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Enteric methane (CH4) emissions of 3 genetic groups (GG) of dairy cows were recorded across the grazing season (early March to late October). The 3 GG were (1) high economic breeding index (EBI) Holstein-Friesian (HF) representative of the top 1% of dairy cows in Ireland at the time of the study (elite), (2) national average (NA) EBI, which were representative of the average HF dairy cow in Ireland, and (3) purebred Jersey (JE) cows. Enteric CH4 was recorded using GreenFeed technology. Seasonal variation in CH4 was observed, with the lowest daily CH4 emissions and CH4 expressed per unit of dry matter intake occurring in spring (253 g/d and 15.56 g/kg, respectively), intermediate in summer (303 g/d and 18.26 g/kg, respectively), and greatest in autumn (324 g/d and 19.80 g/kg, respectively). Seasonal variation was also observed in the proportion of gross energy intake converted to CH4 (Ym); in the spring the Ym was lowest at 0.046, increasing to 0.053 and 0.058 in the summer and autumn, respectively. There was no difference in daily CH4 between the elite and NA, whereas JE had lower CH4 emissions compared with the elite. When expressed per unit of milk solids (fat + protein yield; MS), the elite and JE produced 6.8% and 9.7% less CH4 per kilogram of MS, respectively, compared with NA. There was no difference between the GG for CH4 per unit of DMI or the Ym. This research emphasizes the variation in CH4 emissions across the grazing season and among cows of differing genetic merit for CH4 emission intensities but not for CH4 per unit of DMI or the Ym.
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Lactancia , Leche , Femenino , Bovinos , Animales , Leche/metabolismo , Lactancia/genética , Dieta/veterinaria , Metano/metabolismo , Ingestión de EnergíaRESUMEN
The United Nations Sustainable Development Goals aim to double the productivity of small-medium food producers (2015-2030), while food demand is estimated to increase by 60 % by 2050. The objectives of this paper were to identify and quantify the relationship between energy efficiency and milking efficiency, identify the main energy consuming processes associated with milking, and investigate whether milking efficiency, energy efficiency or the relationship between them varies depending on parlour type. Energy and milking efficiency data from 26 pasture-based dairy farms in the Republic of Ireland were analysed (17 herringbone, nine rotary). Energy consumption was monitored continuously on the herringbone farms and for two distinct, seven-day periods (observation periods 1 and 2) for the rotary farms. Milking performance was monitored for all 26 farms during these periods. During the observation periods, the rotary farms achieved superior energy efficiency (29.85 Wh kgMilk-1) and milking efficiency (152 cows/hour) than the herringbone farms (32.83 Wh kgMilk-1, 97 cows/hour). Moderate correlations existed between milking efficiency (cows/hour) and energy efficiency (Wh kgMilk-1) for rotary (r = -0.58, R2 = 0.34) and herringbone (r = -0.44, R2 = 0.19). These results indicated that higher levels of milking efficiency were moderately correlated with improved energy efficiency.
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The objective of this study was to characterize the species composition and functional potential of the vaginal and uterine microbiota at 1 wk postpartum in dairy cows diagnosed with or without purulent vaginal discharge (PVD) at 3 wk postpartum. The hypothesis was that differences in the vaginal and uterine microbiota between cows diagnosed with (PVD+) or without (PVD-) PVD were dependent on parity and breed. Cytobrush samples of the vagina and uterus were collected at 1 wk postpartum from 36 Holstein-Friesian (7 primiparous and 29 multiparous) and 29 Jersey (10 primiparous and 19 multiparous) cows. Microbial DNA was isolated from each sample and processed for shotgun metagenomic sequencing. The odds of multiparous cows being diagnosed as PVD+ was less compared with primiparous cows (OR = 0.21). Neither the α-diversity nor ß-diversity of the uterine and vaginal microbiota were associated with PVD but the ß-diversity was different between breeds and between parities. In the vagina of primiparous cows, differences in the microbiota of PVD- and PVD+ cows were minor, but the microbiota of multiparous PVD+ cows had greater relative abundance of Fusobacterium necrophorum, Trueperella pyogenes, Porphyromonas levii, and greater functional potential for amino acid and protein synthesis, energy metabolism, and growth compared with PVD- cows. The uterus of primiparous PVD+ cows had lesser relative abundance of Bacteroides heparinolyticus compared with PVD- cows. In the uterine microbiota, differences included greater functional potential for cellulose biosynthesis and fucose catabolism in multiparous PVD+ cows compared with PVD- cows. In the uterine microbiota of primiparous PVD+ cows, the functional potential for gram-negative cell wall synthesis and for negative regulation of tumor necrosis factor signaling was lesser compared with multiparous PVD+ cows. In the vagina of Holstein-Friesian PVD+ cows, the relative abundance of Caviibacter abscessus was greater whereas in the vagina of Jersey PVD+ cows the relative abundance of Catenibacterium mitsuokai, Finegoldia magna, Klebsiella variicola, and Streptococcus anginosus was greater compared with PVD- cows. In the uterine microbiota of Holstein-Friesian cows, the functional potential for spermidine biosynthesis was reduced compared with PVD- cows. In summary, differences in the species composition and functional potential of the vaginal and uterine microbiota between PVD- and PVD+ cows were dependent on parity and breed. The findings suggest that alternative strategies may be required to treat PVD for different parities and breeds of dairy cow.
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INTRODUCTION: Measures of mood and effective coping strategies have notable correlations with quality of life and treatment responses. There is evidence that patients with previously diagnosed anxiety disorders have less improvement in patient-reported outcome measures (PROMs) after laparoscopic anti-reflux surgery (LARS) and that objective pathology does not correlate well with symptom severity. We were interested in investigating whether anxiety and hypervigilance, as measured preoperatively with the esophageal hypervigilance anxiety scale (EHAS), is associated with the improvement in GERD-specific PROMs and EHAS scores 6 months after LARS. METHODS: We performed a retrospective cohort study of 102 adult patients (31% men, average age 64) who underwent LARS. In the preoperative evaluation, baseline gastroesophageal reflux disease-health-related quality of life (GERD-HRQL), laryngopharyngeal reflux symptom index (LPR-RSI) and EHAS scores were collected in addition to the standard reflux workup, including endoscopy, manometry, barium swallow, and pH study. For all three surveys, a higher score represents worse symptom severity. At 6 months postoperatively, 70 patients completed repeat GERD-HRQL, LPR-RSI, and EHAS surveys. We then analyzed for surgical and patient-related factors associated with improvement in the 6-month postoperative GERD-HRQL and LPR-RSI scores. RESULTS: There was a statistically significant decrease in the GERD-HRQL (25 vs. 2, p < 0.001), LPR-RSI (17 vs. 3, p < 0.001) and EHAS (34 vs. 15, p < 0.001) 6 months after LARS. On multivariable linear regression, a higher baseline EHAS score was independently associated with a greater improvement in GERD-HRQL (ß 0.35, p < 0.001) and LPR-RSI (ß 0.19, p = 0.03) 6-months after LARS. Additionally, the degree of improvement in EHAS, GERD-HRQL, and LPR-RSI was not influenced by the type of LARS performed or by the severity of disease. CONCLUSION: These findings are consistent with literature suggesting that measures of psychoemotional health correlate better with symptom intensity than objective pathology. We found that patients with a higher EHAS score have greater symptom severity and lower quality of life at baseline. Novel findings to this study are that patients with a higher preoperative EHAS, a measure of psychoemotional health, actually benefitted more from surgery and not less, which has been the traditional view in the literature. Future studies are warranted to establish directionality and explore the role of preoperative cognitive behavioral therapy with LARS for patients with significant symptoms of hypervigilance and anxiety.
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Laparoscopía , Reflujo Laringofaríngeo , Adulto , Ansiedad/diagnóstico , Ansiedad/etiología , Bario , Femenino , Humanos , Reflujo Laringofaríngeo/diagnóstico , Masculino , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Greenhouse gas (GHG) emissions and nitrogen (N) efficiencies were modeled for 2 genetic groups (GG) of Holstein-Friesian cows across 3 contrasting feeding treatments (FT). The 2 GG were (1) high economic breeding index (EBI) animals representative of the top 5% of cows nationally (elite) and (2) EBI representative of the national average (NA). The FT represented (1) generous feeding of pasture, (2) a slight restriction in pasture allowance, and (3) a high-concentrate feeding system with adequate pasture allowance. Greenhouse gas and N balance models were parameterized using outputs generated from the Moorepark Dairy Systems model, a stochastic budgetary simulation model, having integrated biological data pertaining to the 6 scenarios (2 GG × 3 FT) obtained from a 4-yr experiment conducted between 2013 and 2016. On a per hectare basis, total system GHG emissions were similar for both elite and NA across the 3 FT. Per unit of product, however, the elite group had 10% and 11% lower GHG emissions per kilogram of fat- and protein-corrected milk and per kilogram of milk solids (MSO; fat + protein kg), respectively, compared with the NA across the 3 FT. The FT incorporating high concentrate supplementation had greater absolute GHG emissions per hectare as well as GHG per kilogram of fat- and protein-corrected milk and MSO. The elite group had a slightly superior N use efficiency (N output/N input) and lower N surplus (N input - N output) compared with the NA group. The high concentrate FT had an inferior N use efficiency and a higher N surplus. The results of the current study demonstrate that breeding for increased EBI will lead to a general improvement in GHG emissions per unit of product as well as improved N efficiency. The results also illustrate that reducing concentrate supplementation will reduce GHG emissions, GHG emissions intensity, while improving N efficiency in the context of pasture-based dairy production.
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Industria Lechera , Gases de Efecto Invernadero , Alimentación Animal , Animales , Bovinos , Dieta , Femenino , Lactancia , Leche , Nitrógeno , Estaciones del AñoRESUMEN
Patient-reported outcomes (PROs) are integral to determining the success of foregut surgical interventions and psychoemotional factors have been hypothesized to impact the quality of life of patients. This study evaluates the correlation between PROs-specifically the Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) and the Laryngopharangeal Reflux Symptom Index (LPR-RSI)-and the recently validated Esophageal Hypervigilance Anxiety Scale (EHAS). We hypothesize that patients with higher EHAS scores have significantly elevated GERD-HRQL LPR-RSI compared to those with normal scores. EHAS has been developed and validated in chronic esophageal disorders, but clinical impact is unknown. In this retrospective study, 197 patients (38% men, average age 56 ± 16) completed the following surveys:(1) EHAS, (2) GERD-HRQL, and (3) LPR-RSI. All patients referred for surgical evaluation of GERD completed the surveys as part of their pre-operative workup and post-operative follow-up In bivariate analysis, EHAS correlated with both GERD-HRQL (r 0.53, P = <0.001) and LPR-RSI (r 0.36, P = 0.009). Accounting for potential confounding with sex and age in multivariable linear regression models, a higher GERD-HRQL score (ß 0.38; 95% CI 0.29 to 0.48; P = <0.001; Semipartial R2 0.20) and a higher LPR-RSI score (ß 0.21; 95% CI 0.13 to 0.29; P = <0.001; Semipartial R2 0.08) were independently associated with higher EHAS. The observed relationship between mental health and GERD symptom intensity is consistent with the biopsychosocial paradigm of illness. Future studies focused on post-surgical outcomes following the incorporation of EHAS into perioperative care is needed to evaluate its effectiveness as a clinical decision support tool in ARS.
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Enfermedades del Esófago , Reflujo Gastroesofágico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
The objective of this study was to investigate the economic performance of 2 genetic groups (GG) of Holstein-Friesian dairy cows of divergent Economic Breeding Index (EBI), evaluated within 3 contrasting spring-calving pasture-based feeding treatments (FT). The study was a simulated economic appraisal, using the Moorepark Dairy Systems Model, a stochastic budgetary simulation model integrating biological data obtained from a 4-yr experiment conducted from 2013 to 2016. The 2 divergent GG were (1) high EBI representative of the top 5% nationally (elite) and (2) EBI representative of the national average (NA). The 3 FT were reflective of slight restriction to generous feeding. The elite GG had the lowest replacement rate, and therefore had lower replacement costs and an older and more productive parity structure. The elite GG consistently had higher sales of milk (on average +3% or +18,370 kg of milk) and milk solids (milk fat plus protein yield; +8.7% or +4,520 kg) compared with the NA GG across the 3 FT scenarios. Milk income was consequently greater for elite versus NA (on average +9.5% or +21,489) cows. Livestock sales were greater (on average +13.2% or +4,715) for NA compared with elite cows. Baseline net farm profit and net profit/ha at a base milk price of 29.5 cents per liter (3.3% protein and 3.6% fat) were on average 31,156, and 772 greater for elite compared with NA cows across the 3 FT. Greater profitability achieved with elite cows in each of the FT investigated demonstrated the adaptability of high-EBI cows across different levels of feeding intensities in seasonal pasture-based feeding systems. Sensitivity analysis of varying milk price and concentrate cost did not result in a reranking of GG for farm profit. This study clearly demonstrates the power of a suitably constructed genetic-selection index together with a well-considered breeding program to deliver genetics capable of favorable change to farm physical performance and profit over a relatively short duration.
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Bovinos/fisiología , Industria Lechera/economía , Leche/química , Selección Genética , Animales , Cruzamiento , Bovinos/genética , Dieta/veterinaria , Femenino , Glucolípidos , Glicoproteínas , Lactancia , Gotas Lipídicas , Leche/metabolismo , Proteínas de la Leche/análisis , Paridad , Embarazo , Estaciones del AñoRESUMEN
Breeding values for feed intake and feed efficiency in beef cattle are generally derived indoors on high-concentrate (HC) diets. Within temperate regions of north-western Europe, however, the majority of a growing beef animal's lifetime dietary intake comes from grazed grass and grass silage. Using 97 growing beef cattle, the objective of the current study was to assess the repeatability of both feed intake and feed efficiency across 3 successive dietary test periods comprising grass silage plus concentrates (S+C), grazed grass (GRZ) and a HC diet. Individual DM intake (DMI), DMI/kg BW and feed efficiency-related parameters, residual feed intake (RFI) and gain to feed ratio (G : F) were assessed. There was a significant correlation for DMI between the S+C and GRZ periods (r = 0.32; P < 0.01) as well as between the S+C and HC periods (r = 0.41; P < 0.001), whereas there was no association for DMI between the GRZ and HC periods. There was a significant correlation for DMI/kg BW between the S+C and GRZ periods (r = 0.33; P < 0.01) and between the S+C and HC periods (r = 0.40; P < 0.001), but there was no association for the trait between the GRZ and HC periods. There was a significant correlation for RFI between the S+C and GRZ periods (r = 0.25; P < 0.05) as well as between S+C and HC periods (r = 0.25; P < 0.05), whereas there was no association for RFI between the GRZ and HC periods. Gain to feed ratio was not correlated between any of the test periods. A secondary aspect of the study demonstrated that traits recorded in the GRZ period relating to grazing bite rate, the number of daily grazing bouts and ruminating bouts were associated with DMI (r = 0.28 to 0.42; P < 0.05 - 0.001), DMI/kg BW (r = 0.36 to 0.45; P < 0.01 - 0.001) and RFI (r = 0.31 to 0.42; P < 0.05 - 0.001). Additionally, the number of ruminating boli produced per day and per ruminating bout were associated with G : F (r = 0.28 and 0.26, respectively; P < 0.05). Results from this study demonstrate that evaluating animals for both feed intake and feed efficiency indoors on HC diets may not reflect their phenotypic performance when consuming conserved forage-based diets indoors or when grazing pasture.
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Poaceae , Ensilaje , Alimentación Animal/análisis , Animales , Bovinos , Dieta/veterinaria , Ingestión de Alimentos , Europa (Continente) , Conducta Alimentaria , Ensilaje/análisisRESUMEN
Pasture-based production systems typically require highly fertile, healthy, and robust genetics, with greater emphasis on milk solids (MSo; kg of fat + protein) production as opposed to milk yield. This study assessed milk production, production efficiency, reproductive performance, body weight (BW), body condition score, and functional traits in 3 different dairy cow genotypes: Holstein-Friesian (HF), Jersey × Holstein-Friesian (JEX), and Norwegian Red × (Jersey × Holstein-Friesian) (3-way). The 3 genotypes were rotationally grazed on 4 different grazing treatments after calving in spring and were stocked at a rate of 2.75 cows/ha. Holstein-Friesian cows produced higher daily and total milk yields compared with JEX and 3-way cows (5,718 vs. 5,476 and 5,365 kg/cow, respectively). However, JEX and 3-way cows had higher milk fat and protein contents (4.86 and 4.75%, respectively, for JEX and 3.87 and 3.88%, respectively, for 3-way) compared with HF (4.52 and 3.72%), resulting in similar MSo yield for JEX and HF (469 and 460 kg/cow) and slightly lower MSo yield for 3-way (453 kg/cow) compared with JEX. As parity increased, milk and MSo yield per cow increased. Reproductive performance was not significantly different between the 3 genotypes, which had similar 24-d submission rates, 6-wk pregnancy rates, and overall pregnancy rates over the 4-yr period. No difference in calving difficulty, incidence of mastitis, or incidence of lameness was observed among the 3 genotypes. Body weight was significantly different among all 3 genotypes, with HF being the heaviest followed by 3-way and JEX (530, 499, and 478 kg, respectively), and 3-way cows had a higher body condition score throughout lactation compared with HF and JEX cows. The differences in BW coupled with similar MSo production resulted in JEX cows having the highest production efficiency (4.58 kg of MSo/kg of metabolic BW), 3-way cows being intermediate (4.30 kg of MSo/kg of metabolic BW), and HF cows having the lowest (4.16 kg of MSo/kg of metabolic BW). In conclusion, HF herds with poor reproductive performance and low milk fat and protein contents are likely to benefit considerably from crossbreeding with Jersey, and all herds are likely to benefit in terms of production efficiency. However, where herd performance, particularly in relation to reproductive performance, is comparable with HF in the current study, crossbreeding with Jersey or Norwegian Red is unlikely to lead to significant improvements in overall herd performance.
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Bovinos/fisiología , Industria Lechera/métodos , Métodos de Alimentación/veterinaria , Fertilidad , Leche/metabolismo , Reproducción , Animales , Peso Corporal , Dieta/veterinaria , Femenino , Glucolípidos/análisis , Glicoproteínas/análisis , Lactancia , Gotas Lipídicas , Leche/química , Fenotipo , EmbarazoRESUMEN
BACKGROUND AND AIMS: The objective of this study was to examine expert opinion and agreement on the treatment of distinct GERD profiles from surgical and therapeutic endoscopy perspectives. METHODS: We used the RAND/University of California, Los Angeles Appropriateness Method over 6 months (July 2018 to January 2019) to assess the appropriateness of antireflux interventions among foregut surgeons and therapeutic gastroenterologists. Patients with primary atypical or extraesophageal symptoms were not considered. Patient scenarios were grouped according to their symptom response to proton pump inhibitor (PPI) therapy. The primary outcome was appropriateness of an intervention. RESULTS: Antireflux surgery with laparoscopic fundoplication (LF) and magnetic sphincter augmentation (MSA) were ranked as appropriate for all complete and partial PPI responder scenarios. Transoral incisionless fundoplication was ranked as appropriate in complete and partial PPI responders without a hiatal hernia. Radiofrequency energy was not ranked as appropriate for complete or partial responders. There was lack of agreement between surgery and interventional gastroenterology groups on the appropriateness of LF and MSA for PPI nonresponders. Rankings for PPI nonresponders were similar when results from impedance-pH testing on PPI therapy were available, except that LF and MSA were not ranked as appropriate for PPI nonresponders if the impedance-pH study was negative. CONCLUSIONS: This work highlights areas of agreement for invasive therapeutic approaches for GERD and provides impetus for further interdisciplinary collaboration and trials to compare and generate novel and effective treatment approaches and care pathways, including the role of impedance-pH testing in PPI nonresponders.
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Reflujo Gastroesofágico , Laparoscopía , Adulto , Anciano , Endoscopía , Endoscopía Gastrointestinal , Femenino , Fundoplicación , Reflujo Gastroesofágico/tratamiento farmacológico , Reflujo Gastroesofágico/cirugía , Humanos , Los Angeles , Masculino , Persona de Mediana Edad , Inhibidores de la Bomba de Protones/uso terapéutico , Resultado del TratamientoRESUMEN
The objective of the current study was to examine phenotypic fertility performance and survival, and to gain insight into underlying factors that may contribute to greater fertility performance in 2 divergent genetic groups (GG) of Holstein-Friesian, selected using the Irish Economic Breeding Index (EBI). The GG were evaluated across 3 spring calving pasture-based feeding treatments (FT) over 4 yr. The 2 divergent GG were (1) high EBI; representative of the top 5% nationally (elite), and (2) EBI representative of the national average (NA). In each year, 90 elite and 45 NA cows were randomly allocated to 1 of 3 FT: control, lower grass allowance, and high concentrate. No interaction between GG and FT was observed for any of the measures of fertility investigated. The elite cows achieved significantly greater pregnancy rate to first service (+14.9 percentage points), and significantly greater pregnancy rates after 21, 42, and 84 d of breeding (+17.3, +15.2, and +9.6 percentage points, respectively) compared with NA. The number of services per cow was fewer for elite (1.57) compared with NA (1.80). The interval from mating start date to pregnancy was significantly shorter for elite cows compared with NA. The elite cows maintained greater mean body condition score than NA throughout the study (2.91 vs. 2.72), and had greater body condition score at calving, artificial insemination, and drying off compared with NA. The elite cows had greater mean circulating concentrations of insulin-like growth factor-1 compared with NA. No significant effect was observed of GG on commencement of luteal activity, or progesterone profile variables. Greater survival to the start of fifth lactation was observed for elite cows. The elite cows were 43% less likely to be culled than NA by the beginning of the fifth lactation. The results highlight the success of the Economic Breeding Index to deliver reproductive performance and longevity consistent with industry targets across a range of seasonal pasture-based FT. The results also clearly demonstrate the potential of appropriate genetic selection to reverse negative fertility trends incurred during previous decades of selection for milk production alone.
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Bovinos/fisiología , Industria Lechera , Dieta/veterinaria , Fertilidad , Animales , Cruzamiento , Bovinos/genética , Bovinos/crecimiento & desarrollo , Industria Lechera/métodos , Femenino , Fertilidad/genética , Inseminación Artificial/veterinaria , Lactancia , Leche , Poaceae , Embarazo , Progesterona , Reproducción/genética , Estaciones del AñoRESUMEN
BACKGROUND & AIMS: Regurgitative gastroesophageal reflux disease (GERD) refractive to medical treatment is common and caused by mechanical failure of the anti-reflux barrier. We compared the effects of magnetic sphincter augmentation (MSA) with those of proton-pump inhibitors (PPIs) in a randomized trial. METHODS: Patients with moderate to severe regurgitation (assessed by the foregut symptom questionnaire) despite once-daily PPI therapy (n = 152) were randomly assigned to groups given twice-daily PPIs (n = 102) or laparoscopic MSA (n = 50) at 20 sites, from July 2015 through February 2017. Patients answered questions from the foregut-specific reflux disease questionnaire and GERD health-related quality of life survey about regurgitation, heartburn, dysphagia, bloating, diarrhea, flatulence, and medication use, at baseline and 6 and 12 months after treatment. Six months after PPI therapy, MSA was offered to patients with persistent moderate to severe regurgitation and excess reflux episodes during impedance or pH testing on medication. Regurgitation, foregut scores, esophageal acid exposure, and adverse events were evaluated at 1 year. RESULTS: Patients in the MSA group and those who crossed over to the MSA group after PPI therapy (n = 75) had similar outcomes. MSA resulted in control of regurgitation in 72/75 patients (96%); regurgitation control was independent of preoperative response to PPIs. Only 8/43 patients receiving PPIs (19%) reported control of regurgitation. Among the 75 patients who received MSA, 61 (81%) had improvements in GERD health-related quality of life improvement scores (greater than 50%) and 68 patients (91%) discontinued daily PPI use. Proportions of patients with dysphagia decreased from 15% to 7% (P < .005), bloating decreased from 55% to 25%, and esophageal acid exposure time decreased from 10.7% to 1.3% (P < .001) from study entry to 1-year after MSA (Combined P < .001). Seventy percent (48/69) of patients had pH normalization at study completion. MSA was not associated with any peri-operative events, device explants, erosions, or migrations. CONCLUSIONS: In a prospective study, we found MSA to reduce regurgitation in 95% of patients with moderate to severe regurgitation despite once-daily PPI therapy. MSA is superior to twice-daily PPIs therapy in reducing regurgitation. Relief of regurgitation is sustained over 12 months. ClinicalTrials.gov no: NCT02505945.
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Inhibidores de la Bomba de Protones , Calidad de Vida , Impedancia Eléctrica , Esfínter Esofágico Inferior/cirugía , Humanos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Outcomes associated with magnetic sphincter augmentation (MSA) in patients with gastroesophageal reflux disease (GERD) have been reported, however the optimal population for MSA and the related patient care pathways have not been summarized. This Minireview presents evidence that describes the optimal patient population for MSA, delineates diagnostics to identify these patients, and outlines opportunities for improving GERD patient care pathways. Relevant publications from MEDLINE/EMBASE and guidelines were identified from 2000-2018. Clinical experts contextualized the evidence based on clinical experience. The optimal MSA population may be the 2.2-2.4% of GERD patients who, despite optimal medical management, continue experiencing symptoms of heartburn and/or uncontrolled regurgitation, have abnormal pH, and have intact esophageal function as determined by high resolution manometry. Diagnostic work-ups include ambulatory pH monitoring, high-resolution manometry, barium swallow, and esophagogastroduodenoscopy. GERD patients may present with a range of typical or atypical symptoms. In addition to primary care providers (PCPs) and gastroenterologists (GIs), other specialties involved may include otolaryngologists, allergists, pulmonologists, among others. Objective diagnostic testing is required to ascertain surgical necessity for GERD. Current referral pathways for GERD management are suboptimal. Opportunities exist for enabling patients, PCPs, GIs, and surgeons to act as a team in developing evidence-based optimal care plans.
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The objective of this study was to compare mid-infrared reflectance spectroscopy (MIRS) analysis of milk and near-infrared reflectance spectroscopy (NIRS) analysis of feces with regard to their ability to predict the dry matter intake (DMI) of lactating grazing dairy cows. A data set comprising 1,074 records of DMI from 457 cows was available for analysis. Linear regression and partial least squares regression were used to develop the equations using the following variables: (1) milk yield (MY), fat percentage, protein percentage, body weight (BW), stage of lactation (SOL), and parity (benchmark equation); (2) MIRS wavelengths; (3) MIRS wavelengths, MY, fat percentage, protein percentage, BW, SOL, and parity; (4) NIRS wavelengths; (5) NIRS wavelengths, MY, fat percentage, protein percentage, BW, SOL, and parity; (6) MIRS and NIRS wavelengths; and (7) MIRS wavelengths, NIRS wavelengths, MY, fat percentage, protein percentage, BW, SOL, and parity. The equations were validated both within herd using animals from similar experiments and across herds using animals from independent experiments. The accuracy of equations was greater for within-herd validation compared with across-herds validation. Across-herds validation was deemed the more suitable method to assess equations for robustness and real-world application. The benchmark equation was more accurate [coefficient of determination (R2) = 0.60; root mean squared error (RMSE) = 1.68 kg] than MIRS alone (R2 = 0.30; RMSE = 2.23 kg) or NIRS alone (R2 = 0.16; RMSE = 2.43 kg). The combination of the benchmark equation with MIRS (R2 = 0.64; RMSE = 1.59 kg) resulted in slightly superior fitting statistics compared with the benchmark equation alone. The combination of the benchmark equation with NIRS (R2 = 0.58; RMSE = 1.71 kg) did not result in a more accurate prediction equation than the benchmark equation. The combination of MIRS and NIRS wavelengths resulted in superior fitting statistics compared with either method alone (R2 = 0.36; RMSE = 2.15 kg). The combination of the benchmark equation and MIRS and NIRS wavelengths resulted in the most accurate equation (R2 = 0.68; RMSE = 1.52 kg). A further analysis demonstrated that Holstein-Friesian cows could predict the DMI of Jersey × Holstein-Friesian crossbred cows using both MIRS and NIRS. Similarly, the Jersey × Holstein-Friesian animals could predict the DMI of Holstein-Friesian cows using both MIRS and NIRS. The equations developed in this study have the capacity to predict DMI of grazing dairy cows. From a practicality perspective, MIRS in combination with variables in the benchmark equation is the most suitable equation because MIRS is currently used on all milk-recorded milk samples from dairy cows.
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Bovinos , Dieta/veterinaria , Herbivoria , Espectrofotometría Infrarroja/veterinaria , Animales , Peso Corporal , Ingestión de Alimentos , Heces/química , Femenino , Lactancia , Análisis de los Mínimos Cuadrados , Modelos Lineales , Leche , Embarazo , Espectrofotometría Infrarroja/métodosRESUMEN
The objective of the current study was to explore differences in dry matter intake, intake capacity, production efficiency, energy balance, and grazing behavior, of 2 divergent genetic groups (GG) of lactating Holstein-Friesian, selected using the Irish Economic Breeding Index (EBI). The GG were evaluated across 3 spring calving pasture-based feeding treatments (FT) over 3 yr. The 2 divergent GG were (1) high EBI, representative of the top 5% nationally (elite), and (2) EBI representative of the national average (NA). In each year 90 elite and 45 NA cows were randomly allocated to 1 of 3 FT: control, lower grass allowance, and high concentrate. Although FT did affect animal performance, there were few notable incidences of GG × FT interaction. The elite cows expressed lower daily milk yield (-1 kg) compared with NA. Elite cows did, however, express higher daily concentrations of milk fat (+3.7 g/kg) and protein (+2.1 g/kg) compared with NA. Daily yield of milk solids and net energy of lactation (NEL) was similar for both GG. Body weight (BW) was greater for NA (+13 kg) compared with elite, whereas mean body condition score was greater (+0.14) for elite compared with NA. Intake did not differ significantly between GG. Intake capacity, expressed as total dry matter intake/100 kg of BW, was greater with elite compared with NA. Production efficiency expressed as yield of milk solids per 100 kg of BW was greater with elite compared with NA, although milk solids/total dry matter intake did not differ between GG. Expressed as NEL as a proportion of net energy intake minus net energy of maintenance (NEL/NEI - NEM) and NEI/milk solids kg, indicated a slight reduction in the utilization of ingested energy for milk production with elite compared with NA. This is, however, suggested as favorable as it manifested as a more positive energy balance with elite compared with NA and so is likely to enhance robustness, increase longevity, and increase overall lifetime efficiency. Noteworthy was a consistent numerical trend toward more intense grazing activity with elite compared with NA cows, exhibited in the numerically greater grazing time (+19 min) and total number of bites per day (+2,591).
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Alimentación Animal , Cruzamiento/economía , Bovinos/genética , Ingestión de Alimentos/genética , Conducta Alimentaria , Animales , Peso Corporal/genética , Cruzamiento/métodos , Bovinos/fisiología , Industria Lechera/economía , Dieta/veterinaria , Ingestión de Energía/genética , Metabolismo Energético/genética , Femenino , Lactancia/genética , Leche/química , Poaceae , Estaciones del AñoRESUMEN
Current techniques for measuring the dry matter intake (DMI) of grazing lactating beef cows are invasive, time consuming and expensive making them impractical for use on commercial farms. This study was undertaken to explore the potential to develop and validate a model to predict DMI of grazing lactating beef cows, which could be applied in a commercial farm setting, using non-invasive animal measurements. The calibration dataset used to develop the model was comprised of 94 measurements recorded on 106 beef or beef-dairy crossbred cows (maternal origin). The potential of body measurements, linear type scoring, grazing behaviour and thermal imaging to predict DMI in combination with known biologically plausible adjustment variables and energy sinks was investigated. Multivariable regression models were constructed for each independent variable using SAS PROC REG and contained milk yield, BW, parity, calving day and maternal origin (dairy or beef). Of the 94 variables tested, 32 showed an association with DMI (P < 0.25) upon multivariable analysis. These variables were incorporated into a backwards linear regression model using SAS PROC REG. Variables were retained in this model if P < 0.05. Five variables; width at pins, full body depth, ruminating mastications, central ligament and rump width score, were retained in the model in addition to milk yield, BW, parity, calving day and maternal origin. The inclusion of these variables in the model increased the predictability of DMI by 0.23 (R2 = 0.68) when compared to a model containing milk yield, BW, parity, calving day and maternal origin only. This model was applied to data recorded on an independent dataset; a herd of 60 lactating beef cows two years after the calibration study. The R2 for the validation was 0.59. Estimates of DMI are required for measuring feed efficiency. While acknowledging challenges in applicability, the findings suggest a model such as that developed in this study may be used as a tool to more easily and less invasively estimate DMI on large populations of commercial beef cows, and therefore measure feed efficiency.
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Bovinos/fisiología , Ingestión de Alimentos , Modelos Lineales , Leche/metabolismo , Alimentación Animal/análisis , Animales , Peso Corporal , Femenino , Lactancia , Paridad , Embarazo , Análisis de RegresiónRESUMEN
The objective of this study was to validate the effect of genetic improvement using the Irish genetic merit index, the Economic Breeding Index (EBI), on total lactation performance and lactation profiles for milk yield, milk solids yield (fat plus protein; kg), and milk fat, protein, and lactose content within 3 pasture-based feeding treatments (FT) and to investigate whether an interaction exists between genetic group (GG) of Holstein-Friesian and pasture-based FT. The 2 GG were (1) extremely high EBI representative of the top 5% nationally (referred to as the elite group) and (2) representative of the national average EBI (referred to as the NA group). Cows from each GG were randomly allocated each year to 1 of 3 pasture-based FT: control, lower grass allowance, and high concentrate. The effects of GG, FT, year, parity, and the interaction between GG and FT adjusted for calving day of year on milk and milk solids (fat plus protein; kg) production across lactation were studied using mixed models. Cow was nested within GG to account for repeated cow records across years. The overall and stage of lactation-specific responses to concentrate supplementation (high concentrate vs. control) and reduced pasture allowance (lower grass allowance vs. control) were tested. Profiles of daily milk yield, milk solids yield, and milk fat, protein, and lactose content for each week of lactation for the elite and NA groups within each FT and for each parity group within the elite and NA groups were generated. Phenotypic performance was regressed against individual cow genetic potential based on predicted transmitting ability. The NA cows produced the highest milk yield. Milk fat and protein content was higher for the elite group and consequently yield of solids-corrected milk was similar, whereas yield of milk solids tended to be higher for the elite group compared with the NA group. Milk lactose content did not differ between GG. Responses to concentrate supplementation or reduced pasture allowance did not differ between GG. Milk production profiles illustrated that elite cows maintained higher production but with lower persistency than NA cows. Regression of phenotypic performance against predicted transmitting ability illustrated that performance was broadly in line with expectation. The results illustrate that the superiority of high-EBI cattle is consistent across diverse pasture-based FT. The results also highlight the success of the EBI to deliver production performance in line with the national breeding objective: lower milk volume with higher fat and protein content.
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Cruzamiento/economía , Bovinos/genética , Bovinos/fisiología , Industria Lechera/métodos , Lactancia/genética , Estaciones del Año , Animales , Bovinos/clasificación , Industria Lechera/economía , Dieta/veterinaria , Grasas/análisis , Femenino , Irlanda , Lactancia/fisiología , Lactosa/metabolismo , Leche/química , Proteínas de la Leche/análisis , Paridad , Poaceae , EmbarazoRESUMEN
BACKGROUND AND AIMS: GERD patients frequently complain of regurgitation of gastric contents. Medical therapy with proton-pump inhibitors (PPIs) is frequently ineffective in alleviating regurgitation symptoms, because PPIs do nothing to restore a weak lower esophageal sphincter. Our aim was to compare effectiveness of increased PPI dosing with laparoscopic magnetic sphincter augmentation (MSA) in patients with moderate-to-severe regurgitation despite once-daily PPI therapy. METHODS: One hundred fifty-two patients with GERD, aged ≥21 years with moderate-to-severe regurgitation despite 8 weeks of once-daily PPI therapy, were prospectively enrolled at 21 U.S. sites. Participants were randomized 2:1 to treatment with twice-daily (BID) PPIs (N = 102) or to laparoscopic MSA (N = 50). Standardized foregut symptom questionnaires and ambulatory esophageal reflux monitoring were performed at baseline and at 6 months. Relief of regurgitation, improvement in foregut questionnaire scores, decrease in esophageal acid exposure and reflux events, discontinuation of PPIs, and adverse events were the measures of efficacy. RESULTS: Per protocol, 89% (42/47) of treated patients with MSA reported relief of regurgitation compared with 10% (10/101) of the BID PPI group (P < .001) at the 6-month primary endpoint. By intention-to-treat analysis, 84% (42/50) of patients in the MSA group and 10% (10/102) in the BID PPI group met this primary endpoint (P < .001). Eighty-one percent (38/47) of patients with MSA versus 8% (7/87) of patients with BID PPI had ≥50% improvement in GERD-health-related quality of life scores (P < .001), and 91% (43/47) remained off of PPI therapy. A normal number of reflux episodes and acid exposures was observed in 91% (40/44) and 89% (39/44) of MSA patients, respectively, compared with 58% (46/79) (P < .001) and 75% (59/79) (P = .065) of BID PPI patients at 6 months. No significant safety issues were observed. In MSA patients, 28% reported transient dysphagia; 4% reported ongoing dysphagia. CONCLUSION: Patients with GERD with moderate-to-severe regurgitation, especially despite once-daily PPI treatment, should be considered for minimally invasive treatment with MSA rather than increased PPI therapy. (Clinical trial registration number: NCT02505945.).
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Esfínter Esofágico Inferior/cirugía , Reflujo Gastroesofágico/terapia , Imanes , Omeprazol/administración & dosificación , Inhibidores de la Bomba de Protones/administración & dosificación , Adulto , Anciano , Estudios Cruzados , Monitorización del pH Esofágico , Femenino , Humanos , Laparoscopía , Reflujo Laringofaríngeo/terapia , Masculino , Persona de Mediana Edad , Calidad de Vida , Resultado del Tratamiento , Adulto JovenRESUMEN
Comparison of alternative dairy (cross-)breeding programs requires full appraisals of all revenues and costs, including beef merit. Few studies exist on carcass characteristics of crossbred dairy progeny originating from dairy herds as well as their dams. The objective of the present study was to quantify, using a national database, the carcass characteristics of young animals and cows differing in their fraction of Jersey. The data set consisted of 117,593 young animals and 42,799 cows. The associations between a combination of sire and dam breed proportion (just animal breed proportion when the dependent variable was on cows) with age at slaughter (just for young animals), carcass weight, conformation, fat score, price per kilogram, and total carcass value were estimated using mixed models that accounted for covariances among herdmates of the same sex slaughtered in close proximity in time; we also accounted for age at slaughter in young animals (which was substituted with carcass weight and carcass fat score when the dependent variable was age at slaughter), animal sex, parity of the cow or dam (where relevant), and temporal effects represented by a year-by-month 2-way interaction. For young animals, the heaviest of the dairy carcasses were from the mating of a Holstein-Friesian dam and a Holstein-Friesian sire (323.34 kg), whereas the lightest carcasses were from the mating of a purebred Jersey dam to a purebred Jersey sire which were 46.31 kg lighter (standard error of the difference = 1.21 kg). The young animal carcass weight of an F1 Holstein-Friesian × Jersey cross was 20.4 to 27.0 kg less than that of a purebred Holstein-Friesian animal. The carcass conformation of a Holstein-Friesian young animal was 26% superior to that of a purebred Jersey, translating to a difference of 0.78 conformation units on a scale of 1 to 15. Purebred Holstein-Friesians produced carcasses with less fat than their purebred Jersey counterparts. The difference in carcass price per kilogram among the alternative sire-dam breed combinations investigated was minimal, although large differences existed among the different breed types for overall carcass value; the carcass value of a Holstein-Friesian animal was 20% greater than that of a Jersey animal. Purebred Jersey animals required, on average, 21 d longer to reach a given carcass weight and fat score relative to a purebred Holstein-Friesian. The difference in age at slaughter between a purebred Holstein-Friesian animal and the mating between a Holstein-Friesian sire with a Jersey dam, and vice versa, was between 7.0 and 8.9 d. A 75.8-kg difference in carcass weight existed between the carcass of a purebred Jersey cow and that of a Holstein-Friesian cow; a 50% Holstein-Friesian-50% Jersey cow had a carcass 42.0 kg lighter than that of a purebred Holstein-Friesian cow. Carcass conformation was superior in purebred Holstein-Friesian compared with purebred Jersey cows. Results from this study represent useful input parameters to populate simulation models of alternative breeding programs on dairy farms, and to help beef farmers evaluate the cost-benefit of rearing, for slaughter, animals differing in Jersey fraction.
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Bovinos/genética , Carne/análisis , Crianza de Animales Domésticos/economía , Animales , Cruzamiento/economía , Bovinos/crecimiento & desarrollo , Bovinos/fisiología , Comercio , Costos y Análisis de Costo , Femenino , Masculino , Carne/economía , Paridad , Linaje , Embarazo , ReproducciónRESUMEN
BACKGROUND: The magnetic sphincter augmentation device continues to become a more common antireflux surgical option with low complication rates. Erosion into the esophagus is an important complication to recognize and is reported to occur at very low incidences (0.1-0.15%). Characterization of this complication remains limited. We aim to describe the worldwide experience with erosion of the magnetic sphincter augmentation device including presentation, techniques for removal, and possible risk factors. MATERIALS AND METHODS: We reviewed data obtained from the device manufacturer Torax Medical, Inc., as well as the Manufacturer and User Facility Device Experience (MAUDE) database. The study period was from February 2007 through July 2017 and included all devices placed worldwide. RESULTS: In total, 9453 devices were placed and there were 29 reported cases of erosions. The median time to presentation of an erosion was 26 months with most occurring between 1 and 4 years after placement. The risk of erosion was 0.3% at 4 years after device implantation. Most patients experienced new-onset dysphagia prompting evaluation. Devices were successfully removed in all patients most commonly via an endoscopic removal of the eroded portion followed by a delayed laparoscopic removal of the remaining beads. At a median follow-up of 58 days post-removal, there were no complications and 24 patients have returned to baseline. Four patients reported ongoing mild dysphagia. CONCLUSIONS: Erosion of the LINX device is an important but rare complication to recognize that has been safely managed via minimally invasive approaches without long-term consequences.