Relationship of body weight at first calving with milk yield and herd life.

The objectives of this study were to investigate the association of body weight (BW) at first calving (BWFC) and maturity rate (MR; BWFC as a percentage of mature BW) with first-lactation 305-d milk yield (FLMY), milk yield (MY) in the 24 mo following first calving (24MMY), herd life, and BW change (BWC) through the first month of lactation in Holstein heifers. We retrieved daily milk production records and daily BW records from AfiFarm (S. A. E. Afikim, Kibbutz Afikim, Israel). The data set included daily records for 1,110 Holstein cows from The Pennsylvania State University (n = 435,002 records) and 1,229 Holstein cows from University of Florida (n = 462,013 records) that calved from 2001 to 2016. Body weight at first calving was defined as mean BW from 5 to 10 d in milk of the first lactation, whereas BWC represented change from BWFC to average BW from 30 to 40 d in milk. First-lactation 305-d MY and 24MMY were analyzed with a linear model that included effects of farm-year-season of calving, age at calving, and quintiles of BWFC, MR, or BWC. Body weight change was analyzed with the same model to determine associations with BWFC. Survival analysis was performed to estimate the effect of BWFC on survival. Heifers in the top 60% of BWFC had significantly higher FLMY (10,041 to 10,084 kg) than lighter heifers (9,683 to 9,917 kg), but there was wide variation in every quintile, and no relationship of BWFC and FLMY existed within the top 60%. Relationships between BWFC and 24MMY were not significant. Heifers with higher BWFC or MR lost significantly more BW in early lactation. Although BWFC and MR were significant predictors of FLMY, they accounted for <3% of variation in FLMY or 24MMY, suggesting that BWFC and MR are not primary contributors to variation in MY. Compared with the lightest heifers, the heaviest heifers were 49% more likely to be culled at a given time. These data indicated that, among heifers managed similarly, heavier heifers produced more milk in first lactation than lighter heifers but lost more BW, faced a higher risk of being culled, and did not produce more milk in the long term. Based on our data, heifers that reach between 73 and 77% MR at first calving can produce more milk in their first lactation without sacrificing long-term MY and herd life.

Retinoic acid metabolites in plasma are higher after intake of liver paste compared with a vitamin A supplement in women.

The objectives of the present study were to compare the bioavailability of vitamin A from liver paste and from a vitamin A supplement at three nutritionally relevant levels of intake, and to estimate levels of "safe" intake based on concentrations of retinoic acid and its metabolites in plasma after a single dose of vitamin A from liver paste. Women (n = 35; 19-47 y of age) consumed 3.0, 7.5 or 15 mg vitamin A as liver paste or as a vitamin A supplement with a test meal in a randomized design, with a combined crossover (two sources) and parallel approach (three dosages). Retinyl esters and retinoic acid (RA) metabolites were quantified in blood samples at 2-24 h after dosing. The areas under the time-response curves (AUC) were calculated to evaluate responses in plasma vitamin A after intake of liver paste and the vitamin A supplements. For retinyl esters, the AUC was significantly affected by the dosage, but not by the source. The formation of 13-cis-RA, 13-cis-4-oxo-RA, and to a lesser extent all-trans-RA was significantly higher after consumption of liver paste compared with the supplement, especially at higher dosages. Long-term baseline concentrations of retinol were not affected by a single intake of vitamin A. In conclusion, the bioavailability of vitamin A from single doses of liver paste and a vitamin A supplement does not differ, but the plasma concentrations of RA metabolites are higher after intake of liver paste. Thus, pregnant women should indeed limit the intake of vitamin A from liver products.

Leukocyte depletion results in improved lung function and reduced inflammatory response after cardiac surgery.

Leukocyte depletion during cardiopulmonary bypass has been demonstrated in animal experiments to improve pulmonary function. Conflicting results have been reported, however, with clinical depletion by arterial line filter of leukocytes at the beginning of cardiopulmonary bypass. In this study, we examined whether leukocyte depletion from the residual heart-lung machine blood at the end of cardiopulmonary bypass would improve lung function and reduce the postoperative inflammatory response. Thirty patients undergoing elective heart operations were randomly allocated to a leukocyte-depletion group or a control group. In the leukocyte-depletion group (n = 20), all residual blood (1.2 to 2.1 L) was filtered by leukocyte-removal filters and reinfused after cardiopulmonary bypass, whereas in the control group an identical amount of residual blood after cardiopulmonary bypass was reinfused without filtration (n = 10). Leukocyte depletion removed more than 97% of leukocytes from the retransfused blood (p < 0.01) and significantly reduced circulating leukocytes (p < 0.05) and granulocytes (p < 0.05) compared with the control group. Levels of the inflammatory mediator thromboxane B2 determined at the end of operation (p < 0.05) were significantly lower in the depletion group than in the control group, whereas no statistical differences in interleukin-6 levels were found between the two groups. After operation, pulmonary gas exchange function (arterial oxygen tension at a fraction of inspired oxygen of 0.4) was significantly higher in the leukocyte-depletion group 1 hour after arrival to the intensive care unit (p < 0.05) and after extubation (p < 0.05). There were no statistical differences between the two groups with respect to postoperative circulating platelet levels and blood loss, and no infections were observed during the whole period of hospitalization. These results suggest that leukocyte depletion of the residual heart-lung machine blood improves postoperative lung gas exchange function and is safe for patients who are expected to have a severe inflammatory response after heart operations.

The development of integrated service networks in Minnesota.

The formation of health insurance purchasing alliances in Minnesota has caused a restructuring of the provider system. One of the results has been the formation of competing delivery systems that organize hospitals, physicians, and insurance plans into vertically and horizontally integrated organizations termed integrated service networks (ISNs). This article describes the formation of these ISNs and identifies some of the salient features that distinguish them from other provider systems.

Efficacy of single-dose azithromycin versus doxycycline in the treatment of cervical infections caused by Chlamydia trachomatis.

The efficacy of single-dose azithromycin therapy in the treatment of cervical Chlamydia trachomatis infections was compared to that of a standard seven-day course of treatment with doxycycline. Cervical samples from 60 patients reacted positively in an enzyme immunoassay for detection of Chlamydia trachomatis. In 31 patients Chlamydia trachomatis was isolated from the sample taken before treatment. Fourteen of the 31 patients were treated with doxycycline and 17 with azithromycin. All cultures of samples taken one and four weeks after the start of therapy were negative. All 31 isolates showed a similar pattern of MICs for the seven antibiotics tested, including azithromycin and doxycycline. No differences were observed between isolates of different serovars. In samples from four patients chlamydial DNA could be detected by PCR one week after the start of the therapy and in two patients also after four weeks. No difference in microbiological parameters could be observed between the two treatment groups. It is concluded that single-dose azithromycin is as effective as a seven-day course of doxycycline in the therapy of cervical Chlamydia trachomatis infections.