Effects of prepartum metabolizable protein supply and management strategy on lactational performance and blood biomarkers in dairy cows during early lactation.

Our objective was to investigate the effects of prepartum metabolizable protein (MP) supply and management strategy on milk production and blood biomarkers in early lactation dairy cows. Ninety-six multigravida Holstein cows were used in a randomized complete block design study, blocked by calving date, and then assigned randomly to 1 of 3 treatments within block. Cows on the first treatment were fed a far-off lower MP diet [MP = 83 g/kg of dry matter (DM)] between -55 and -22 d before expected calving and then a close-up lower MP diet (MP = 83 g/kg of DM) until parturition (LPLP). Cows on the second treatment were fed the far-off lower MP diet between -55 to -22 d before expected parturition and then a prepartum higher MP diet (MP = 107 g/kg of DM) until calving (LPHP). Cows on the third treatment had a shortened 43-d dry period and were fed the prepartum higher MP diet from dry-off to parturition (SDHP). After calving, cows received the same fresh diet from d 0 to 14 and the same high diet from d 15 to 84. Data were analyzed separately for wk -6 to -1 and wk 1 to 12, relative to parturition. Dry matter intake from wk -6 to -1 was not different between LPHP and LPLP and increased for SDHP compared with LPLP. In contrast, dry matter intake for wk 1 to 12 postpartum did not change for LPHP versus LPLP or for SDHP versus LPLP. Compared with LPLP cows, LPHP cows had lower energy-corrected milk yield and tended to have decreased milk fat yield during wk 1 to 12 of lactation. Conversely, yields of energy-corrected milk and milk fat and protein were similar for SDHP compared with LPLP. Plasma urea N during wk -3 to -1 increased for LPHP versus LPLP and for SDHP versus LPLP; however, no differences in plasma urea N were observed postpartum. Elevated prepartum MP supply did not modify circulating total fatty acids, ß-hydroxybutyrate, total protein, albumin, or aspartate aminotransferase during the prepartum and postpartum periods. Increased MP supply prepartum combined with a shorter dry period (SDHP vs. LPLP) tended to increase whole-blood ß-hydroxybutyrate postpartum; however, other blood metabolites were not affected. Taken together, under the conditions of this study, elevated MP supply in close-up diets reduced milk production without affecting blood metabolites in multiparous dairy cows during early lactation. A combination of a shorter dry period and increased prepartum MP supply (i.e., SDHP vs. LPLP) improved prepartum dry matter intake without modifying energy-corrected milk yield and blood biomarkers in early lactation cows.

Examination of Some Factors Affected Right-to-left Shunt Rate and the Normal Value of Right-to-left Shunt Rate in Lung Perfusion Scintigraphy.

PURPOSE: Diagnosis for right-to-left shunt was determined by the assessment of shunt-rate, which was obtained by using 99 mTc-macroaggregated albumin. However, it is difficult to diagnose right-to-left shunt, using the normal level of shunt-rate measured by using conventional methods. To solve this problem, we investigated ourselves the normal level of shunt-rate. METHOD: We researched 20 patients with pulmonary embolism, and they didn't have right-to-left shunt. We investigated three points for the normal level of shunt-rate. First, we examined the region of interest (ROI) area of the lungs to modify the upper level of gray scale. Second, we confirmed the difference between the whole visual field and body contour of the ROI area. Third, we examined the necessity whether we correct the background of whole body and the lungs. RESULT: We resulted three points. First, stable right-to-left shunt rate is got to set that the upper level of gray scale is 35%. Second, there is no significant difference between the whole visual field and body contour of the ROI area. Third, correcting background isn't needed to get right-to-left shunt rate. The normal level of the shunt-rate was 12.6±2.8% in the condition. CONCLUSION: We are able to decide the optimal condition for the normal level of shunt-rate. It is important to evaluate the normal level of the shunt-rate fixed on each factor in each hospital.

[Video-assisted thoracoscopic implantation of left ventricular pacing lead;usefulness of CARTO system;report of a case].

A 70-year-old man, with a history of broad anterior myocardial infarction and repeated several hospitalizations due to heart failure, was referred to our institution for cardiac resynchronization therapy. However, as intravenous implantation of the left ventricular pacemaker lead was not possible, the patient underwent video-assisted thoracoscopic (VAT) implantation. We noted broad myocardial scarring and patent grafts, along with previously bypassed left internal thoracic artery( LITA)-left anterior descending artery (LAD) and right internal thoracic artery (RITA)-D1;thus, the area suitable for implantation of the left ventricule (LV) pacemaker was believed to be restricted. Therefore, we decided to determine the viable myocardial area by using CARTO system and identify the appropriate access port positions for the subsequent VAT surgery. After the LV pacemaker lead was implanted, the recorded pacing threshold was found to be <1.2 V at 0.5 ms. Thus, the CARTO system might be useful to preoperatively identify an area suitable for surgical implantation of a LV pacemaker lead in patients with ischemic cardiomyopathy.

Utility of endoscopic ultrasound-guided fine-needle aspiration cytology in rapid on-site evaluation for the diagnosis of gastric submucosal tumors: Retrospective analysis of a single-center experience.

BACKGROUND: Recently, there have been reports of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology being used for the diagnosis of various kinds of tumors. This method has also been adopted in the diagnosis of gastric submucosal tumors (SMTs). The aim of this study was to analyze the utility of EUS-FNA cytological examination in rapid on-site evaluation (ROSE) for gastric SMTs. METHODS: Retrospective analyses of the cytological specimens of EUS-FNA in ROSE for gastric SMTs and determination of the diagnostic accuracy of EUS-FNA combined with immunohistochemical analysis of cell blocks and surgically resected specimens were performed. RESULTS: A total of 110 patients were enrolled in this study. The most common cytodiagnosis was spindle cell tumor (62 patients, 55.5%), followed by negative for tumor (34 patients), and malignant lymphoma and adenocarcinoma (five patients each). Cell blocks were prepared for 60 of the patients (96.8%), cytologically diagnosed with spindle cell tumor. Immunohistochemical analyses using cell block revealed gastrointestinal stromal tumor (GIST, c-kit+ /desmin- , 49 patients) and leiomyoma (desmin+ /c-kit- , five patients). Thus, using EUS-FNA specimens, 83.1% of GIST patients were pre-operatively diagnosed. CONCLUSIONS: EUS-FNA cytological examination in ROSE for gastric SMTs aided in the collection of sufficient amounts of tumor tissues for preparing cell blocks. This method led to a high rate of accurate pre-operative diagnosis in patients with gastric SMTs.

A case of adrenocorticotropin-independent bilateral adrenal macronodular hyperplasia (AIMAH) with primary hyperparathyroidism (PHPT).

We report a rare case of ACTH-independent macronodular adrenal hyperplasia (AIMAH) with primary hyperparathyroidism (PHPT). A 57-year-old woman was admitted to our hospital for further examination of secondary hypertension and bilateral adrenal macrotumors. Midnight serum cortisol elevation with undetectable plasma ACTH, increased 24-hour urinary free cortisol excretion, and loss of the normal circadian rhythm in cortisol secretion established the diagnosis of Cushing's syndrome. Total resection of the enlarged left adrenal gland was performed with subsequent steroid replacement. Her general condition improved but serum calcium level increased 3 weeks after surgery. PHPT was diagnosed on the basis of endocrinological examination, although imaging studies failed to detect parathyroid lesion. In summary, we believe this to be the first report of a case of AIMAH with PHPT.