Effects of particle size and phytase supplementation on apparent and standardized total tract digestibility of phosphorus in hybrid rye fed to growing pigs.

An experiment was conducted to investigate the effects of particle size (PS) and levels of phytase supplementation on the apparent (ATTD) and standardized (STTD) total tract digestibility of P in hybrid rye fed to growing pigs. Thirty-six growing barrows (23.6 ± 1.5 kg initial BW) were individually housed in metabolism crates and randomly allotted to one of six dietary treatments to give six replicates per treatment. The six dietary treatments were arranged in a 2 × 3 factorial with main effects of PS and phytase supplementation levels (0, 500, or 2,500 FTU/kg). Hybrid rye was ground using a hammermill mounted with 4.0- and 3.2-mm screens to obtain material with coarse and fine PS, respectively. Pigs were fed experimental diets for 11 d, including 5 d for adaptation and 6 d for total collection of feces. All data were analyzed using the MIXED procedure of SAS with PS, phytase, and their interaction as fixed effects. Orthogonal polynomial contrasts were used to test linear and quadratic effects of phytase level in both coarse and fine hybrid rye diets. The ATTD and STTD of P were greater (P < 0.05) in diets with fine than in those with coarse hybrid rye. Increasing levels of phytase supplementation linearly (P < 0.01) and quadratically (P < 0.01) improved the ATTD and STTD of P in hybrid rye diets. There were no interaction effects between PS and phytase supplementation on the ATTD and STTD of P in hybrid rye diets. In conclusion, PS reduction improved the digestibility of P in hybrid rye, and supplementing increasing levels of phytase improved P digestibility in linear and quadratic manner in growing pigs fed hybrid rye diets.

Cereal grains such as corn, wheat, and barley are widely used as an energy source in swine diets. However, due to their recent soaring prices, it is necessary to use alternative feedstuffs for swine. New commercial hybrid rye with improved ergot resistance and higher yield has been developed. This hybrid rye contains similar energy content as barley and sorghum, making it a promising ingredient for pigs. Phosphorus is an essential nutrient in swine diets for bone growth and cellular functions. However, most phosphorus in hybrid rye is bound to phytic acid, which is not digested well by pigs. The excessive phosphorus in swine manure may runoff and cause environmental problems such as eutrophication. Increasing phosphorus digestibility can decrease its excretion in pigs. Therefore, in the current study, we formulated six diets including fine or coarse hybrid rye particle size supplemented with three levels of phytase to determine the effects of particle size and phytase supplementation on phosphorus digestibility in hybrid rye. Our results showed that fine particle size and supplementing increasing levels of phytase could improve the phosphorus digestibility in growing pigs fed hybrid rye diets.

Examination of the interaction between method of anesthesia and shunting with carotid endarterectomy.

BACKGROUND: Although the choice of anesthesia during carotid endarterectomy (CEA) does not seem to increase the risk of perioperative stroke, it might affect the outcomes of shunting during CEA. This study aims to evaluate whether the choice of anesthesia modifies the association between shunting and in-hospital stroke/death after CEA. METHODS: We retrospective reviewed all CEA cases performed between 2003 and 2017 in the Vascular Quality Initiative. Patients were divided into three groups: (1) no shunting during CEA (n = 29,227 [48.4%]), (2) routine shunting (n = 28,673 [47.5%]), and (3) selective shunting based on an intraoperative indication (n = 2499 [4.1%]). Multivariable logistic regression analysis was used to study the interaction between anesthesia (local anesthesia [LA]/regional anesthesia [RA] vs general anesthesia [GA]) and intraoperative shunting (no shunting vs routine and selective shunting) during CEA in predicting the risk of in-hospital stroke/death after CEA. RESULTS: The final cohort included 60,399 patients. The majority of CEA cases (90.2%) were performed under GA. Of the study cohort, 29,227 (48.4%) underwent CEA without shunting, 28,673 patients (47.5%) had routine shunting, and the remaining (n = 2499 [4.1%]) were selectively shunted. The interaction between intraoperative shunting and anesthesia in predicting in-hospital stroke/death was statistically significant (P < .05). When CEA is performed under LA/GA, routine shunting was associated with 3.5 times the adjusted odds of in-hospital stroke/death after CEA (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.8-6.8; P < .001) compared with no shunting, whereas selective shunting was associated with 7.1 the odds (OR, 7.1; 95% CI, 3.5-14.7; P < .001). In contrast, under GA, there was no significant association between routine shunting and in-hospital stroke/death (OR, 1.2; 95% CI, 1.0-1.5; P = .12), whereas selective shunting was associated with 1.7 times the odds (OR, 1.7; 95% CI, 1.2-2.4; P < .01) compared with not performing shunting during CEA. CONCLUSIONS: The use of LA/RA is associated with increased odds of stroke/death compared with GA when intraoperative shunting is performed. The effect of anesthesia is more pronounced in patients who develop clamp-related ischemia and undergo selective shunting. More controlled studies are needed to explain these findings and validate them.

Nutrient digestibility of multi-enzyme supplemented low-energy and AA diets for grower pigs1.

A study was conducted to determine effects of supplementing multi-enzyme on apparent ileal digestibility (AID) of energy and AA; and apparent total tract digestibility (ATTD) of energy for pigs fed low-energy and AA diets. Eight ileal-cannulated barrows (initial BW: 38.7 ± 2.75 kg) were fed four diets in a replicated 4 × 4 Latin square design to give 8 replicates per diet. Diets were positive control (PC) diet, negative control (NC) diet without or with multi-enzyme at 0.5 or 1.0 g/kg. The PC diet was formulated to meet or exceed NRC (2012) nutrient recommendations for grower pigs (25 to 50 kg), except for Ca and digestible P, which were lower than NRC (2012) recommendations by 0.13 and 0.17 percentage points, respectively, due to phytase supplementation at 1,000 FTU/kg. The NC diet was formulated to be lower in NE by 75 kcal/kg and standardized ileal digestible AA content by a mean of 3%. These reductions were achieved by partial replacement of corn and soybean meal (SBM) and complete replacement of soybean oil and monocalcium phosphate in PC diet with 25% corn distillers dried grains with solubles (DDGS) and 3.6% soybean hulls. Multi-enzyme at 1.0 g/kg supplied 1,900 U of xylanase, 300 U of ß-glucanase, 1,300 U of cellulase, 11,500 U of amylase, 120 U of mannanase, 850 U of pectinase, 6,000 U of protease, and 700 U of invertase per kilogram of diet. The AID of GE, N, most AA, most component sugars of nonstarch polysaccharides (NSP) and P; ATTD of GE for PC diet was greater (P < 0.05) than those for NC diets. An increase in dietary level of multi-enzyme from 0 to 1.0 g/kg resulted in a linear increase (P < 0.05) in AID of Ile by 4.3%, and tended to linearly increase (P < 0.10) AID of Leu, Met, Phe, and Val by a mean of 3.4%. Increasing dietary multi-enzyme from 0 to 1.0 g/kg linearly increased (P < 0.05) AID of total NSP and P by 53.7% and 19.2%, respectively; ATTD of GE by 8.4% and DE and NE values by 8.8% and 8.2%, respectively; tended to linearly increase (P < 0.10) AID of GE by 8.1%. The NE values for NC diet with multi-enzyme at 1.0 g/kg tended to be greater (P < 0.10) than that for PC diet (2,337 vs. 2,222 kcal/kg of DM). In conclusion, multi-enzyme supplementation improved energy and nutrient digestibilities of a corn-SBM-corn DDGS-based diet, implying that the multi-enzyme fed in the current study can be used to enhance energy and nutrient utilization of low-energy AA diets for grower pigs.

Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: a randomized controlled clinical trial.

OBJECTIVE: The aim of this study was to investigate the potential of mindfulness-based stress reduction (MBSR) as a treatment for chronic primary insomnia. DESIGN: A randomized controlled trial was conducted. SETTING: The study was conducted at a university health center. PATIENTS: Thirty adults with primary chronic insomnia based on criteria of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision, 4th Edition were randomized 2:1 to MBSR or pharmacotherapy (PCT). INTERVENTIONS: Mindfulness-based stress reduction, a program of mindfulness meditation training consisting of eight weekly 2.5 hour classes and a daylong retreat, was provided, with ongoing home meditation practice expectations during three-month follow-up; PCT, consisting of three milligrams of eszopiclone (LUNESTA) nightly for eight weeks, followed by three months of use as needed. A 10-minute sleep hygiene presentation was included in both interventions. MAIN OUTCOMES: The Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), sleep diaries, and wrist actigraphy were collected pretreatment, posttreatment (eight weeks), and at five months (self-reports only). RESULTS: Between baseline and eight weeks, sleep onset latency (SOL) measured by actigraphy decreased 8.9 minutes in the MBSR arm (P < .05). Large, significant improvements were found on the ISI, PSQI, and diary-measured total sleep time, SOL, and sleep efficiency (P < .01, all) from baseline to five-month follow-up in the MBSR arm. Changes of comparable magnitude were found in the PCT arm. Twenty-seven of 30 patients completed their assigned treatment. This study provides initial evidence for the efficacy of MBSR as a viable treatment for chronic insomnia as measured by sleep diary, actigraphy, well-validated sleep scales, and measures of remission and clinical recovery.

Determining the relationship of heart rate and blood pressure using voluntary cardio-respiratory synchronization (VCRS).

Voluntary cardio-respiratory synchronization (VCRS) was used to investigate heart rate and blood pressure changes in the supine position in 21 subjects. VCRS involves a breathing pattern that is synchronized with the cardiac cycle. The signals to inhale and exhale are derived from the ECG. In this study, the subjects inspired for four heart beats and expired for four heart beats for 35 cycles. This technique is designed to have the heart beat occur at exactly the same phase in the respiratory cycle and lends itself to the study of the influence of the respiration cycle on heart rate and blood pressure changes. The heart rate and blood pressure changed simultaneously in the same direction, with the largest significant positive change occurring on the second heart beat during inspiration. The authors discuss the potential of VCRS for research, and clinical applications as a respiration modulator for hypertension therapy or increased heart rate variability.

Feasibility and effects of transcutaneous phrenic nerve stimulation combined with an inspiratory impedance threshold in a pig model of hemorrhagic shock.

OBJECTIVE: Intrathoracic pressure changes are of particular importance under hypovolemic conditions, especially when central venous blood pressure is critically low. Accordingly, the purpose of this study was to assess the feasibility of transcutaneous phrenic nerve stimulation, used in conjunction with an inspiratory impedance threshold, on hemodynamic variables during hemorrhagic shock. DESIGN: Prospective, randomized laboratory investigation using a porcine model for measurement of hemodynamic variables, left and right ventricular diameter, and transmitral, transpulmonary, and transaortic blood flow employing transesophageal echo-Doppler technique. SETTING: University hospital laboratory. SUBJECTS: Thirteen female pigs weighing 28-36 kg. INTERVENTIONS: The anesthetized pigs were subjected to profound hemorrhagic shock by withdrawal of 55% of estimated blood volume over 20 mins. After a 10-min recovery period, the diaphragm was stimulated with a prototype transcutaneous phrenic nerve stimulator at a rate of ten per minute while the airway was intermittently occluded with an inspiratory threshold valve between positive pressure ventilations. Hemodynamic variables were monitored for 30 mins. MEASUREMENTS AND MAIN RESULTS: Phrenic nerve stimulation in combination with the inspiratory threshold valve significantly (p <.001) improved right and left ventricular diameter compared with hypovolemic shock values by 34 +/- 2.5% and 20 +/- 2.5%, respectively. Moreover, phrenic nerve stimulation together with the inspiratory threshold valve also increased transaortic, transpulmonary, and transmitral valve blood flow by 48 +/- 6.6%, 67 +/- 13.3, and 43 +/- 8.2%, respectively (p <.001 for comparisons within group). Mean +/- sem coronary perfusion and systolic aortic blood pressures were also significantly (p <.001) higher compared with values before stimulation (30 +/- 2 vs. 20 +/- 2 mm Hg, and 37 +/- 2 vs. 32 +/- 3 mm Hg, respectively). CONCLUSIONS: This feasibility study suggests that phrenic nerve stimulation with the inspiratory threshold valve may improve cardiac preload and, subsequently, key hemodynamic variables in porcine model of severe hemorrhagic shock.