Effect of antepartum vitamin D3 (cholecalciferol) and postpartum oral calcium administration on serum total calcium concentration in Holstein cows fed an acidogenic diet in late gestation.

Several strategies are available to control periparturient hypocalcaemia in dairy cows. Three complementary strategies were applied in this study: feeding a low DCAD (acidogenic) ration during late gestation, oral vitamin D3 (cholecalciferol) administration in late gestation, and oral Ca administration immediately after parturition. Multiparous Holstein cows (n = 240) were fed an acidogenic ration in late gestation and randomly assigned to one of three treatment groups. Group A (n = 80) were fed the acidogenic diet without supplementary Ca or cholecalciferol. Group Ca + A (n = 80) received 50 g of Ca as an oral bolus at calving and 12 h later. Group D3 + Ca + A (n = 80) were administered 3 mg of cholecalciferol orally each day starting 3 to 5 days before the anticipated calving date and 50 g of Ca as an oral bolus at calving and 12 h later. Blood and urine samples were obtained periodically from a random subset of 20 cows in each group from day 5 antepartum to day 21 postpartum and selected analytes measured. Data was analyzed using mixed models analysis. Serum Ca concentrations in group D3 + Ca + A were higher 12 h before and at parturition, compared to the two other groups. Oral Ca administration transiently increased mean serum Ca concentrations at 6 h after treatment initiation in groups D3 + Ca + A and Ca + A. We conclude that daily oral administration of 3 mg of cholecalciferol for up to 5 days before calving, combined with feeding an acidogenic ration in late gestation and oral Ca immediately after parturition, provided the highest periparturient serum Ca concentrations.

Predictors of allograft ischemic injury in clinical heart transplantation.

OBJECTIVES: 1. Identify clinical, biochemical and inflammatory predictors of allograft ischemic injury in clinical heart transplantation. 2. Evaluate the impact of high dose insulin (GIK) on allograft metabolism during blood cardioplegia and post-ischemic injury. DESIGN: A clinical, prospective, randomized open trial comprising 25 consecutive heart transplantations at a university hospital. Ischemic injury was evaluated from plasma levels of creatine kinase isoenzyme MB (CK-MB). Blood cardioplegic arterial and coronary sinus concentrations of C3a, IL-6, substrates, amino acids and blood gases were measured at the end of the implantation period, prior to reperfusion. Twelve patients received high dose insulin with glucose, potassium and amino acids. RESULTS: CK-MB increased from 1.9 +/- 0.2 to 161 +/- 13 microg/l (range 47-293 microg/l). The peak level of CK-MB correlated with donor age (r = 0.48, p = 0.02) and implantation time (r = 0.53, p = 0.02); and with recipient plasma IL-6 (r = 0.56, p = 0.02), allograft oxygen extraction (r = 0.56, p = 0.02), lactate release (r = 0.47, p = 0.02) and allograft arterial-coronary sinus (cs) pH (r = 0.47, p = 0.02) all during final cardioplegia before reperfusion. Seventy-two percent of the variance of CK-MB was explained by a model which included donor age, art-cs pH difference and arterial IL-6. In contrast, CK-MB was unrelated to total ischemic time (r = -0.17, p = 0.38). Insulin infusion had no effect on myocardial substrates during cardioplegia, or on post-ischemic CK-MB. CONCLUSION: Donor age, duration and quality of the implantation period are significant predictors of allograft ischemic injury in heart transplantation. High dose insulin had no detectable effects on allograft metabolism during cardioplegia, or on subsequent ischemic injury.