Effects of forage quantity and access-time restriction on feeding behaviour, feed efficiency, nutritional status, and dairy performance of dairy cows fed indoors.

Optimising feed is a key challenge for dairy livestock systems, as forage stock shortages are increasingly frequent and feed is the biggest operating cost. The aim of this experiment was to evaluate the effects of reducing forage quantity and access time on dairy performance and animal nutritional status during indoor feeding. Twenty-seven Montbéliarde and Holstein cows were randomly allocated to three groups of nine cows balanced by breed, parity, days in milk, and milk yield. The three groups were given 3.9 kg DM/day of second-cut hay and 4.5 kg/day of concentrate and either i) ad libitum access to first-cut hay (Ad Libitum group; AL), ii) 10.5 kg/day of first-cut hay (Quantity-restricted group; QR), or iii) 10.5 kg/day of first-cut hay but with access time restricted to only 2 h in the morning and 2 h in the afternoon (Quantity-and-Time-restricted group; QTR). Milk yield, composition and coagulation properties, cow nutritional status (weight, body condition score, blood metabolites) and cow activities were recorded. The AL group ingested 10 % more feed than the QR group and 16 % more feed than the QTR group. Organic matter digestibility was lower in the AL group than in the QR and QTR groups whereas feed efficiency did not differ. Milk yield was not significantly different among the three groups. Compared to the QR and QTR groups, the AL group had significantly higher milk fat (35.9 vs 32.9 and 32.8 g/kg of milk) and milk protein content (29.5 vs 27.7 and 28.5 g/kg of milk). QR and QTR cows mobilised their body fat, resulting in a lower final body condition score, and tended to have a lower blood non-esterified fatty acid concentration than the AL group. QTR cows showed greater body fat mobilisation, but their final corrected BW was not different from AL cows. Access-time restriction did not impact fat and protein content but led to decreased casein, lactose contents and casein-to-whey protein ratio. The forage savings achieved through this feed management practice could prove economically substantial when forage prices increase. This practice can be of interest in grassland systems to overcome certain climatic hazards without having to resort to purchases or to increase the farm's forage autonomy.

Cheese quality from cows given a tannin extract in 2 different grazing seasons.

The aim of the present study was to compare the effect of dietary tannins on cow cheese quality in 2 different grazing seasons in the Mediterranean. Two experiments were performed on 14 dairy cows reared in an extensive system. The first experiment took place in the wet season (WS), and the second experiment took place in the dry season (DS). In the WS and DS experiments, cows freely grazed green pasture or dry stubbles, respectively, and the diet was supplemented with pelleted concentrate and hay. In both experiments, the cows were divided into 2 balanced groups: a control group and a group (TAN) receiving 150 g of tannin extract/head per day. After 23 d of dietary treatment, individual milk was collected, processed into individual cheeses, and aged 25 d. Milk was analyzed for chemical composition, color parameters, and cheesemaking aptitude (laboratory cheese yield and milk coagulation properties). Cheese was analyzed for chemical composition, proteolysis, color parameters, rheological parameters, fatty acid profile, and odor-active volatile compounds. Data from the WS and DS experiments were statistically analyzed separately with an analysis of covariance model. In the WS experiment, dietary tannin supplementation had no effect on milk and cheese parameters except for a reduced concentration of 2-heptanone in cheese. In the DS experiment, TAN milk showed lower urea N, and TAN cheese had lower C18:1 trans-10 concentration and n-6:n-3 polyunsaturated fatty acid ratio compared with the control group. These differences are likely due to the effect of tannins on rumen N metabolism and fatty acid biohydrogenation. Dietary tannins may differently affect the quality of cheese from Mediterranean grazing cows according to the grazing season. Indeed, tannin bioactivity on rumen metabolism seems to be enhanced during the dry season, when diet is low in protein and rich in acid detergent fiber and lignin. The supplementation dose used in this study (1% of estimated dry matter intake) had no detrimental effects on cheese yield or cheesemaking parameters. Also, it is unlikely that sensorial characteristics would be affected by this kind of dietary tannin supplementation.

Feeding cows with hay, silage, or fresh herbage on pasture or indoors affects sensory properties and chemical composition of milk and cheese.

In European countries, silage-free feeding is an ancient tradition and has a particularly positive reputation among consumers. In the present study, we compared grass-based forages from the same plot conserved as hay or silage or fed fresh either on pasture or indoors, and we evaluated the differences in sensory properties of milk and uncooked pressed cheese. All herbage from the first cut of a grassland dominated by perennial ryegrass was harvested on the same day and preserved either as hay or silage. The first regrowth of the same plot was used for strip grazing or green feeding indoors. Balanced by breed, 24 Montbéliarde and 24 Holstein cows were allocated to the 4 treatments. Apart from the forages, the late-lactation cows received 3 kg/d of dry matter from concentrate. After 2 wk of dietary adaptation, the bulk milk of 3 subgroups, each with 4 cows, was collected. Part of the milk was pasteurized, and part was left raw and partly transformed to small-sized Cantal-type cheese ripened for 9 wk. Milk and cheese underwent descriptive sensory analysis by a trained sensory panel, as well as analyses of physicochemical traits. Volatile organic compounds of the cheeses were also analyzed. Raw and pasteurized milk from hay-fed cows had less intense odors of cooked milk, cream, and barnyard than milk from grazing cows, whereby the effect of pasteurization did not differ between herbage utilization methods. Cheeses obtained from cows fed fresh herbage (grazing and indoors) were clearly yellower than cheeses from silage- and hay-fed cows, which coincided with the color intensity perceived by the panelists. Moreover, cheeses from cows fed fresh herbage had more intense barnyard and dry fruit flavors, were perceived as creamier and having less lactic odor, and exhibited more fat exudation than those from cows fed conserved herbage. Only a few differences were observed in milk and cheeses from hay-fed compared with silage-fed cows, and those differences were far less pronounced than those of milk and cheeses from cows fed fresh herbage. In conclusion, the present study did not substantiate assumptions of clear sensory differences of milk and uncooked pressed cheese from hay-fed compared with silage-fed cows. For the first time, this study reports that the global flavor intensity of cheeses from indoor green-fed cows is similar to that of cheeses derived from cows fed conserved forages, whereas cheeses from grazing cows have the greatest global flavor intensity.

Repeated attacks of type III hereditary angioedema with factor XII mutation during pregnancy.

In type III hereditary angioedema (HAE type III), the phenotype is the same as type I and type II disease, but the level and function of C1-esterase inhibitor (C1-INH) is normal. Hereditary angioedema type III has been described as an oestrogen-sensitive form because it can be triggered or aggravated by exposure to high oestrogen levels as seen during pregnancy, especially when associated with Factor XII mutation. This case report describes the evolution and management of repeated angioedema attacks during pregnancy in a woman with HAE, with normal levels and function of C1-INH (type III); and a mis-sense mutation of factor XII. The physiopathology and genetic features, the unpredictability of clinical manifestations and the management during pregnancy and delivery are discussed.

How to replace codeine after tonsillectomy in children under 12 years of age? Guidelines of the French Oto-Rhino-Laryngology--Head and Neck Surgery Society (SFORL).

The authors present the guidelines of the French Oto-rhino-laryngology--Head and Neck Surgery Society (SFORL) regarding pain management in children and adults following tonsillectomy. A multidisciplinary work group was entrusted with a literature review. Guidelines were drawn up based on the articles retrieved and the group members' experience. They were read over by an editorial group independent of the work group. A coordination meeting drew up the final version. Guidelines were graded A, B or C or as professional agreement in decreasing order of level of evidence. At home, non-steroid anti-inflammatory drugs (NSAIDs) are recommended in association with paracetamol in elevated respiratory risk and especially obstructive sleep apnea syndrome; in elevated hemorrhagic risk (hemostasis disorder, surgical problems, etc.), tramadol is recommended. Two other treatment schedules (modified NSAIDs and corticosteroids) have not undergone dedicated study and should be assessed. Management of post-tonsillectomy pain in children is founded on individual risk/benefit analysis.

Guidelines (short version) of the French Oto-Rhino-Laryngology--Head and Neck Surgery Society (SFORL) for the management of post-tonsillectomy pain in adults.

OBJECTIVES: The present clinical practice guidelines cover the entire field of management of post-tonsillectomy pain. Given the French and European regulatory restrictions on the use of codeine, an update appears necessary to clarify the management of post-tonsillectomy pain in adults. METHOD: A work group approached the issue of pain management, following the chronological pathway from initial consultation to postoperative period. As exhaustive a study of the literature as possible assessed the pain impact of the various surgical techniques and the efficacy of the various analgesia schedules. RESULTS: Guidelines on the management of post-tonsillectomy pain in adults were drawn up and graded, based on the levels of evidence of selected articles and on work group consensus. The guidelines stress the importance of patient information and seek to harmonize practice, reduce the risk of postoperative complications and above all improve control of post-tonsillectomy pain in adults.

Pregnancy is associated with a decrease in pharyngeal but not tracheal or laryngeal cross-sectional area: a pilot study using the acoustic reflection method.

BACKGROUND: The risk of difficult upper airway access is increased during pregnancy, especially in labor. Changes in upper airway calibre have been poorly studied during pregnancy. The acoustic reflection method is a non-invasive technique that allows a longitudinal assessment of the cross-sectional area of the upper airway from the mouth to carina. We used this technique to evaluate upper airway calibre during normal pregnancy. METHODS: We conducted a prospective, single centre, observational study with a clinical and upper airway acoustic reflection method evaluation of healthy women during the first, second and third trimesters of pregnancy, and up to two days and one month after delivery. RESULTS: Fifty women participated to the study. The mean pharyngeal cross-sectional area decreased between the first and third trimesters (P < 0.001) with no significant change of the minimal and mean tracheal cross-sectional areas. The Mallampati score increased during pregnancy between the first and third trimesters (P< 0.001). CONCLUSION: Using measurements with the acoustic reflection method, normal pregnancy is associated with a significant reduction in the cross-sectional area of the pharynx and a concomitant increase in the Mallampati score. No change was observed in the minimal and mean tracheal cross-sectional areas.

Using visible or near infrared spectroscopy (NIRS) on cheese to authenticate cow feeding regimes.

An experiment was conducted to evaluate the ability of two spectroscopy methods to distinguish between pasture and preserved-forage cheeses. The reflectance spectra of 308 fresh and freeze-dried samples of cow's milk cheeses were recorded at wavelengths in the range of the visible, using a portable MINOLTA CM-2002 spectrophotometer. The reflectance spectra of the same samples were also measured in near infrared range using a non-portable laboratory monochromator NIRSystem 6500. The proportion of cheeses correctly classified by NIRS and visible spectra was respectively 0.96 and 0.91 for pasture samples, and 0.96 and 0.79 for preserved-forage samples. No significant differences were found when fresh and freeze-dried cheeses were compared. We conclude that NIRS is able to classify cheese samples from different regimes (here, pasture vs. preserved-forage).

[Gestational diabetes insipidus during a twin pregnancy]. / Diabète insipide gestationnel au cours d'une grossesse gémellaire.

Gestational diabetes insipidus is an uncommon clinical disease whose prevalence is approximately two to three pregnancies per 100,000. It may be isolated or associated with preeclampsia. We report a case of gestational diabetes insipidus in a twin pregnancy, originally isolated during two months, and secondarily complicated by HELLP-syndrome. We recall the specific pathophysiology of polyuric-polydipsic syndrome during pregnancy and summarize its various causes. Finally, we discuss the indications, in case of isolated gestational diabetes insipidus, of treatment by dDAVP.

[The exposure method of treatment of burns in children]. / Le pansement par exposition à l'air dans le traitement des brûlures de l'enfant.

Acute burn is a more or less profound destruction of the skin envelope. The depth of the injury determines the severity of functional and aesthetic sequelae. Local care prevents the infection, factor of deepening of the burn. Currently the dressing used in most Burns centers is a bandage covering a bacterial product applied to the burn. The advantage of this dressing is to prevent the occurrence of local infection. In contrast, open-air method of treatment is based on the notions that the wound is infected. His purpose is to reduce the effects of infection by creating an unfavourable environment to the growth and multiplication of bacteria. The principle of this method is the formation over the burned area of an eschar. The eschar acts as a natural dressing to protect the injured area against infection. The residual skin islets are preserved. The surgical cleavage of the eschar is easy; the deep surface of the crust defines the surgical plan. Deep tangential excisions are not necessary. The implementation of this technique is easy and it is particularly well suited to pediatrics. Treatment is not painful and the child's activities are not hampered by bandages. Respect of the children's quality of life and medical-economic efficiency of this method give it a prominent place in the treatment of burns in children.

[Update on propofol TCI in children]. / Nouvelles avancées en AIVOC pédiatrique au propofol.

For several years, total intravenous anaesthesia (TIVA) has demonstrated many advantages that allow considering propofol anaesthesia as an interesting alternative in pediatric anaesthesia. TCI in children requires calculation and validation of pharmacokinetic (PK) models specifically adapted to the paediatric population. Several PK models based on a 3-compartement approach have been proposed in children: all these models, which integrate only weight as covariable, show increased distribution volumes with a wide interindividual variability. The particular importance to include physiological covariables, as age and lean body mass, to describe metabolic processes during growth and maturation in pediatric PKPD models is in agreement with recent allometric scaling works in children. However, as pharmacodynamic (PD) parameters are still debated in children, there is up to now, no PKPD model currently available for paediatric anaesthesia. Schnider et al.'s model, a model described in adults that includes numerous covariables, may be adapted and more efficient than the classical paediatric models to describe propofol-PKPD relationship in children over 5years. Whatever the model, a pharmacodynamic feedback such as the bispectral index may be useful to counteract interindividual variability in the paediatric population.

Pediatric tonsillectomy: clinical practice guidelines.

OBJECTIVE: This article presents the Clinical Practice Guidelines for Pediatric Tonsillectomy of the French Society of ENT and Head and Neck Surgery (SFORL), entitled "Amygdalectomie de l'enfant : Recommandation pour la pratique clinique" (SFORL, 2009). METHOD: The French Society of ENT (SFORL), in partnership with the French Association for Ambulatory Surgery (AFCA) and French Society for Anaesthesia and Intensive Care (SFAR), set up a representative panel in the fields of anesthesiology, ENT and head-and-neck surgery, pediatrics, sleep medicine and general medicine. Following the literature analysis reported in the Presentation of the Guidelines, recommendations were drawn up taking account of risk/benefit ratios, levels of evidence, feasibility in pediatric tonsillectomy and baseline risk assessment in the relevant population. RESULTS: Around 50,000 pediatric tonsillectomies, with or without associated adenoidectomy, are performed in France each year. Postoperative morbidity and mortality are non-negligible, despite progress in peri-operative management. The present guidelines address the following questions: 1) What are the indications for tonsillectomy, notably in case of obstructive sleep disorder; 2) What pre-operative assessment is required? 3) What are the technical principles involved? 4) What are the selection criteria for ambulatory tonsillectomy? 5) How should postoperative follow-up be organized? 6) How should complications be managed? CONCLUSION: The present Clinical Practice Guidelines for pediatric tonsillectomy in France should improve clinical and organizational practices to enhance patient safety. They seek to ensure optimal conditions of care for all children undergoing tonsillectomy.

Authentication of cow feeding and geographic origin on milk using visible and near-infrared spectroscopy.

The ability of near-infrared spectroscopy to trace cow feeding systems and farming altitude was tested on 486 bulk milk samples from France and northwestern Italy. Milks were grouped into feeding systems according to the main forage in the diet. Partial least square discriminant analysis correctly classified 95.5, 91.5, and 93.3% of pasture versus maize silage, hay, and fermented herbage feeding systems, respectively. Discrimination was slightly less successful when diets with large proportions of the nondominant forage were included in each group. Near-infrared spectroscopy correctly discriminated no-pasture from pasture milk, even with only 30% of pasture in the diet (5.4% cross-validation error), and the error stabilized when pasture exceeded 70% (2.5% error). Near-infrared spectroscopy did not reliably trace milk geographic origin when the feeding system effect was isolated from the altitude effect. These findings may be usefully exploited for the authentication of dairy products.

[General anaesthesia in children: a French survey of practices]. / Anesthésie générale chez l'enfant : quid des pratiques en 2010 ?

INTRODUCTION: The practice of pediatric anesthesia requires a regular update of scientific knowledge and technical skills. To provide the most adequate Continuing Medical Education programs, it is necessary to assess the practices of pediatric anesthesiologists. Thus, the objective of this survey was to draw a picture of the current clinical practices of general anesthesia in children, in France. MATERIAL AND METHODS: One thousand one hundred and fifty questionnaires were given to anesthesiologists involved in pediatric cases. These questionnaires collected information on various aspects of clinical practice relative to induction, maintenance, recovery from general anaesthesia and also classical debated points such as children with Upper Respiratory Infection (URI), emergence agitation, epileptoid signs or anaesthetic management of adenoidectomy. Differences in practices between CHG (general hospital), CHU (teaching hospital), LIBERAL (private) and PSPH (semi-private) hospitals were investigated. RESULTS: There were 1025 questionnaires completed. Fifty-five percent of responders worked in public hospitals (CHG and CHU); 77% had a practice that was 25% or less of pediatric cases. In children from 3 to 10 years: 72% of respondents used always premedication and two thirds performed inhalation induction in more than 50% of cases. For induction, 53% used sevoflurane (SEVO) at 7 or 8%. Respondents from LIBERAL used higher SEVO concentrations. Tracheal intubation was performed with SEVO alone (37%), SEVO and propofol (55%) and SEVO with myorelaxant (8%), 93% of respondents used a bolus of opioid. For maintenance, the majority of respondents used SEVO associated with sufentanil; desflurane and remifentanil were more frequently used in CHU. Two thirds of respondents used N(2)O. Depth of anesthesia was commonly assessed by hemodynamic changes (52%), end tidal concentration of halogenated (38%) or automated devices based on EEG (7%). In children with URI, 98% of respondents used SEVO for anesthesia. To control the airway 42% used a tracheal tube, 30% a laryngeal mask and 20% a facial mask. Emergence agitation was an important concern for two thirds of respondents, while epileptoid signs were considered as important by only 20%. Eighty-nine percent of respondents practiced anesthesia for adenoidectomy. Anesthesia was induced by inhalation of SEVO 7-8% (41%), 6% (39%) or 4% (12%), 66% put an intravenous line (less frequently in LIBERAL). 67% of the responders managed adenoidectomy without any device to control the airway (more frequently in LIBERAL), 32% administrated a bolus of opioid (less frequently in LIBERAL). DISCUSSION: This survey demonstrated that the practices regarding general anesthesia in children are relatively homogenous. Most of the differences appeared between LIBERAL and the others structures; the anaesthetic management for adenoidectomy illustrates these findings.

Minimal alveolar concentration of sevoflurane inhibiting the reflex pupillary dilatation after noxious stimulation in children and young adults.

BACKGROUND: In children, sevoflurane is the most commonly used anaesthetic. Its excellent haemodynamic tolerance gives it a wide therapeutic index. This halogenated agent can abolish movement [minimal alveolar concentration (MAC)] or haemodynamic responses (MACBAR) to noxious stimulus in children as in adults. Reflex pupillary dilatation (RPD) has been demonstrated as a very sensitive measure of noxious stimulation. In order to investigate the effect of sevoflurane on the RPD, a subcortical reflex, we determined the MAC of sevoflurane inhibiting the RPD in 50% of the subjects in response to skin incision (MACpup) in pre- and post-pubertal subjects. METHODS: We included 30 pre-pubertal children and 19 post-pubertal subjects. Patients received sevoflurane at preselected concentrations according to an 'up and down' design, and after a steady-state period, skin incision was performed. The RPD was considered as significant when the pupillary diameter increased by more than 100%. Heart rate (HR) and bispectral index (BIS) changes were analysed according to the pupillary response. RESULTS: The MACpup of sevoflurane was 4.8% (95% confidence interval, 4.6-5.1%) in pre-pubertal children vs 3.4% (3.5-3.3%) in post-pubertal subjects (P<0.001). Inhibition of RPD was always associated with lack of significant HR response. In pre-pubertal children receiving high concentrations of sevoflurane, RPD in response to noxious stimulation was frequently associated with lack of HR response and low BIS values. CONCLUSIONS: MACpup was higher than MAC and close to the MACBAR. Inhibition of RPD in pre-pubertal children required higher sevoflurane concentrations compared with post-pubertal subjects, suggesting that the relationship between the brain structure sensitivities may differ with brain maturation.

Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies.

BACKGROUND: Emergence agitation (EA) in children is increased after sevoflurane anaesthesia. The efficacy of prophylactic treatment is controversial. The aim of this study was to provide a meta-analysis of the studies of the pharmacological prevention of EA in children. METHODS: A comprehensive literature search was conducted to identify clinical trials that focused on the prevention of EA in children anaesthetized with sevoflurane, desflurane, or both. The data from each trial were combined using the Mantel-Haenszel model to calculate the pooled odds ratio (OR) and 95% confidence interval. I(2) statistics were used to assess statistics heterogeneity and the funnel plot and the Begg-Mazumdar test to assess bias. RESULTS: Thirty-seven articles were found which included a total of 1695 patients in the intervention groups and 1477 in the control ones. Midazolam and 5HT(3) inhibitors were not found to have a protective effect against EA [OR=0.88 (0.44, 1.76); OR=0.39 (0.12, 1.31), respectively], whereas propofol [OR=0.21 (0.16, 0.28)], ketamine [OR=0.28 (0.13, 0.60)], alpha(2)-adrenoceptors [OR=0.23 (0.17, 0.33)], fentanyl [OR=0.31 (0.18, 0.56)], and peroperative analgesia [OR=0.15 (0.07, 0.34)] were all found to have a preventive effect. Subgroup analysis according to the peroperative analgesia given does not affect the results. CONCLUSIONS: This meta-analysis found that propofol, ketamine, fentanyl, and preoperative analgesia had a prophylactic effect in preventing EA. The analgesic properties of these drugs do not seem to have a role in this effect.

Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies.

BACKGROUND: Premedication is considered important in pediatric anesthesia. Benzodiazepines are the most commonly used premedication agents. Clonidine, an alpha2 adrenoceptor agonist, is gaining popularity among anesthesiologists. The goal of the present study was to perform a meta-analysis of studies comparing premedication with clonidine to Benzodiazepines. METHODS: A comprehensive literature search was conducted to identify clinical trials focusing on the comparison of clonidine and Benzodiazepines for premedication in children. Six reviewers independently assessed each study to meet the inclusion criteria and extracted data. Original data from each trial were combined to calculate the pooled odds ratio (OR) or the mean differences (MD), 95% confidence intervals [95% CI] and statistical heterogeneity were accessed. RESULTS: Ten publications fulfilling the inclusion criteria were found. Premedication with clonidine, in comparison with midazolam, exhibited a superior effect on sedation at induction (OR=0.49 [0.27, 0.89]), decreased the incidence of emergence agitation (OR=0.25 [0.11, 0.58]) and produced a more effective early post-operative analgesia (OR=0.33 [0.21, 0.58]). Compared with diazepam, clonidine was superior in preventing post-operative nausea and vomiting (PONV). DISCUSSION: Premedication with clonidine is superior to midazolam in producing sedation, decreasing post-operative pain and emergence agitation. However, the superiority of clonidine for PONV prevention remains unclear while other factors such as nausea prevention might interfere with this result.