ABSTRACT
The objective of this study was to compare neutral detergent fiber (NDF) digestibility of corn stover that had been treated by 2 alkali treatment methods. Two experiments were conducted to test a sodium hydroxide (NaOH) treatment method that uses an ethanol/water co-solvent (NaOH/ethanol-H2O, United States Patent No. 20140220228) and a calcium hydroxide (CaOH) treatment method, which uses water as a solvent (CaOH/H2O). An in situ trial was conducted to compare NDF digestion kinetics between NaOH/ethanol-H2O-treated stover, CaOH/H2O-treated stover, untreated corn stover, and soy hulls. The digestion rate of potentially digestible NDF (kd) of NaOH/ethanol-H2O-treated corn stover (5.36%/h) was higher than CaOH/H2O-treated stover (2.27%/h), or untreated corn stover (1.76%/h) and similar to the kd of soy hulls (4.93%/h). The indigestible NDF (iNDF) fraction of untreated corn stover (35.1% of NDF) was reduced by CaOH/H2O treatment (27.3% of NDF) and by NaOH/ethanol-H2O treatment (2.8% of NDF). The iNDF fraction in soy hulls (3.6% of NDF) was similar to iNDF of NaOH/ethanol-H2O-treated stover. An in vivo digestibility trial was also conducted to compare fiber digestibility of diets supplemented with untreated corn stover, NaOH/ethanol-H2O-treated corn stover, or soy hulls. Total-tract apparent dry matter (DM) and NDF digestibility were measured with 8 lactating Holstein cows in a replicated 4 × 4 Latin square with four 21-d periods. Apparent DM digestibility (DMD) was improved when supplemental soy hulls were added to the base diet (60.0% DMD) compared with the base diet with no supplemental fiber (57.7% DMD). Apparent DM digestibility was reduced when diets were supplemented with untreated stover (52.4%). Dry matter digestibility of NaOH/ethanol-H2O-treated stover was similar (54.8% DMD) to all other treatments. Digestibility of NDF was lowest when cows were fed the diet with supplemented untreated stover (35.5% of NDF), and improved when soy hulls (40.6% of NDF) or NaOH/ethanol-H2O-treated stover (43.8% of NDF) were added to the diets. The NaOH/ethanol-H2O treatment process improves the DM and NDF digestibility of corn stover to values similar to those of soy hulls.
Subject(s)
Animal Feed , Cattle/metabolism , Detergents , Dietary Fiber/metabolism , Food Handling/methods , Alkalies , Animals , Diet , Digestion , Female , Lactation , Rumen , Silage , Zea maysABSTRACT
Transposons are mobile DNA elements that generate both adaptive and deleterious phenotypic variation thereby driving genome evolution. For these reasons, genomes have mechanisms to regulate transposable element (TE) activity. Approximately 12-16% of the Caenorhabditis elegans genome is composed of TEs, of which the majority are likely inactive. However, most studies of TE activity have been conducted in the laboratory strain N2, which limits our knowledge of the effects of these mobile elements across natural populations. We analyzed the distribution and abundance of TEs in 208 wild C. elegans strains to better understand how transposons contribute to variation in natural populations. We identified 3,397 TEs as compared with the reference strain, of which 2,771 are novel insertions and 241 are TEs that have been excised in at least one wild strain. Likely because of their hypothesized deleterious effects, we find that TEs are found at low allele frequencies throughout the population, and we predict functional effects of TE insertions. The abundances of TEs reflect their activities, and these data allowed us to perform both genome-wide association mappings and rare variant correlations to reveal several candidate genes that impact TE regulation, including small regulatory piwi-interacting RNAs and chromatin factors. Because TE variation in natural populations could underlie phenotypic variation for organismal and behavioral traits, the transposons that we identified and their regulatory mechanisms can be used in future studies to explore the genomics of complex traits and evolutionary changes.
Subject(s)
Caenorhabditis elegans/genetics , DNA Transposable Elements/genetics , Alleles , Animals , Evolution, Molecular , Gene Frequency/genetics , Genetic Variation/genetics , Genome-Wide Association Study , GenomicsABSTRACT
Alkaline treatment of gramineous crop residues can convert an abundant, minimally utilized, poorly digestible straw into a moderately digestible feedstuff. Given the volatile nature of grain prices, substitution of treated stover for grain was investigated with dairy cows to provide insights on ruminal and digestibility effects of a feed option that makes use of alternative, available resources. The objective of this study was to evaluate changes in diet digestibility and ruminal effects when increasing levels of calcium oxide-treated corn stover (CaOSt) were substituted for corn grain in diets of lactating cows. Mature corn stover was treated with calcium oxide at a level of 50gâkg(-1) dry matter (DM), brought up to a moisture content of 50% following bale grinding, and stored anaerobically at ambient temperatures for greater than 60d before the feeding experiment. Eight ruminally cannulated Holstein cows averaging 686kg of body weight and 35kg of milkâd(-1) were enrolled in a replicated 4×4 Latin square, where CaOSt replaced corn grain on a DM basis in the ration at rates of 0, 40, 80, and 120gâkg(-1) DM. All reported significant responses were linear. The DM intake declined by approximately 1kg per 4% increase in CaOSt inclusion. With increasing replacement of corn grain, dietary neutral detergent fiber (NDF) concentration increased. However, rumen NDF turnover, NDF digestibility, NDF passage rate, and digestion rate of potentially digestible NDF were unaffected by increasing CaOSt inclusion. Total-tract organic matter digestibility declined by 5 percentage units over the range of treatments, approximately 1.5 units per 4-percentage-unit substitution of CaOSt for grain. With increasing CaOSt, the molar proportions of butyrate and valerate declined, whereas the lowest detected ruminal pH increased from 5.83 to 5.94. Milk, fat, and protein yields declined as CaOSt increased and DM intake declined with the result that net energy in milk declined by approximately 1 Mcal per 4% increase in CaOSt. Time spent ruminating (minâkg(-1) DM intake) increased with increasing CaOSt, though total minutes per day were unaffected. These insights on the effect of substitution of treated corn stover for corn grain may be used to predict the effect on nutrient supply to the cow over a range of substitution levels. The acceptability of the effect will depend on the economics of milk production and availabilities of feedstuffs.
Subject(s)
Cattle/metabolism , Lactation , Zea mays/metabolism , Animal Feed , Animal Nutritional Physiological Phenomena , Animals , Diet/veterinary , Dietary Fiber/metabolism , Digestion , Female , Fermentation , Milk/chemistry , Rumen/metabolism , Starch/metabolismABSTRACT
The objective of this trial was to evaluate, in dairy cattle, the effects of calcium hydroxide treatment of whole-plant corn and a treatment applied to the bottom stalk fraction of the corn plant, achieved by harvesting corn in 2 crop streams. The treatments were calcium hydroxide-treated corn silage (TRTCS), toplage supplemented with calcium hydroxide-treated stalklage (TPL), a positive control of brown midrib corn silage (BMR), and a negative control of conventional whole-plant corn silage (WPCS). The toplage was harvested at a height of 82 cm with 2 of the 6 rows set as ear-snapping to incorporate higher tissues into the stalklage. Stalklage was harvested at 12 cm, and other corn silages were harvested at 27 cm. Sixteen pens, each with 8 Holstein cows averaging 70±25 d in milk and 46±11 kg of milk d(-1), were assigned 4 per treatment in a completely randomized design. The diet was approximately 40% corn silage, 20% alfalfa silage, and 40% concentrate on a dry matter basis. A 2-wk covariate period with conventional corn silage was followed by an 8-wk treatment period in which the 4 corn silage treatments were the only effective difference in diets. Cows fed TPL and TRTCS consumed more (1.9 and 1.4 kg of organic matter d(-1), respectively) than did cows fed WPCS. Milk yield was greater for cows fed BMR, TPL, and TRTCS. Cows fed BMR and TPL produced 2.9 and 2.7 kg d(-1), respectively, more energy-corrected milk (ECM) than cows fed WPCS, and cows fed TRTCS had the greatest ECM production (4.8 kg of ECM d(-1) greater than cows fed WPCS). No differences in body weight or body condition scored were observed. Milk fat concentration was similar among treatments and milk protein concentration was reduced for TRTCS. Starch and neutral detergent fiber digestibility were greater for cows fed TRTCS.
Subject(s)
Calcium Hydroxide/metabolism , Cattle/physiology , Dietary Fiber/metabolism , Feeding Behavior/drug effects , Milk/metabolism , Zea mays/chemistry , Alkalies/chemistry , Animals , Calcium Hydroxide/administration & dosage , Dairying , Diet/veterinary , Dietary Fiber/administration & dosage , Dietary Supplements/analysis , Female , Lactation/drug effects , Milk/drug effects , Random Allocation , Silage/analysisABSTRACT
Ruminal digestion of neutral detergent fiber (NDF) is affected in part by the proportion of NDF that is indigestible (iNDF), and the rate at which the potentially digestible NDF (pdNDF) is digested. Indigestible NDF in forages is commonly determined as the NDF residue remaining after long-term in situ or in vitro incubations. Rate of pdNDF digestion can be determined by measuring the degradation of NDF in ruminal in vitro or in situ incubations at multiple time points, and fitting the change in residual pdNDF by time with log-transformed linear first order or nonlinear mathematical treatments. The estimate of indigestible fiber is important because it sets the pool size of potentially digestible fiber, which in turn affects the estimate of the proportion of potentially digestible fiber remaining in the time series analysis. Our objective was to compare estimates of iNDF based on in vitro (IV) and in situ (IS) measurements at 2 fermentation end points (120 and 288h). Further objectives were to compare the subsequent rate, lag, and estimated total-tract NDF digestibility (TTNDFD) when iNDF from each method was used with a 7 time point in vitro incubation of NDF to model fiber digestion. Thirteen corn silage samples were dried and ground through a 1-mm screen in a Wiley mill. A 2×2 factorial trial was conducted to determine the effect of time of incubation and method of iNDF analysis on iNDF concentration; the 2 factors were method of iNDF analysis (IS vs. IV) and incubation time (120 vs. 288h). Four sample replicates were used, and approximately 0.5g/sample was weighed into each Ankom F 0285 bag (Ankom Technology, Macedon, NY; pore size=25 µm) for all techniques. The IV-120 had a higher estimate of iNDF (37.8% of NDF) than IS-120 (32.1% of NDF), IV-288 (31.2% of NDF), or IS-288 technique (25.7% of NDF). Each of the estimates of iNDF was then used to calculate the rate of degradation of pdNDF from a 7 time point in vitro incubation. When the IV-120 NDF residue was used, the subsequent rates of pdNDF digestion were fastest (2.8% h(-1)) but the estimate of lag was longest (10.3h), compared with when iNDF was based on the IS-120 or IV-288 NDF residues (rates of 2.3%h(-1) and 2.4%h(-1); lag times of 9.7 and 9.8 h, respectively). Rate of pdNDF degradation was slowest (2.1% h(-1)) when IS-288 NDF residue was used as the estimate of iNDF. The estimate of lag based on IS-288 (9.4h) was similar to lag estimates calculated when IS-120 or IV-288 were used as the estimate of iNDF. The TTNDFD estimates did not differ between treatments (35.5%), however, because differences in estimated pools of iNDF resulted in subsequent changes in rates and lag times of fiber digestion that tended to cancel out. Estimates of fiber digestion kinetic parameters and TTNDFD were similar when fit to either the linear or nonlinear fiber degradation models. All techniques also yielded estimates of iNDF that were higher than predicted iNDF based on the commonly used ratio of 2.4 × lignin.
Subject(s)
Cattle/physiology , Dairying/methods , Dietary Fiber/analysis , In Vitro Techniques/veterinary , Silage/analysis , Animal Nutritional Physiological Phenomena , Animals , Diet/veterinary , Digestion , Female , Fermentation , In Vitro Techniques/methods , Kinetics , Models, Theoretical , Rumen/metabolism , Time FactorsABSTRACT
Our objective was to evaluate the effects of replacing either corn or alfalfa silage with tall fescue hay on total-tract neutral detergent fiber (NDF) digestibility and lactation performance in dairy cows. Twenty-four primiparous (75±35 d in milk) and 40 multiparous (68±19 d in milk) Holstein cows were blocked by parity and randomly assigned to 1 of 4 treatment groups in a pen equipped with 32 feeding gates to record intake by cow. Each gate was randomly assigned to 1 treatment group; thus, each cow had access to all 8 gates within the respective treatment and cow was the experimental unit. Treatments were formulated to replace either corn silage (CS) or alfalfa silage (AS) with tall fescue hay (TF) as follows (DM basis): 33% AS and 67% CS (control; 33AS67CS), 60% TF and 40% AS (60TF40AS), 60% TF and 40% CS (60TF40CS), and 33% TF and 67% CS (33TF67CS). The experiment was a 7-wk continuous lactation trial with a 2-wk covariate period. Milk production did not differ among treatments and averaged 40.4 kg/d. Fat yield and concentration and protein yield and concentration did not differ among treatments and averaged 1.58 kg/d, 3.94%, 1.28 kg/d, and 3.15%, respectively. Dry matter intake was greater for 33AS67CS (24.5 kg/d) compared with 60TF40CS (22.1 kg/d) and 33TF67CS (22.7 kg/d), and tended to be greater than 60TF40AS (23.2 kg/d). In vivo total-tract dry matter digestibility did not differ among treatments and averaged 66.2%. In vivo total-tract NDF digestibility was lower for 33AS67CS (37.8%) compared with 60TF40AS (44.4%) and 33TF67CS (45.3%), and similar to 60TF40CS (42.4%). In vivo total-tract NDF digestibility and an estimate of in situ total-tract NDF digestibility were similar between techniques across all treatment diets (42.3 vs. 42.6%, respectively). Inclusion of tall fescue grass hay increased the total-tract NDF digestibility of the diet and has the potential to replace corn silage and alfalfa silage and maintain milk production if economically feasible based on current market prices.
Subject(s)
Cattle/physiology , Digestion/drug effects , Festuca/chemistry , Lactation/drug effects , Silage/analysis , Animal Nutritional Physiological Phenomena/drug effects , Animals , Dairying , Diet/veterinary , Dietary Fiber/analysis , Female , Medicago sativa/chemistry , Milk/metabolism , Models, Biological , Random Allocation , Zea mays/chemistryABSTRACT
An in vivo study was performed to test an in vitro procedure and model that predicts total-tract neutral detergent fiber (NDF) digestibility for lactating dairy cattle. Corn silage (CS) and alfalfa silage (AS) were used as forages for this study. These forages had similar NDF composition, but fiber in the CS contained less indigestible NDF compared with AS (35.5 and 47.8% of indigestible NDF, respectively). The in vitro method estimated rate of digestion of alfalfa potentially digestible NDF to be approximately 2 times faster than CS fiber (6.11 and 3.21%/h, respectively). Four diets were formulated containing different proportions of CS to AS: 100CS:0AS, 67CS:33AS, 33CS:67AS, and 0CS:100AS, as percentage of diet DM basis. The objective was to construct diets that contained approximately similar levels of NDF but with different pool sizes and rates of digestion of potentially digestible NDF. Diets were fed to 8 ruminally cannulated, multiparous, lactating dairy cows in a replicated 4×4 Latin square with 21-d periods. Total-tract fiber digestibility and fiber digestion kinetic parameters observed in vivo were compared with the values predicted by the in vitro assay and model. Total-tract NDF digestibility coefficients were similar (41.8 and 40.6% of total NDF) for the in vitro and in vivo methods, respectively. As the proportion of dietary alfalfa increased, the digestibility of NDF increased. The rate of digestion of potentially digestible NDF predicted from the in vitro assay was also similar to what was observed in vivo. Results suggest that the in vitro total-tract NDF digestibility model could be used to predict rate of fiber digestion and NDF digestibility for lactating dairy cattle.
Subject(s)
Animal Feed/analysis , Medicago sativa/chemistry , Silage/analysis , Zea mays/chemistry , Animal Nutritional Physiological Phenomena , Animals , Cattle , Diet/veterinary , Dietary Fiber/analysis , Digestion , Female , Lactation , Milk/chemistry , Rumen/metabolismABSTRACT
An in vivo study was performed to validate an in vitro procedure that predicts rate of fiber digestion and total-tract neutral detergent fiber digestibility (TTNDFD). Two corn silages that differed in fiber digestibility were used in this trial. The corn silage with lower fiber digestibility (LFDCS) had the TTNDFD prediction of 36.0% of total NDF, whereas TTNDFD for the corn silage with higher fiber digestibility (HFDCS) was 44.9% of total neutral detergent fiber (NDF). Two diets (1 with LFDCS and 1 with HFDCS) were formulated and analyzed using the in vitro assay to predict the TTNDFD and rumen potentially digestible NDF (pdNDF) digestion rate. Similar diets were fed to 8 ruminally cannulated, multiparous, high-producing dairy cows in 2 replicated 4×4 Latin squares with 21-d periods. A 2×2 factorial arrangement of treatments was used with main effects of intake (restricted to approximately 90% of ad libitum intake vs. ad libitum) and corn silage of different fiber digestibility. Treatments were restricted and ad libitum LFDCS as well as restricted and ad libitum HFDCS. The input and output values predicted from the in vitro model were compared with in vivo measurements. The pdNDF intake predicted by the in vitro model was similar to pdNDF intake observed in vivo. Also, the pdNDF digestion rate predicted in vitro was similar to what was observed in vivo. The in vitro method predicted TTNDFD of 50.2% for HFDCS and 42.9% for LFDCS as a percentage of total NDF in the diets, whereas the in vivo measurements of TTNDFD averaged 50.3 and 48.6% of total NDF for the HFDCS and LFDCS diets, respectively. The in vitro TTNDFD assay predicted total-tract NDF digestibility of HFDCS diets similar to the digestibility observed in vivo, but for LFDCS diets the assay underestimated the digestibility compared with in vivo. When the in vitro and in vivo measurements were compared without intake effect (ad libitum and restricted) considering only diet effect of silage fiber digestibility (HFDCS and LFDCS), no differences were observed between methods. These values suggest that our in vitro TTNDFD model could be used to predicted rate of fiber digestion and NDF digestibility for dairy cattle.
Subject(s)
Cattle/physiology , Dairying/methods , Diet/veterinary , Dietary Fiber/metabolism , Digestion/physiology , Models, Biological , Animal Nutritional Physiological Phenomena , Animals , Feeding Behavior , Female , Gastrointestinal Tract/metabolism , Lactation , Rumen/metabolism , Silage/analysis , Zea mays/chemistryABSTRACT
Identifying genetic and metabolic biomarkers in neonates has the potential to improve diagnosis and treatment of common complex neonatal diseases, and potentially lead to risk assessment and preventative measures for common adulthood illnesses such as diabetes and cardiovascular disease. There is a wealth of information on using fatty acid, amino acid and organic acid metabolite profiles to identify rare inherited congenital diseases through newborn screening, but little is known about these metabolic profiles in the context of the 'healthy' newborn. Recent studies have implicated many of the amino acid and fatty acid metabolites utilized in newborn screening in common complex adult diseases such as cardiovascular disease, insulin resistance and obesity. To determine the heritability of metabolic profiles in newborns, we examined 381 twin pairs obtained from the Iowa Neonatal Metabolic Screening Program. Heritability was estimated using multilevel mixed-effects linear regression adjusting for gestational age, gender, weight and age at time of sample collection. The highest heritability was for short-chain acylcarnitines, specifically C4 (h²=0.66, P=2 × 10⻹6), C4-DC (h²=0.83, P<10⻹6) and C5 (h²=0.61, P=1 × 10â»9). Thyroid stimulating hormone (h²=0.58, P=2 × 10â»5) and immunoreactive trypsinogen (h²=0.52, P=3 × 10â»9) also have a strong genetic component. This is direct evidence for a strong genetic contribution to the metabolic profile at birth and that newborn screening data can be utilized for studying the genetic regulation of many clinically relevant metabolites.
Subject(s)
Inheritance Patterns , Metabolome/genetics , Twins, Dizygotic/genetics , Twins, Monozygotic/genetics , Birth Weight , Carnitine/analogs & derivatives , Carnitine/blood , Carnitine/genetics , Female , Gestational Age , Humans , Infant, Newborn , Linear Models , Male , Neonatal Screening , Thyrotropin/blood , Thyrotropin/genetics , Trypsinogen/blood , Trypsinogen/geneticsABSTRACT
OBJECTIVE: To compare the oral absorption profile of gabapentin following administration of the contents of opened capsules that were mixed with food vehicles of varied macronutrient (protein) composition. DESIGN: An unblinded, randomized, single-dose, four-way crossover pharmacokinetic study in nine healthy adult men and women volunteers. METHODS: Following an overnight fast, a single 600-mg dose of gabapentin (2 x 300-mg Neurontin capsules) was given either as an intact capsule swallowed with 120 mL of tap water (control, phase I), or after capsule contents were opened and mixed with; 4 oz. of applesauce (phase II), 120 mL of orange juice (phase III), or 4 oz. of fat-free chocolate pudding (phase IV). Subjects fasted for 4 hours following drug ingestion. Serial venous blood samples were obtained over 24 hours to determine gabapentin serum concentrations. Pharmacokinetic variables including AUC, maximum serum concentration (Cmax), and time to maximum serum concentration (tmax) were calculated by using standard noncompartmental methods. Subjects served as their own controls, and were randomly crossed over following a minimum 7-day washout period. Statistical analysis was performed by using ANOVA and Student's t-test where appropriate. RESULTS: No statistically significant differences in any kinetic variable were found between any study arm. A trend was noted for a modest increase in both Cmax and AUC in phase IV (chocolate pudding) compared with control (+18.6% and +13.2%, respectively). In a comparison of protein (phase IV) versus nonprotein phases (phases I-III), gabapentin AUC was 26% greater (47.28+/-14.65 vs. 37.43+/-9.78 microg/mL x h; p = 0.03), and Cmax was 32% higher (4.72+/-1.04 vs. 3.56+/-0.92 microg/mL; p = 0.003). CONCLUSIONS: Opening and mixing the contents of gabapentin capsules does not significantly impair drug absorption. This may be a viable administration option for patients who are unable to swallow intact capsules. Dietary macronutrient composition (i.e., protein) may favorably influence gabapentin oral absorption.
Subject(s)
Acetates/pharmacokinetics , Amines , Anticonvulsants/pharmacokinetics , Cyclohexanecarboxylic Acids , Food-Drug Interactions , gamma-Aminobutyric Acid , Acetates/blood , Adult , Anticonvulsants/blood , Area Under Curve , Cross-Over Studies , Dietary Carbohydrates/pharmacology , Dietary Fats/pharmacology , Dietary Proteins/pharmacology , Female , Gabapentin , Humans , MaleABSTRACT
OBJECTIVE: To report a case of successful desensitization to dapsone for Pneumocystis carinii pneumonia (PCP) prophylaxis in a patient unable to tolerate trimethoprim/sulfamethoxazole (TMP/SMX) desensitization or dapsone at standard doses. CASE SUMMARY: A 37-year-old HIV-positive African-American man was treated for pneumonia with TMP/SMX and then continued on the drug for PCP prophylaxis. After experiencing a pruritic maculopapular rash with TMP/SMX, both at standard doses and after attempting a desensitization regimen to the drug, he was started on dapsone for PCP prophylaxis. He experienced a rash and fever after taking dapsone at standard PCP prophylactic doses. At this time, an 18-day oral dapsone rechallenge by dose escalation was attempted, and it was well tolerated. CONCLUSIONS: This case suggests that utilization of a dapsone desensitization regimen may permit a viable treatment option in patients previously thought to be intolerant to the agent. More regimens of this type should be attempted and the results published, using both dapsone and TMP/SMX, so that standard desensitization treatment guidelines may eventually be adopted.
Subject(s)
AIDS-Related Opportunistic Infections/prevention & control , Anti-Infective Agents/therapeutic use , Dapsone/therapeutic use , Desensitization, Immunologic , Pneumonia, Pneumocystis/prevention & control , Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects , AIDS-Related Opportunistic Infections/drug therapy , Adult , Anti-Infective Agents/adverse effects , Drug Hypersensitivity/therapy , HIV Seropositivity , Humans , Male , Pneumonia, Pneumocystis/drug therapyABSTRACT
The following report illustrates a case of trimethoprim/sulfamethoxazole-induced hypoprothrombinemia in a patient receiving ongoing warfarin therapy for atrial fibrillation and aortic valve replacement. He was treated with trimethoprim/sulfamethoxazole (TMP/SMX) for sinusitis. During this time, the patient's prothrombin time international normalized ratio (INR) increased 3.5 times higher than the baseline value. The INR values decreased when the antibiotic was discontinued. If a patient is on warfarin and TMP/SMX is added, INR values should be monitored closely.
Subject(s)
Hypoprothrombinemias/chemically induced , Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects , Aged , Aortic Valve , Atrial Fibrillation/drug therapy , Drug Interactions , Heart Valve Prosthesis , Humans , Male , Prothrombin Time , Sinusitis/drug therapy , Trimethoprim, Sulfamethoxazole Drug Combination/pharmacology , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Warfarin/pharmacology , Warfarin/therapeutic useABSTRACT
As part of a general medical curriculum renewal, a new one-week course in diagnostic radiology was given to students at the beginning of their third year. The course format consisted of didactic presentations to the entire class, a single afternoon session of small group discussions of unknowns, and three daily case-of-the-day unknowns with prizes for correct responses. One hundred fifty-eight students were tested on the first and last days of the course; testing consisted of two parallel 46-item multiple choice questions given in a crossed design. Questions covered radiographic anatomy and pathology as well as proper test ordering. Differences in achievement before and after the course as measured by the pre- and post-tests were highly significant. The class achieved a mean of 27 (59%) correct responses on the pre-test and a mean of 37 (80%) on the post-test (F(1156) = 15.79; P less than .001). The reliability coefficient of the pre- and post-tests was about .30. A course critique was returned by 88 students. There was anticipated variation in the evaluations of the different didactic lecturers. Instructors receiving the highest scores were cited for their enthusiasm, clarity, and the relevance of their presentation. Conversely, those receiving low marks were cited as being unenthusiastic and boring, merely presenting example after example of radiographic abnormalities with little explanation. The afternoon small group discussions were perceived as the best part of the course. Despite the fact that moderator experience ranged from second year resident to full professor, the seminars received uniformly positive comments.
Subject(s)
Education, Medical , Radiography/education , Evaluation Studies as TopicABSTRACT
Five pediatric patients with primary liver tumors were evaluated preoperatively with ultrasound (US), computerized tomography (CT), and angiography, and tentative operative plans were formulated. Intraoperative US was subsequently used to examine these children, resulting in changes in operative strategy of all five patients despite their extensive preoperative evaluations. Intraoperative ultrasound appears to provide the most accurate assessment of both the extent of tumor and its vascular relationships. Thus, operative strategies may be precisely tailored on the basis of such information, allowing rational resection where appropriate, while futile attempts at removal of inoperable lesions may be averted.
Subject(s)
Carcinoma, Hepatocellular/surgery , Hamartoma/surgery , Liver Neoplasms/surgery , Ultrasonography , Carcinoma, Hepatocellular/blood supply , Child , Female , Humans , Infant , Intraoperative Period , Liver Neoplasms/blood supply , MaleSubject(s)
Emblems and Insignia/trends , Philosophy, Medical , Wit and Humor as Topic , Humans , United StatesSubject(s)
Physical Examination/methods , Physicians , Schools , Sports , Colorado , Humans , Malpractice , School Health ServicesSubject(s)
Politics , State Medicine/trends , Aged , Cost Control/trends , Health Services for the Aged/trends , Humans , United StatesABSTRACT
To determine whether renal ultrasound (US) is necessary in all patients with azotemia, the authors retrospectively evaluated renal US examinations in 394 azotemic patients. The patients included 119 patients considered clinically to be at high risk for postrenal urinary obstruction and 275 patients considered to be at low risk. In the high-risk population, 35 patients were found to have hydronephrosis (29%). In the low-risk population, three patients were found to have hydronephrosis (1%). In two of these patients surgical intervention resulted in reversal of the azotemia. The authors recommend that renal US be performed in all high-risk patients and in low-risk patients only if temporization and standard medical treatment do not resolve the azotemia.
Subject(s)
Hydronephrosis/diagnosis , Ultrasonography , Uremia/diagnosis , Humans , Hydronephrosis/complications , Retrospective Studies , Risk Factors , Uremia/etiologyABSTRACT
Scans of 14 patients with hemoglobin levels of 7.6 to 10.2 grams/deciliter (gm/dL) were positive for the diagnosis of anemia. All demonstrated the interventricular septum and ascending and descending aortic walls. Scans of 23 patients with hemoglobin levels of 10.5 to 12.8 gm/dL were positive for the diagnosis of anemia in 11 and negative in 12. The ascending and descending aortic walls were seen 39% and 48% of the time, respectively. Scans of 13 patients with hemoglobin levels of 12.9 to 16.0 gm/dL were negative for the diagnosis of anemia.