Cost-effectiveness analysis of adding omega-3 or vitamin D supplementation to standard therapy in treating painful crises of pediatric sickle cell disease patients.

OBJECTIVE: Painful crises represents a predominant complication of sickle cell disease (SCD). The only approved treatments for painful crises in many countries are hydroxyurea plus potent analgesics. Our earlier clinical trial concluded that omega-3 and vitamin D had a potential therapeutic impact on painful crises. However, there is limited research evaluating their therapeutic applications and cost-effectiveness. This paper aims at comparing the cost-effectiveness of omega-3 and vitamin D supplementation to the standard therapy in treating painful crises among children with SCD. PATIENTS AND METHODS: Cost-effectiveness analyses of daily supplementation of omega-3 and vitamin D were performed. The economic evaluation was based on data derived from a prospective 10-month randomized clinical trial (n = 165 patients; 15 patients dropped). 50 patients were recruited into the omega-3 + standard therapy group (hydroxyurea and folic acid daily with ibuprofen as needed), 50 patients into the vitamin D + standard therapy group, and 50 patients receiving standard therapy alone served as a control group. Outcome measures from the randomized clinical trial were used to determine incremental effectiveness. Cost estimates were calculated from the healthcare payer's perspective. The analysis considered the improvement in various outcome measures and are presented here as percent change from baseline to determine the incremental effectiveness and the incremental cost for the treatment of both interventions. RESULTS: Adding omega-3 or vitamin D to the standard therapy was more cost-effective than standard treatment alone. Vitamin D was a cheaper but less cost-effective alternative for most outcomes between the two treatments, including LDL-C and HDL-C. It was also more cost-effective but less clinically effective in reducing vaso-occlusive crisis episodes and pain severity. Omega-3 supplementation was significantly more cost-effective than vitamin D supplementation and the standard treatment for those measures. CONCLUSIONS: The present study showed that using vitamin D and omega-3 as add-on treatments for a painful crisis in pediatric sickle cell disease could have overall cost-saving and clinical benefits. However, further studies with a longer treatment duration are needed to establish more significant effects of the interventions for better policy and clinical decision-making.

Comparative effectiveness of adding Omega-3 or Vitamin D to standard therapy in preventing and treating episodes of painful crisis in pediatric sickle cell patients.

OBJECTIVE: Sickle Cell Anemia (SCA), also called the Sickle Cell Disease (SCD), is an inherited hematological disorder characterized by a syndrome of acute anemia and a painful crisis. The sickling hemoglobin, Hgb-S causes viscosity and inflammation of blood vessels. Eventually, the red blood cells get eliminated from the circulation process, which leads to hemolytic anemia. This study examined the comparative effectiveness of supplementation of Omega-3 or vitamin-D to standard therapy (hydroxyurea + Ibuprofen) used for prevention and treatment of pain crises in pediatric patients living with SCD. PATIENTS AND METHODS: 165 patients participated in this randomized, double-blind, standard therapy-controlled, parallel-design trial. The patients were randomly divided into three groups, receiving three capsules of either 1,000 mg Omega-3 fish oil (400 mg EPA and 300 mg DHA) or 1.5 mL vitamin-D (2,800 IU/7 ml) daily for 10 months plus the standard therapy. Lactate dehydrogenase, high-density lipoprotein (HDL), low-density lipoprotein (LDL), hematocrit, reticulocyte count, and white-blood-cell count were determined at baseline (month zero) and end of the 10th month. The pain severity was measured using the visual analog scale method (VAS). Therefore, a 10-cm ruler with a VAS design was used to determine the patient pain intensity. The baseline time point was defined as the time spot before starting to deliver the experimental medication to the patients (month zero). At that time, the biodata of the patient on the frequency of pain episodes and the rest of the variables were collected, and the baseline data were one-year retrospective data. RESULTS: Of 165 patients enrolled in the trial, 150 were included in the final analysis. At the end of the study, there was a significant increase in serum LDL and HDL in the Omega-3 group as compared with the control group (mean of 82 mg/dL vs. 57 mg/dL; p < 0.01 and mean of 47 mg/dL vs. 43 mg/dL; p < 0.028, respectively). Other laboratory parameters were significantly influenced. The number of painful crises and pain levels was significantly decreased in the Omega-3 group compared with the control group (mean of one-episode vs. mean of three episodes; p = 0.01, mean of three on pain scale vs. six on pain scale; p = 0.018). CONCLUSIONS: Results showed that Omega-3 was more effective than vitamin-D or standard treatment alone relative to pain crises and most of the other studied items. Vitamin-D was more effective than standard therapy alone. Clinicians should consider the addition of Omega-3 supplements to the standard therapy and a de-escalation dose plan for the hydroxyurea medication.

Effect of feeding single-dam or pooled colostrum on maternally derived immunity in dairy calves.

The role of colostrum management in providing adequate immunological protection to neonatal calves has been widely investigated, and thresholds for colostrum quality, as well as optimum volume and timing for colostrum feeding have been established. However, limited information is available on the effect of colostrum source (single dam or pooled) on passive immunity, as well as subsequent antibody survival in the calf. This study aimed to assess the effect of feeding single-dam colostrum (own and other dam) or pooled colostrum on transfer of passive immunity, and also investigate the rate of depletion of disease-specific antibodies among dairy calves. In total, 320 cows and 119 dairy heifer calves were enrolled in the study. Calves were blood-sampled immediately after birth and received either own-dam, other-dam, or pooled colostrum. Calves were blood-sampled at 24 h to assess serum IgG concentrations and at monthly intervals thereafter to document disease-specific antibody survival. Mean colostrum IgG concentration was higher for other-dam treatment group, whereas own-dam and pooled treatments were similar. For all treatment groups, the mean IgG concentration was >80 mg/mL, exceeding the quality threshold of 50 mg/mL. Mean calf serum IgG concentration was lower for calves fed pooled colostrum compared with those that received colostrum from a single cow. There was a negative association with 24-h serum IgG and calf birth bodyweight; calves <30 kg at birth had the highest 24-h serum IgG concentration. Survival of antibodies to bovine viral diarrhea, Salmonella infection, leptospirosis, bovine parainfluenza 3 virus, bovine respiratory syncytical virus, rotavirus, and coronavirus was not associated with colostrum source; however, antibodies to infectious bovine rhinotracheitis had a greater period of survival among calves fed own-dam colostrum. We found that feeding single-dam colostrum can thus improve calf immunity through increased serum IgG levels and antibody survival rates. Furthermore, we hypothesize that immune exclusion may occur with pooled colostrum; therefore, providing pooled colostrum may still be a good practice as long as it can be ensured that enough antibodies are absorbed into the blood stream to deal with pathogens calves may encounter because different dams may have antibodies against different strains of viruses and bacteria, yielding cross protection.

Long-term outcome of sacral nerve stimulation for faecal incontinence.

AIM: Sacral nerve stimulation (SNS) is a minimally invasive treatment for faecal incontinence (FI). We report our experience of patients who have undergone SNS for FI with a minimum of 5 years' follow-up. This is a single centre prospective observational study with the aim to assess the long-term function of SNS. METHOD: All patients implanted with SNS were identified from our prospective database. The date of implantation, first and last clinic follow-up, surgical complications and St Mark's incontinence scores were abstracted and analysed. RESULTS: From 1996 to 2014, 381 patients were considered for SNS. Of these, 256 patients met the study inclusion criteria. Median age at implantation was 52 years (range 18-81). The ratio of women to men was 205:51. Indications were urge FI (25%), passive FI (17.9%) and mixed FI (57%). The median of the incontinence score at baseline was 19/24 and this improved to 7/24 at the 6-month follow-up. Of the total cohort, 235 patients received a medium-term follow-up (median 110 months, range 12-270) with a median continence score of 10/24 which was also confirmed at the telephone long-term follow-up on 185 patients (132 months, range 60-276). CONCLUSION: This study demonstrates that SNS is an effective treatment in the long term. SNS results in an improvement of validated scores for approximately 60% of patients; however, there is a significant reduction of efficacy over time due to underlying causes.

Identifying older people at risk of malnutrition and treatment in the community: prevalence and concurrent validation of the Patients Association Nutrition Checklist with 'MUST'.

BACKGROUND: Despite policy guidance and quality standards, the majority of older adults with or at risk of malnutrition living in the community still remain under-detected and under-treated by health and social care professionals. The present study aimed to evaluate the concurrent validity of the Patients Association Nutrition Checklist against the 'Malnutrition Universal Screening Tool' ('MUST'). METHODS: This cross-sectional study involved 312 older adults recruited from 21 lunch and social groups. All participants were screened as per standard methodology for 'MUST'. For the Patients Association Nutrition Checklist, they provided information about signs of unintentional weight loss in the past 3-6 months, experiencing loss of appetite or interest in eating. Chance-corrected agreement (κ) was assessed. RESULTS: Mean (SD) age of participants was 79.6 (8.3) years and body mass index was 27.8 (5.6) kg m-2 . The majority (n = 197; 63%) were living alone. Using 'MUST', the overall prevalence of malnutrition was 9.9% (n = 31) comprising 6.7% at medium risk and 3.2% at high risk. There were 21.8% of participants (n = 68) rated at risk of overall malnutrition by the Patients Association Nutrition Checklist. Moderate agreement was observed between the two tools (κ = 0.47, P < 0.001). CONCLUSIONS: The Patients Association Nutrition Checklist has potential for early identification of malnutrition risk, attributed to unintentional weight loss and appetite changes with signposting to basic dietary advice and appropriate support. Further work is required to understand how this tool could be effectively used by stakeholders including volunteers, community workers and home care staff.

Utilization of Child Psychiatry Consultation Embedded in Primary Care for an Urban, Latino Population.

OBJECTIVE: In a novel model of embedded primary care child psychiatry serving an urban Latino population, we examined determinants of successful referral and relationship between clinical need and service intensity. METHODS: We conducted a chart review of referred patients from July 2013-March 2015. We used multiple logistic regressions controlling for confounders to identify determinants of successful referral. We examined the relationship between service intensity and clinical need using Poisson regression, adjusting for exposure time, age, sex, ethnicity, and language. RESULTS: Seventy-four percent of patients completed an evaluation. Younger children (p=.0397) and those with a history of therapy (p=.0077) were more likely to make initial contact. The markers of clinical need included PSC-35 Global Scores (p=.0027) and number of psychiatric diagnoses (p=.0178) predicted number of visits. CONCLUSIONS: Our findings support early referral to improve engagement, and provide initial evidence that embedded child psychiatry consultation is feasible and may increase access to care.

Does the Internet provide patients or clinicians with useful information regarding faecal incontinence? An observational study.

BACKGROUND: The Internet has become an important platform for information communication. This study aim to investigate the utility of social media and search engines to disseminate faecal incontinence information. METHODS: We looked into Social media platforms and search engines. There was not a direct patient recruitment and any available information from patients was already on public domain at the time of search. A quantitative analysis of types and volumes of information regarding faecal incontinence was made. RESULTS: Twelve valid pages were identified on Facebook: 5 (41%) pages were advertising commercial incontinence products, 4 (33%) pages were dedicated to patients support groups and 3 (25%) pages provided healthcare information. Also we found 192 Facebook posts. On Twitter, 2890 tweets were found of which 51% tweets provided healthcare information; 675 (45%) were sent by healthcare professionals to patients, 530 tweets (35.3%) were between healthcare professionals, 201 tweets (13.4%) were from medical journals or scientific books and 103 tweets (7%) were from hospitals or clinics with information about events and meetings. The second commonest type of tweets was advertising commercial incontinence products 27%. Patients tweeted to exchange information and advice between themselves (20.5%). In contrast, search engines as Google/Yahoo/Bing had a higher proportion of healthcare information (over 70%). CONCLUSION: Internet appears to have potential to be a useful platform for patients to learn about faecal incontinence and share information; however, given one lack of focus of available data, patients may struggle to identify valid and useful information.

The effect of colostrum storage conditions on dairy heifer calf serum immunoglobulin G concentration and preweaning health and growth rate.

The objective of the present study was to compare serum IgG concentration, weight gain, and health characteristics in Irish spring-born dairy calves fed colostrum stored using a range of conditions. Immediately after birth, 75 dairy heifer calves were assigned to 1 of 5 experimental colostrum treatments: (1) fresh pasteurized colostrum, fed immediately after pasteurization; (2) fresh colostrum, fed immediately after collection but not pasteurized; (3) colostrum stored unpasteurized at 4°C in a temperature-controlled unit for 2d before being fed to calves; (4) colostrum stored unpasteurized at 13°C in a temperature-controlled unit for 2d before being fed to calves; and (5) colostrum stored unpasteurized at 22°C in a temperature-controlled unit for 2d before being fed to calves. All colostrum had IgG concentrations >50g/L and was fed to calves promptly after birth. Blood samples were obtained from calves via the jugular vein at 0h (before colostrum feeding) and at 24h of age to determine the rate of passive transfer of IgG; individual calf live-weights were recorded to monitor weight gain (kg/d) from birth to weaning. Colostrum stored in warmer conditions (i.e., 22°C) had >42 times more bacteria present and a pH that was 0.85 units lower and resulted in a serum IgG concentration that was almost 2 times lower compared with colostrum that was pasteurized, untreated, or stored at 4°C for 2d. Colostrum stored at 4°C for 2d had more bacteria present than pasteurized and fresh colostrum but did not result in reduced calf serum IgG concentrations. Average daily weight gain from birth to weaning did not differ among treatments. Even if colostrum has sufficient IgG (>50g/L) but cannot be fed to calves when freshly collected, storage at ≤4°C for 2d is advisable to ensure adequate passive transfer when it is consumed by the calf.

The effect of high and low levels of supplementation on milk production, nitrogen utilization efficiency, and milk protein fractions in late-lactation dairy cows.

To fill the feed deficit in the autumn/late lactation period in a seasonal grazing system, supplementation is required. This study aimed to investigate the use of baled grass silage or concentrate as supplementation to grazing dairy cows in late lactation. Eighty-four grass-based spring-calving dairy cows, averaging 212d in milk, were allocated to 1 of 6 treatments [high grass allowance (HG), low grass allowance (LG), grass with a low concentrate allocation (GCL), grass with a low grass silage allocation (GSL), grass with a high concentrate allocation (GCH), and grass with a high grass silage allocation (GSH)] to measure the effects of using baled grass silage or concentrate as supplements to grazed grass. Effects on intake, milk yield, milk composition and N fractions, and N utilization efficiency were measured. Treatments HG and LG received 17 and 14kg of dry matter (DM) grass/cow per d, respectively. Treatments GCL and GSL were offered 14kg of DM grass/cow per d and 3kg of DM of supplementation/cow per d. Treatments GCH and GSH were offered 11kg of DM grass/cow per d and 6kg of DM of supplementation/cow per d. Milk yield was greatest in the GCH treatment and milk solids yield was greatest in both concentrate-supplemented treatments. The HG and LG treatments excreted a greater quantity of N as a proportion of N intake than the supplemented treatments. The HG treatment also excreted the greatest total quantity of N. This indicates an improvement in N utilization efficiency when supplementation is offered compared with grazing only. Offering 6kg of DM of either grass silage or concentrate as supplementation decreased milk true protein concentration compared with offering a grass-only diet. This suggests that increasing the proportion of supplementation relative to grass may negatively affect milk processability, which is associated with milk true protein concentration.

Effect of feeding colostrum at different volumes and subsequent number of transition milk feeds on the serum immunoglobulin G concentration and health status of dairy calves.

Transfer of sufficient IgG to the newborn calf via colostrum is vital to provide it with adequate immunological protection and resistance to disease. The objectives of the present study were to compare serum IgG concentration and health parameters of calves (1) fed different volumes of colostrum [7, 8.5, or 10% of body weight (BW)] within 2h of birth and (2) given 0, 2, or 4 subsequent feedings of transition milk (i.e., milkings 2 to 6 postcalving). Ninety-nine dairy calves were fed 7, 8.5, or 10% of BW in colostrum within 2h of birth and given 0, 2, or 4 subsequent feedings of transition milk. The concentration of IgG in the serum of calves was measured at 24, 48, 72, and 642 h of age by an ELISA. The apparent efficiency of absorption for IgG was determined. Health scores were assigned to calves twice per week and all episodes of disease were recorded. The effect of experimental treatment on calf serum IgG concentration differed by the age of the calf. Calves fed 8.5% of BW in colostrum had a greater mean serum IgG concentration than calves fed 7 or 10% of BW at 24, 48, and 72 h of age. At 642 h of age, serum IgG concentrations of calves fed 8.5% of BW (24.2g/L) and calves fed 10% of BW (21.6g/L) did not differ, although the serum IgG concentration of calves fed 8.5% of BW was still greater than that of calves fed 7% of BW (20.7 g/L). No difference in serum IgG concentration existed between calves fed 7% of BW and those fed 10% of BW at any age. No significant effect of number of subsequent feedings of transition milk on calf serum IgG concentration was detected. The apparent efficiency of absorption of calves fed 8.5% of BW in colostrum (38%) was greater than calves fed 7% of BW in colostrum (26%) and tended to be greater than in calves fed 10% of BW (29%). Calves fed further feedings of transition milk after the initial feeding of colostrum had a lower odds (0.62; 95% confidence interval: 0.41 to 0.93) of being assigned a worse eye/ear score (i.e., a more copious ocular discharge or pronounced ear droop) and a lower odds (0.5; 95% confidence interval: 0.32 to 0.79) of being assigned a worse nasal score (i.e., a more copious and purulent nasal discharge) during the study period relative to calves that received no further feedings of transition milk. In conclusion, calves fed 8.5% of BW in colostrum within 2h of birth achieved a greater concentration of IgG in serum in the first 3 d of life than calves fed either 7 or 10% of BW. Feeding calves transition milk subsequently reduced their odds of being assigned a worse eye/ear and nasal score.

Does iodine supplementation of the prepartum dairy cow diet affect serum immunoglobulin G concentration, iodine, and health status of the calf?

Absorption of adequate IgG from colostrum is critical to provide the newborn calf with adequate immunological protection and resistance to disease. Excessive iodine supplementation of the prepartum ewe reduces IgG absorption of her offspring; it is possible that excessive iodine supplementation of the prepartum dairy cow may similarly impair the ability of the calf to acquire immunological protection. The objectives of this study were to determine whether the iodine status, health status, and ability of calves to absorb IgG from colostrum were affected by prepartum iodine supplementation strategies of their dams. Dairy cows (n=127) received one of the following levels of iodine supplementation precalving: 15mg of iodine/kg of dietary dry matter (DM) (HI); no additional iodine supplementation (MI); 5mg/kg of dietary DM (SI); and 15mg of iodine/kg of DM for the first 3.5wk of the precalving period and no additional supplementation for the second 3.5wk (HMI). Calves were assigned to 1 of 6 experimental treatments, based on the prepartum iodine supplementation treatment of their dam and the precalving treatment group of the cows from which the colostrum fed was obtained: (1) HI_HI: born to HI dams, fed HI colostrum (i.e., colostrum produced by cows in the HI group); (2) MI_MI: born to MI dams, fed MI colostrum; (3) SI_SI: born to SI dams, fed SI colostrum; (4) HI_MI: born to HI dams, fed MI colostrum; (5) MI_HI: born to MI dams, fed HI colostrum; and (6) HMI_HMI: born to HMI dams, fed HMI colostrum. Concentration of calf serum IgG and plasma inorganic iodine (PII) was measured at 0 and 24h of age. Apparent efficiency of absorption for IgG was determined. Health scores were assigned to calves twice weekly and all episodes of disease were recorded. Cow experimental treatment group affected calf PII at 0h of age; the PII of calves born to HI dams (987.2µg/L) was greater than that of calves born to MI dams (510.1µg/L), SI (585.2µg/L), and HMI dams (692.9µg/L). Calf experimental treatment group affected calf PII at 24h of age; the PII of HI_HI (1,259.2µg/L) and HI_MI (1,177.8µg/L) calves was greater than MI_MI (240.7µg/L), SI_SI (302.2µg/L), HMI_HMI (320.7µg/L), and MI_HI (216.3µg/L) calves. No effect of experimental treatment was observed on the concentration of IgG measured in calf serum at 24h of age, or on apparent efficiency of absorption. Experimental treatment had no effect on the likelihood of a calf being assigned a worse nasal, eye and ear, cough, or fecal score within the study period, nor did it affect the probability of a calf receiving treatment for a disease a greater number of times. Prepartum iodine supplementation of cows at 15mg/kg of DM increased the iodine levels in their calves at birth and 24h of age, but did not affect their ability to absorb IgG from colostrum. Supplementation with iodine above the minimum requirements established by the National Research Council was unnecessary to ensure appropriate iodine levels in calves at birth.

Chondrogenic differentiation of human bone marrow-derived mesenchymal stem cells in a simulated osteochondral environment is hydrogel dependent.

Hydrogels pose interesting features for cartilage regeneration strategies, such as the option for injectability and in situ gelation resulting in optimal filling of defects. We aimed to study different hydrogels for their capability to support chondrogenesis of human bone marrow-derived mesenchymal stem cells (hBMSCs). hBMSCs were encapsulated in alginate, alginate with hyaluronic acid (alginate/HA), fibrin or thermoresponsive HA grafted with poly(N-isopropyl acrylamide) side-chains (HA-pNIPAM). Glycosaminoglycan production and cartilage-related gene expression were significantly higher in hBMSC-alginate and hBMSC-fibrin constructs than in the other constructs. Supplementation of alginate with HA was not beneficial. hBMSC-alginate, hBMSC-fibrin and hBMSC-HA-pNIPAM constructs were placed in simulated defects in osteochondral biopsies and cultured in vitro for 28 d. Biopsies containing hBMSC-alginate and hBMSC-fibrin were implanted subcutaneously in nude mice for 12 weeks. hBMSC-alginate constructs had significantly higher cartilage-related gene expression after 28 d of culture as well as significantly more safranin-O positive repair tissue after 12 weeks in vivo than hBMSC-fibrin constructs. Although initial experiments with hBMSC-hydrogel constructs suggested comparable results of hBMSC-alginate, hBMSC-fibrin and hBMSC-HA-pNIPAM constructs, culture in the osteochondral biopsy model in vitro as well as in vivo revealed differences, suggests that chondrogenesis of hBMSCs in an osteochondral environment is hydrogel-dependent.

Evaluation of the activated partial thromboplastin time assay for clinical monitoring of PEGylated recombinant factor VIII (BAY 94-9027) for haemophilia A.

Patients with haemophilia (PWH) are usually monitored by the one-stage activated partial thromboplastin time (aPTT) factor VIII (FVIII) assay. Different aPTT activators may affect clotting time (CT) and FVIII:C levels in patients treated with PEGylated FVIII. To evaluate the characteristics of PEGylated FVIII (BAY 94-9027) in various aPTT clotting assays, and to identify suitable aPTT reagents for monitoring BAY 94-9027 during the treatment of PWH, BAY 94-9027 and World Health Organization (WHO) 8th FVIII standards (WHO-8) were spiked into pooled and individual severe haemophilia A plasma at 1.0, 0.25 and 0.05 IU mL(-1) . Five commercial aPTT reagents widely used in clinical laboratories were compared and evaluated for BAY 94-9027 activity in plasma from PWH. BAY 94-9027 and WHO-8 bestowed similar CT and excellent precision when ellagic acid (SynthAFax, Dade Actin, and Cephascreen) aPTT reagents were used. In contrast, BAY 94-9027 showed significantly prolonged CT and poor precision compared with WHO-8 using silica aPTT reagents (APTT-SP and STA PTT 5). Furthermore, free 60-kDa polyethylene glycol (PEG), used for the conjugation of FVIII, showed a dose-dependent prolongation of CT in the APTT-SP assay. There was no effect on the SynthAFax-APTT, prothrombin time, or FXIa-initiated thrombin generation assay, demonstrating that the PEG moiety on FVIII has no general effect on the coagulation cascade. In summary, ellagic aPTT reagents (SynthAFax, Dade Actin, and Cephascreen) are most suitable for evaluating potency of BAY 94-9027 and should be the preferred aPTT reagents used in clinical laboratories for monitoring FVIII activity after infusion of BAY 94-9027 to PWH.

Factors associated with the concentration of immunoglobulin G in the colostrum of dairy cows.

Transfer of sufficient immunoglobulin G (IgG) to the neonatal calf via colostrum is vital to provide the calf with immunological protection and resistance against disease. The objective of the present study was to determine the factors associated with both colostral IgG concentration and colostral weight in Irish dairy cows. Fresh colostrum samples were collected from 704 dairy cows of varying breed and parity from four Irish research farms between January and December 2011; colostral weight was recorded and the IgG concentration was determined using an ELISA method. The mean IgG concentration in the colostrum was 112 g/l (s.d. = 51 g/l) and ranged from 13 to 256 g/l. In total, 96% of the samples in this study contained >50 g/l IgG, which is considered to be indicative of high-quality colostrum. Mean colostral weight was 6.7 kg (s.d. = 3.6 kg) with a range of 0.1 to 24 kg. Factors associated with both colostral IgG concentration and colostral weight were determined using a fixed effects multiple regression model. Parity, time interval from calving to next milking, month of calving, colostral weight and herd were all independently associated with IgG concentration. IgG concentration decreased (P < 0.01) by 1.7 (s.e. = 0.6) g/l per kg increase in the colostral weight. Older parity cows, cows that had a shorter time interval from calving to milking, and cows that calved earlier in spring or in the autumn produced colostrum with higher IgG concentration. Parity (P < 0.001), time interval from calving to milking (P < 0.01), weight of the calf at birth (P < 0.05), colostral IgG concentration (P < 0.01) and herd were all independently associated with colostral weight at the first milking. Younger parity cows, cows milked earlier post-calving, and cows with lighter calves produced less colostrum. In general, colostrum quality of cows in this study was higher than in many previous studies; possible reasons include use of a relatively low-yielding cow type that produces low weight of colostrum, short calving to colostrum collection interval and grass-based nutritional management. The results of this study indicate that colostral IgG concentration can be maximised by reducing the time interval between calving and collection of colostrum.

Relative quantitative proteomic analysis reveals wound response proteins correlated with after-cooking darkening.

Many common potato tuber defects are difficult to elucidate because of the degree of genetic complexity involved, making systems biology approaches necessary. Interaction between chlorogenic acid and iron is responsible for the darkening of potato tuber tissues upon heating--termed after-cooking darkening (ACD). To explore mechanisms of darkening severity in tuber tissues, we have employed relative quantitative proteomics to discover differentially expressed proteins involved in ACD. Tuber tissue samples were collected from a family of diploid clones which possess a highly segregated degree of the darkening. Exploiting this segregation, as well as the observation that darkening is more prevalent in the stem end of the tuber than the apical end, three sample groups were formed: (i) stem ends of three high-ACD clones, (ii) stem ends of three low-ACD clones, and (iii) apical ends of three low-ACD clones. Protein samples were digested and differentially labeled using isotopic reductive methylation, allowing for an orthogonal two-way comparison of protein profiles of the sample groups using 2-D-LC-MS/MS. Using a cutoff fold change of 2 between the high- and the low-ACD sample groups, 30 proteins showed a correlation with tissue darkening. Overall, we observed changes in relative protein abundance that showed an enhanced wound-response program in high-ACD tissues. Among these proteins, five proteins were further validated at the transcript level using qRT-PCR. These proteins may be incorporated into design strategies to create potato cultivars with low levels of ACD.

Impact of a novel nutritional formula on asthma control and biomarkers of allergic airway inflammation in children.

BACKGROUND: A novel nutritional formula (NNF) enriched in eicosapentaenoic (EPA) and gamma-linolenic fatty acids and antioxidants reduces airway inflammation and improves clinical outcomes in critically ill patients, but NNF has not been evaluated in chronic inflammatory diseases such as persistent asthma. OBJECTIVE: To evaluate the efficacy, compliance, and safety of NNF in asthmatic children. METHODS: Children, 6-14 years of age, with mild to moderate persistent asthma, on as needed albuterol alone, were randomized to receive daily NNF (n=23) or control formula (n=20) for 12 weeks, with multiple assessments of asthma control, spirometry, measures of airway inflammation, formula tolerance, and adverse events. RESULTS: Daily consumption of either NNF or a control formula showed improvement in asthma-free days over time (P=0.04) but there was no difference between groups. However, the NNF group had lower exhaled nitric oxide levels compared with the control group at weeks 4, 8, and 12 (P<0.05). An overall group difference in log FEV1 PC20 (P=0.05) was found in favour of the NNF group as well. Significantly higher levels of EPA in plasma (P<0.01) and peripheral blood mononuclear cell (PBMC) (P<0.01) phospholipids in the NNF group compared with control group within 2 weeks indicated good adherence with daily NNF intake. There were no differences in adverse events for NNF vs. control after 12 weeks. CONCLUSIONS: Both NNF and control groups demonstrated improvement in asthma-free days. NNF-treated group had reduced biomarkers of disease activity. Rapid PBMC fatty acid composition changes reflected an anti-inflammatory profile. Dietary supplementation with NNF was safe and well tolerated (ClinicalTrials.gov number NCT01087710).

Neonatal jaundice--are we over-treating?

Hyperbilirubinaemia is the most common condition requiring evaluation and treatment in newborns. A study in the NEJM 2006 suggested that current guidelines for the treatment of hyperbilirubinaemia in otherwise healthy infants should be relaxed. Prompted by this we performed a retrospective review of review of all term infants who received phototherapy between 1998 and 2006 (total number births = 56,894) in the National Maternity Hospital, Holles Street. 1441 infants received phototherapy during this time period (2.5%). Of those that were of term gestation (n=539), only 9% of those infants receiving phototherapy had peak total serum bilirubin (TSB) exceeding 400 umol. Twenty six percent of infants who received phototherapy had a peak TSB that never exceeded 250 umol/l. There were no cases of kernicterus. Review of the Coombs status revealed that 27% of those undergoing phototherapy in the lowest TSB range were Coombs positive. Seven Coombs positive infants had peak TSB >400 umol/l (14%). Four Coombs positive infants received exchange transfusions. Following this study we would concur with the opinion of Newman et al that current guidelines for the treatment of hyperbilirubinaemia in otherwise healthy infants could be relaxed.

The effect of herbage allowance and concentrate supplementation on milk production performance and dry matter intake of spring-calving dairy cows in early lactation.

The objective of this study was to determine the effect of daily herbage allowance (DHA) and concentrate level on milk production and dry matter intake of spring-calving dairy cows in early lactation. Seventy-two Holstein-Friesian dairy cows (mean calving date February 2) were randomly assigned across 6 treatments (n = 12) in a 2 x 3 factorial arrangement. The 6 treatments consisted of 2 DHA ( > 4 cm) and 3 concentrate levels: 13 kg of herbage dry matter/cow per d (low) or 17 kg of herbage dry matter/cow per d (high) DHA and unsupplemented, 3 kg, or 6 kg of dry matter concentrate/cow per d. The experimental period (period I) lasted 77 d and was followed by a carryover period (period II) during which animals were randomly reassigned across 2 grazing treatments offering 17 or 21 kg of herbage dry matter/cow per d. Increasing DHA significantly increased milk (+1.85 kg), solids-corrected milk, protein (+79.5 g), and lactose yields, protein concentration, and mean body weight (BW). Mean body condition score (BCS) and end-point BCS were also significantly higher with the high-DHA treatments. There was a linear response in milk yield, milk lactose concentration, and solids-corrected milk to concentrate supplementation. There was a significant difference in mean BW as concentrate increased from 0 to 3 kg (506 and 524 kg, respectively); there was no further increase in BW when 6 kg of concentrate was offered. Cows offered the low DHA had significantly lower grass dry matter intake (13.3 kg) and total dry matter intake (16.3 kg) than the high-DHA cows during period I. Concentrate supplementation significantly increased total dry matter intake. During period II, previous DHA continued to have a significant carryover effect on milk protein concentration, BW change, mean BCS, and end-point BCS. Concentrate supplementation during period I continued to have a significant carryover effect in period II on milk yield; milk fat, protein, and lactose yields; solids-corrected milk yield; BW; and mean BCS. Results from this study indicate that offering a medium level of DHA (17 kg of herbage dry matter) in early lactation will increase milk production. Offering concentrate will result in a linear increase in milk production. In an early spring feed-budgeting scenario, when grass supply is in deficit, offering 3 kg of dry matter concentrate with 17 kg of DHA has the additive effect of maintaining the grazing rotation at the target length as well as ensuring the herd is adequately fed.