measured within 48 h prior to laser surgery. Twins with intermittent or persistent absent/reversed end-diastolic flow (EDF) in the UA (UA-EDF) were analyzed separately. Survival of both or at least one infant at birth and at 30 days postpartum was compared between pregnancies with an intertwin DUAPI of ≥ 0.4 and those with an intertwin DUAPI of < 0.4, as well as between fetuses with intermittent and those with persistent absent/reversed UA-EDF. Parametric and non-parametric tests were used for analysis. Regression analysis was performed to determine if intertwin DUAPI and intermittent or persistent absent/reversed UA-EDF were associated independently with infant survival, while controlling for gestational age at delivery, Quintero stage and other important confounding variables. RESULTS: Of 231 TTTS pregnancies that underwent laser surgery during the study period, UA Doppler information could be retrieved for 206 and delivery information was available for 184, which comprised the study population. Rates of double-twin survival at birth were significantly higher in pregnancies with an intertwin DUAPI of < 0.4 than in those with an intertwin DUAPI of ≥ 0.4 (83.9% (78/93) vs 50.0% (12/24); P < 0.001). Double-infant survival at birth was higher in pregnancies with intermittent compared to those with persistent absent/reversed UA-EDF (73.0% (27/37) vs 36.7% (11/30); P = 0.003). Regression analysis demonstrated that an intertwin DUAPI of < 0.4 was associated with increased survival of both twins at delivery (P < 0.001) and at 30 days postpartum (P = 0.002), as well as increased survival of at least one twin at delivery (P = 0.009). Similarly, intermittent absent/reversed UA-EDF was associated with increased survival of both twins at delivery (P = 0.007) and at 30 days after birth (P = 0.015). CONCLUSIONS: Evaluation of intertwin differences in UA impedance to blood flow as well as identification of intermittent or persistent absent or reversed UA-EDF prior to laser surgery could help in the prediction of double-infant survival at birth and to 30 days in twin pregnancies with TTTS. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Elective delivery at 34 weeks vs routine obstetric care in fetal gastroschisis: randomized controlled trial.

OBJECTIVE: To evaluate whether elective preterm delivery (ED) at 34 weeks is of postnatal benefit to infants with isolated gastroschisis compared with routine obstetric care (RC). METHODS: Between May 2013 and September 2015, all women with a sonographic diagnosis of fetal gastroschisis referred to a single tertiary center, before 34 weeks' gestation, were invited to participate in this study. Eligible patients were randomized to ED (induction of labor at 34 weeks) or RC (spontaneous labor or delivery by 37-38 weeks, based on standard obstetric indications). The primary outcome measure was length of time on total parenteral nutrition (TPN). Secondary outcomes were time to closure of gastroschisis and length of stay in hospital. Outcome variables were compared using appropriate statistical methods. Analysis was based on intention-to-treat. RESULTS: Twenty-five women were assessed for eligibility, of whom 21 (84%; 95% CI, 63.9-95.5%) agreed to participate in the study; of these, 10 were randomized to ED and 11 to RC. The trial was stopped at the first planned interim analysis due to patient safety concerns and for futility; thus, only 21 of the expected 86 patients (24.4%; 95% CI, 15.8-34.9%) were enrolled. Median gestational age at delivery was 34.3 (range, 34-36) weeks in the ED group and 36.7 (range, 27-38) weeks in the RC group. One patient in the ED group delivered at 36 weeks following unsuccessful induction at 34 weeks. Neonates of women who underwent ED, compared to those in the RC group, showed no difference in the median number of days on TPN (54 (range, 17-248) vs 21 (range, 9-465) days; P = 0.08), number of days to closure of gastroschisis (7 (range, 0-15) vs 5 (range, 0-8) days; P = 0.28) and length of stay in hospital (70.5 (range, 22-137) vs 31 (range, 19-186) days; P = 0.15). However, neonates in the ED group were significantly more likely to experience late-onset sepsis compared with those in the RC group (40% (95% CI, 12.2-73.8%) vs 0%; P = 0.03). CONCLUSION: This study demonstrates no benefit of ED of fetuses with gastroschisis when postnatal gastroschisis management is similar to that used in routine care. Rather, the data suggest that ED is detrimental to infants with gastroschisis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Parto inducido a las 34 semanas versus atención obstétrica rutinaria en la gastrosquisis fetal: ensayo controlado aleatorizado OBJETIVO: Evaluar si el parto pretérmino inducido (PI) a las 34 semanas es beneficioso para los recién nacidos con gastrosquisis aislada en comparación con la atención obstétrica rutinaria (AR). MÉTODOS: Entre mayo de 2013 y septiembre de 2015, se invitó a participar en este estudio a todas las mujeres con diagnóstico ecográfico de gastrosquisis fetal remitidas a un mismo centro terciario, antes de las 34 semanas de gestación. Las pacientes elegibles fueron asignadas al azar al PI (inducción del parto a las 34 semanas) o a la AR (parto espontáneo a las 37-38 semanas, en función de los indicios obstétricos estándar). La medida de resultado primaria fue la duración de la nutrición parenteral total (NPT). Las medidas de resultado secundarias fueron el tiempo hasta el cierre de la gastrosquisis y la duración de la estancia hospitalaria. Las variables de resultado se compararon mediante métodos estadísticos apropiados. El análisis se basó en la intención de tratar. RESULTADOS: Se evaluó la elegibilidad de 25 mujeres, de las cuales 21 (84%; IC 95%, 63,9-95,5%) aceptaron participar en el estudio; de ellas, 10 fueron asignadas al azar al PI y 11 a la AR. El ensayo se detuvo después del primer análisis provisional planificado debido a preocupaciones sobre la seguridad de las pacientes y por su intrascendencia; por lo tanto, sólo se reclutaron 21 de las 86 pacientes esperadas (24,4%; IC 95%, 15,8-34,9%). La mediana de la edad gestacional en el momento del parto fue de 34,3 (rango: 34-36) semanas en el grupo de PI y 36,7 (rango: 27-38) semanas en el grupo de AR. Una paciente del grupo de PI tuvo un parto a las 36 semanas, después de una inducción infructuosa a las 34 semanas. Los neonatos de las mujeres que se sometieron a PI, comparados con los del grupo de AR, no mostraron diferencias en la mediana del número de días de NPT (54 (rango: 17-248) vs 21 (rango: 9-465) días; P=0,08), número de días hasta el cierre de la gastrosquisis (7 (rango: 0-15) vs 5 (rango: 0-8) días; P=0,28) y duración de la estancia hospitalaria (70,5 (rango: 22-137) vs 31 (rango: 19-186) días; P=0,15). Sin embargo, la probabilidad de experimentar sepsis de inicio tardío fue mayor en los neonatos del grupo de PI en comparación el grupo de AR (40% (IC 95%, 12,2-73,8%) vs 0%; P=0,03). CONCLUSIÓN: Este estudio demuestra que el PI no presenta ningún beneficio para los fetos con gastrosquisis cuando el tratamiento de la gastrosquisis postnatal es similar al utilizado en la atención rutinaria. Más bien, los datos sugieren que el PI es perjudicial para los lactantes con gastrosquisis.

Effects of hydrolyzed cottonseed protein supplementation on performance, blood metabolites, gastrointestinal development, and intestinal microbial colonization in neonatal calves.

The objective of this study was to investigate the effects of an enzymatically hydrolyzed cottonseed protein (HCSP) as a peptide source on performance, blood metabolites, gastrointestinal development, and intestinal microbes. Forty-eight newborn Holstein calves were randomly assigned to 1 of the 4 dietary treatments including 0, 2, 4, and 6% of HCSP (dry matter basis). All calves received the same amount of pasteurized whole milk, weaned on d 56 of the experiment, and the study was concluded on d 70. Data were analyzed using PROC MIXED in SAS (SAS Institute Inc., Cary, NC) as a randomized complete block design with linear and quadratic contrasts. Results showed that increased amount of HCSP linearly decreased the starter intake during the postweaning (d 57 to 70) and overall period (d 1 to 70). In addition, when dietary HCSP increased during the overall period, average daily gain tended to linearly decrease. All skeletal growth variables also linearly decreased as dietary HCSP increased at the end of the study, except for body length, which did not differ among the treatments. Serum cortisol concentration was higher in calves supplemented with 6% of HCSP at weaning and at the end of the study. This indicates that these calves may have experienced a stressful condition compared with calves in other treatments. Total antioxidant capacity was quadratically affected by HCSP supplementation; calves fed 2 and 4% of HCSP diets had the highest total antioxidant capacity, whereas calves fed 0 and 6% HCSP diets had lower total antioxidant capacity at weaning and at end of the study. Calves supplemented with 6% HCSP had lower empty reticulo-rumen and omasum weights and rumen wall thickness compared with calves in other treatments at the end of the study. In conclusion, supplementation of HCSP at the rate of 2% of starter diet enhanced antioxidant status without any detrimental effects on the performance and metabolic status of calves, whereas greater inclusion rates impaired starter intake and growth of calves, and exposed them to a stressful status.

Outcome of fetuses with lower urinary tract obstruction and normal amniotic fluid volume in second trimester of pregnancy.

OBJECTIVE: Congenital lower urinary tract obstruction (LUTO) is a rare condition with high perinatal mortality and morbidity when associated with severe oligohydramnios or anhydramnios in the second trimester of pregnancy. Severe pulmonary hypoplasia and end-stage renal disease are the underlying causes of poor neonatal outcome in these cases. However, little is known about the subset of fetal LUTO that is associated with a normal volume of amniotic fluid at midgestation. The objective of the current study was to describe the natural history, underlying causes, survival and postnatal renal function outcomes in pregnancies with fetal LUTO and normal amniotic fluid volume during the second trimester of pregnancy. METHODS: This was a retrospective study of all pregnancies with fetal LUTO and normal amniotic fluid volume in the second trimester that received prenatal and postnatal care at our quaternary care institution between 2013 and 2017. Data on demographic characteristics, fetal interventions, perinatal survival, need for neonatal respiratory support, postnatal renal function and need for dialysis at the age of 1 and 24 months were analyzed. RESULTS: Of the 18 fetuses that met the study criteria, 17 (94.4%) survived the perinatal period. Eleven (61.1%) pregnancies developed oligohydramnios in the third trimester, six of which were eligible for and underwent fetal intervention with vesicoamniotic shunt placement, which was performed successfully in all six cases. Two (11.1%) neonates required respiratory support owing to pulmonary hypoplasia. At the age of 2 years, 14 children had follow-up information available, two (14.3%) of whom had normal renal function, eight (57.1%) had developed some degree of chronic kidney disease (Stage 1-4) and four (28.6%) had developed end-stage renal disease (ESRD), including two who had already manifested ESRD in the neonatal period. CONCLUSIONS: Most fetuses diagnosed prenatally with LUTO that is associated with a normal volume of amniotic fluid at midgestation will have a favorable outcome in terms of perinatal survival and few will need long-term respiratory support. However, these children are still at increased risk for chronic renal disease, ESRD and need for renal replacement therapy. Larger multicenter studies are needed to characterize the prenatal factors associated with postnatal renal function, and to investigate the role of fetal intervention in the group of fetuses that present with late-onset oligohydramnios and evidence of preserved fetal renal function. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Five-year Evaluation of Chronic Diseases in Hamadan, Iran: 2005-2009.

BACKGROUND: Now the increasing growth of chronic diseases is the major health challenge worldwide. This survey was conducted to assess noncommunicable diseases related risk factors. METHODS: A population-based cross sectional study was conducted in 2005 and repeated annually by 2009 in Hamadan province, the west of Iran using two-stage cluster sampling method. A total sample of 6500 subjects 15 to 64 years old were enrolled. RESULTS: The total prevalence of cigarette smoking was 18% [95% CI 17% to 19%], 35.1% in men versus 1.1% in women. The smokers consumed on average 15 cigarettes per day. Almost 26.3% [95% CI 24.8% to 27.7%] of the target population eat five or more servings of fruits and vegetables per day; 52.8% [95% CI 51.2% to 54.3%] had work related physical activity; 28.1% [95% CI 26.7% to 29.4%] had physical activity during leisure time; 80.3% [95% CI 79.0% to 81.5%] had transportation related physical activity; 47.2% [95% CI 46.0% to 48.4%] were either overweight or obese; 8.1% [95% CI 7.1% to 9.2%] had impaired fasting blood sugar or were confirmed diabetes; 33.7% [95% CI 31.9% to 35.5%] had hypercholesterolemia; and 15.6% [95% CI 13.0% to 18.3%] had hypertriglyceridemia. There was a statistically significant association of age and gender with body mass index, systolic and diastolic hypertension, hyperglycemia, hypercholesterolemia and hypertriglyceridemia. CONCLUSIONS: The evidences of the present survey promise a silent progressive epidemic of chronic diseases among Iranian citizens that may lead to an increasing growth of noncommunicable diseases in the next decade.

Compositional data on some Persian bezoars.

Fourteen Bezoars from Persia, used in past times and even to-day as a medicine or as a health-preserving precious tone, are examined. Among the concretions ellagic acid prevails. Some are bile pigmented or calcite stones. Other bezoars are mineral substances or artifacts.