Outcome measures for chronic rhinosinusitis with nasal polyps.

BACKGROUND: With the recent proliferation of novel therapeutics for chronic rhinosinusitis with nasal polyps (CRSwNP), there is an immediate need for comprehensive means to assess CRSwNP disease status as well as to determine treatment efficacy. Outcome measures exist in different forms. Patient-reported outcome measures (PROMs) allow patients to provide direct input about their condition that is not possible to obtain in any other way. Common constructs that are measured using PROMs include quality of life or the burden of disease manifestations (e.g., symptom severity). Outcomes may also include the results of objective diagnostic testing/measurement of clinical signs or measured using psychophysical tests. Biomarkers represent an emerging class of outcome measures for CRSwNP and are chosen to directly reflect the active pathophysiologic processes of CRSwNP in the peripheral blood, sinus/polyp tissues, and sinonasal mucus. METHODS: Narrative review of the literature, identifying and describing outcome measures that may be used in the evaluation of CRSwNP and for assessment of treatment responses. RESULTS: In this review, we identify many different outcome measures for CRSwNP that fall under the categories of PROM, objective test, psychophysical test or biomarker. We describe the history of each - including seminal studies - and demonstrate the formal validation, psychometric performance, and limitations of each. CONCLUSIONS: PROMs, objective tests, psychophysical tests and biomarkers represent different classes of outcome measures that are complementary means of assessing CRSwNP disease status and treatment efficacy. The choice or interpretation of a CRSwNP outcome measure should be undertaken with full knowledge of its formal validation, psychometric performance, and limitations.

Features of inhalant allergy on nasal endoscopy: a systematic review and meta-analysis.

BACKGROUND: Nasal endoscopy is increasingly accessible to ENT surgeons. The characteristics of the allergic upper airway are not well recognised. METHODOLOGY: MEDLINE (1946-2021), EMBASE (1974-2021), and the Cochrane Library were searched on 16th November 2021 to identify articles that reported endoscopic findings of patients with documented allergy who had undergone nasal endoscopy. The review followed the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Meta-analysis was performed by pooling sensitivities and specificities using the hierarchical summary receiver operating characteristics model. RESULTS: A total of 4108 articles were identified, of which 15 manuscripts met the inclusion criteria. The included studies involved 4660 patients who had undergone nasal endoscopy. Middle turbinate (diffuse/polypoid) oedema (sensitivity 58.0%, specificity 84.5%), watery secretions (sensitivity 65.7%, specificity 76.5%), inferior turbinate hypertrophy (sensitivity 86.2%, specificity 32.2%), and unspecified turbinate hypertrophy (sensitivity 82.0%, specificity 42.9%) were identified as the features with the highest predictive value of inhalant allergy. CONCLUSIONS: Diffuse or polypoid oedema of the middle turbinate or watery secretions seen on nasal endoscopy can be a useful adjunct in the identification and diagnosis of inhalant allergy. These clinical features should be part of the diagnostic workup for patients that includes a clinical history and surrogate markers of allergic sensitisation from the skin and serum.

Phosphaturic Mesenchymal Tumors in the Head and Neck Demonstrate a Broad Clinical and Morphologic Spectrum.

Phosphaturic mesenchymal tumour (PMT) is a rare tumour that occurs in bone or soft tissue and is associated with production of fibroblast growth factor 23 (FGF23) leading to tumor-induced osteomalacia. We report three cases of PMT involving the head and neck that highlight the broad spectrum of clinical and histologic features of PMT. One of these lesions from the hard palate demonstrated an admixture of epithelial and mesenchymal elements, a feature that can pose a diagnostic challenge. The diagnostic utility of immunohistochemistry including FGF23, somatostatin receptor 2A, SATB2, ERG and CD56 is discussed. The biochemical pathway in the development of PMT associated tumor induced osteomalacia and its role in investigations and management of PMT is also described.

Imidazoline use in sinonasal surgery.

The nasal mucosa is very vascular, receiving more blood flow per cubic centimeter of tissue than does muscle, brain or liver (Drettner and Aust, 1974; [1]). This vascularity can present a major problem during sinus surgery. Surgeons routinely use topical vasoconstrictors in endoscopic sinus surgery however, the optimal regimen is not clear. Imidazoline nasal sprays are often used up to 1hour before sinonasal surgery to aid in intraoperative vasoconstriction. After the induction of anaesthesia, epinephrine-based topical and submucosal preparations are subsequently administered to further enhance vasoconstriction. Imidazolines are non-selective, partial alpha adrenoceptor agonists with a higher affinity, yet lower potency, for alpha adrenoceptors when compared to epinephrine. It is hypothesized that imidazolines block the action of epinephrine on the alpha adrenoceptors of the nasal mucosa resulting in less vasoconstriction, and a poorer intra-operative field, when compared to the use of epinephrine alone. This paper hypothesizes that preoperative imidazoline administration may adversely affect optimal intra-operative vasoconstriction.

Reducing the length of time between slaughter and the secondary gonadotropin-releasing factor immunization improves growth performance and clears boar taint compounds in male finishing pigs.

The objective of this study was to evaluate whether altering the timing of the secondary anti-gonadotropin-releasing factor (GnRF) immunization closer to slaughter in male finishing pigs would reduce the increase in P2 fat depth (6.5 cm from the midline over the last rib), while still limiting the incidence of boar taint. Entire male pigs are immunized against GnRF to reduce the concentration of testicular steroids that in turn limits the incidence of boar taint. Additionally, testicle measurements and color measurements were taken to examine whether they could be used to differentiate nonimmunized entire males from immunized male pigs. A total of 175 Large White × Landrace entire male pigs aged 16 wk (59 kg of BW) were used in a completely randomized design with 5 treatment groups based on the time that pigs received the secondary immunization before slaughter. Pigs were housed in groups of 7 and randomly allocated to 1 of 5 treatments with 5 replicates per treatment. The treatment groups were as follows: no secondary immunization before slaughter, and the secondary immunization given at 2, 3, 4, or 6 wk before slaughter. The P2 fat depth levels were reduced (P = 0.054) with the secondary immunization closer to slaughter (11.7, 11.3, 12.8, 12.6, and 13.7 mm for no secondary immunization, secondary immunization at 2, 3, 4, and 6 wk before slaughter, respectively). Androstenone concentration did not exceed the generally accepted industry sensory threshold of 1.0 µg/g of fat, and both androstenone concentration in the adipose tissue and testosterone concentrations in the blood were suppressed (P < 0.001) in all immunized pigs regardless of timing of the secondary immunization compared with pigs that did not receive the secondary immunization. Skatole concentration of all pigs in the experiment did not exceed the generally accepted industry sensory threshold of 0.2 µg/g. Testes weight was reduced (P < 0.001) with increased time between slaughter and the secondary immunization. Immunized pigs, regardless of time before slaughter, had greater L* (lightness) and b* (yellowness) color of the testicle surface (P < 0.001 and P = 0.020, respectively), and less a* (redness) color compared with entire males (P < 0.001). The study provides further evidence of the efficacy of the anti-GnRF immunization and indicates that the secondary immunization can be moved closer to slaughter, while still limiting the incidence of boar taint. Testicle measurements and color measurements together could provide a method of discrimination between carcasses from immunized entire males clear of boar taint and tainted carcasses.

Management of otitis media with effusion in children with primary ciliary dyskinesia: a literature review.

OBJECTIVE: Primary ciliary dyskinesia is an autosomal recessively inherited group of disorders of ciliary ultrastructure. Otolaryngologists are frequently involved in the management of some of the most common symptoms of primary ciliary dyskinesia including chronic rhinitis, sinusitis and otitis media with effusion. A dilemma for otorhinolaryngologists is whether ventilation tubes are of benefit in children with primary ciliary dyskinesia and otitis media with effusion and what effective alternatives exist. This paper aims to address this issue via a literature review and case presentation. METHODS: An extensive review of the literature was undertaken and a discussion of the advantages and disadvantages of ventilation tubes in the management of otitis media with effusion in these children is presented and compared with that of the general population. We present a case of a 9 months old boy with Kartagener's Syndrome and chronic bilateral otitis media with effusion to illustrate our findings. RESULTS: Eight papers were identified, all with small study numbers. The main outcome measures were hearing, otorrhoea and tympanic membrane structural changes. The natural history of otitis media with effusion and hearing loss in primary ciliary dyskinesia appears to be fluctuant into adulthood. Therefore, otitis media with effusion in primary ciliary dyskinesia does not resolve by the age of 9 years, regardless of treatment, as previously assumed. Ventilation tube insertion improves hearing in primary ciliary dyskinesia, but may lead to a higher rate of otorrhoea when compared to the general population. Tympanic membrane changes were clinically insignificant. Our patient eventually underwent successful insertion of bilateral ventilation tubes with a marked improvement in hearing and language with minimal otorrhoea. CONCLUSION/DISCUSSION: The highest level of evidence found for the management of otitis media with effusion in children with primary ciliary dyskinesia was level IV. Currently, the evidence is inconclusive and conflicting. Whilst our results are promising, clearly higher quality research on a larger number of patients is required to definitively evaluate the management options for otitis media with effusion in these children.

Long-term, but not short-term, treatment with somatotropin during pregnancy in underfed pigs increases the body size of progeny at birth.

Treatment of pigs with porcine ST (pST) in early to mid-pregnancy increases body weight and length of their fetuses by mid-pregnancy, but this increased weight may not persist to birth. We investigated the effects of short- (25 d) and long-term (75 d) treatment with pST, and interactions between long-term pST treatment and crude protein content of diet, in restricted-fed gilts. In both experiments, Large White x Landrace gilts were bred at first estrus to Large White x Duroc boars and allowed to farrow naturally. In the first experiment, gilts were fed 1.8 kg/d of a diet containing 13.5 MJ DE/kg of DM and 15.05% CP (as-fed basis) throughout pregnancy, and were injected daily with 0, 2, or 4 mg pST from d 25 to 50 of pregnancy. Maternal treatment with pST from d 25 to 50 of pregnancy did not affect the number of piglets born per litter or progeny size at birth. In the second experiment, gilts were injected daily with 0 or 2 mg of pST and fed 2.2 kg/d of a diet containing 14.5 MJ DE/kg and either (as-fed basis) 16.6% (0.81% lysine) or 22.2% CP (1.16% lysine) from d 25 to 100 of pregnancy. All gilts were then fed 3.0 kg/d of the lower protein diet from d 100 of pregnancy to farrowing. Treatment with 2 mg pST/d from d 25 to 100 of pregnancy increased live weight of all gilts during the treatment period (P = 0.016), but the change in maternal live weight from d 25 to 100 of pregnancy was only increased (P = 0.001) by pST in gilts fed the higher protein diet. Live weight of gilts 1 d after farrowing was increased by pST treatment (P = 0.007), but was not altered by protein content of diet during pregnancy. In gilts fed the lower protein diet, but not in those fed the higher protein diet, pST treatment decreased maternal backfat depth during treatment (P < 0.020) and 1 d after farrowing (P = 0.002). Treatment with pST during pregnancy did not affect the number of piglets born per litter but independently increased body weight by 11.6% (P < 0.001) and length by 3.4% (P = 0.005) of progeny at birth and decreased (P < 0.01) the negative effect of litter size on body weight at birth. We conclude that in feed-restricted gilts, fetal weight gains in response to 25 d of pST treatment before mid-pregnancy are not maintained to term but that treatment with pST during most of pregnancy increases progeny size at birth and reduces maternal constraint of fetal growth.

Manipulation of growth in pigs through treatment of the neonate with clenbuterol and somatotropin.

Neonatal pigs were treated with lipolytic agents to determine whether this would cause a long-term decrease in their ability to deposit fat, with a consequent increase in muscle growth and feed efficiency. Groups of 25 female piglets were given clenbuterol (100 microg/kg BW), porcine somatotropin (pST; 100 microg/kg BW), pST plus clenbuterol, or saline injections from 3 d to 40 d of age. Five piglets from each group were then slaughtered to determine body composition. Clenbuterol and pST both increased ADG up to weaning when given separately (24%, P < 0.05; 20%, P < 0.1 respectively) but did not reduce fat deposition. In contrast, pigs given clenbuterol plus pST showed no increase in ADG and a 41% reduction in carcass fat (P < 0.05). Clenbuterol caused a marked decrease in beta2-adrenoceptor density in porcine adipose tissue (P < 0.001) and skeletal muscle (P < 0.01). This effect was attenuated by concurrent pST treatment, which helps to explain the synergistic effect of these drugs on fat deposition. Once the drugs were withdrawn at 40 d, the anabolic effect of pST gradually disappeared, so that the live weight of pST-treated and control pigs was identical at 168 d. Clenbuterol withdrawal caused the rapid loss of extra weight gained, plus an additional 4 to 5 kg live weight that was never recovered. During the 4-wk finishing period there was an increase in feed intake in pigs that had previously undergone treatment with pST (23%, P < 0.1), with no increase in ADG, and so feed efficiency was impaired (P < 0.05). Pigs that were treated with pST plus clenbuterol showed no marked increase in feed intake during this period. Carcasses from clenbuterol-treated pigs tended to be leaner at 168 d, but there was no long-term effect of pST or the combined treatment on carcass composition. Overall, the treatment of neonatal pigs with repartitioning agents was counter-productive, due to the withdrawal effects of the beta-adrenefgic agonist and the delayed long-term effect of pST on feed intake.

Effect of dietary betaine on nutrient utilization and partitioning in the young growing feed-restricted pig.

The purpose of this study was to examine the effects of dietary betaine over a range of concentrations (between 0 and 0.5%) on growth and body composition in young feed-restricted pigs. Betaine is associated with decreased lipid deposition and altered protein utilization in finishing pigs, and it has been suggested that the positive effects of betaine on growth and carcass composition may be greater in energy-restricted pigs. Thirty-two barrows (36 kg, n = 8 pigs per group) were restrictively fed one of four corn-soybean meal-skim milk based diets (18.6% crude protein, 3.23 Mcal ME/kg) and supplemented with 0, 0.125, 0.25, or 0.5% betaine. Feed allotment was adjusted weekly according to BW, such that average feed intake was approximately 1.7 kg for all groups. At 64 kg, pigs were slaughtered and visceral tissue was removed and weighed. Carcasses were chilled for 24 h to obtain carcass measurements. Subsequently, one-half of each carcass and whole visceral tissue were ground for chemical analysis. Linear regression analysis indicated that, as betaine content of the diet was elevated from 0 to 0.5%, carcass fat concentration (P = 0.06), P3 fat depth (P = 0.14) and viscera weight (P = 0.129) were decreased, whereas total carcass protein (P = 0.124), protein deposition rate (P = 0.98), and lean gain efficiency (P = 0.115) were increased. The greatest differences over control pigs were observed in pigs consuming 0.5% betaine, where carcass fat concentration and P3 fat depth were decreased by 10 and 26%, respectively. Other fat depth measurements were not different (P > 0.15) from those of control pigs. In addition, pigs consuming the highest betaine level had a 19% increase in the carcass protein:fat ratio, 23% higher carcass protein deposition rate, and a 24% increase in lean gain efficiency compared with controls. Dietary betaine had no effects (P > 0.15) on growth performance, visceral tissue chemical composition, carcass fat deposition rate, visceral fat and protein deposition rates, or serum urea and ammonia concentrations. These data suggest that betaine alters nutrient partitioning such that carcass protein deposition is enhanced at the expense of carcass fat and in part, visceral tissue.

Fluid balance during and after an ironman triathlon.

OBJECTIVE: To record weight changes, fluid intake and changes in serum sodium concentration in ultradistance triathletes. DESIGN: Descriptive research. SETTING: Ironman triathlon (3.8 km swim, 180 km cycle, 42.2 km run). Air temperature at 1200 h was 21 degrees C, (relative humidity 91%). Water temperature was 20.7 degrees C. PARTICIPANTS: 18 triathletes. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Subjects were weighed and had blood drawn for serum sodium concentration [Na], hemoglobin, and hematocrit, pre-race, post-race, and at 0800 h on the morning following the race ("recovery"); subjects were also weighed at transitions. Fluid intake during the race was estimated by athlete recall. RESULTS: Median weight change during the race = -2.5 kg (p < 0.0006). Subjects lost weight during recovery (median = -1.0 kg) (p < 0.03). Median hourly fluid intake = 716 ml/h (range 421-970). Fluid intakes were higher on the bike than on the run (median 889 versus 632 ml/h, p = 0.03). Median calculated fluid losses cycling were 808 ml/h and running were 1,021 ml/h. No significant difference existed between pre-race and post-race [Na] (median 140 versus 138 mmol/L) or between post-race and recovery [Na] (median 138 versus 137 mmol/L). Plasma volume increased during the race, median + 10.8% (p = 0.0005). There was an inverse relationship between change in [Na] pre-race to post-race and relative weight change (r = -0.68, p = 0.0029). Five subjects developed hyponatremia ([Na] 128-133 mmol/L). CONCLUSIONS: Athletes lose 2.5 kg of weight during an ultradistance triathlon. most likely from sources other than fluid loss. Fluid intakes during this event are more modest than that recommended for shorter duration exercise. Plasma volume increases during the ultradistance triathlon. Subjects who developed hyponatremia had evidence of fluid overload despite modest fluid intakes.

Interrelationships between dietary lysine, sex, and porcine somatotropin administration on growth performance and protein deposition in pigs between 80 and 120 kg live weight.

Sixty male and 60 female crossbred pigs were allocated to an experiment to investigate the effects of porcine somatotropin (pST) administration (0 or 6 mg/d) and dietary lysine content on growth performance, tissue deposition, and carcass characteristics over the live weight range of 80 to 120 kg. Pigs receiving pST were given diets containing 6.9, 7.8, 8.8, 9.7, 10.6, or 11.5 g lysine/kg, whereas control pigs received diets containing 4.8, 5.8, 6.9, 7.8, 8.8 or 9.7 g lysine/kg. These dietary levels ranged from 0.40 to 0.70 g available lysine/MJ of DE for pST-treated pigs and from 0.28 to 0.58 g available lysine/MJ of DE for control pigs. Pigs were individually housed in pens, and there were five replicates of each treatment. All diets contained 14.5 MJ of DE/kg and were offered for ad libitum consumption to pigs between 80 and 120 kg live weight. Growth rate increased exponentially and food conversion ratio (FCR) decreased exponentially with increasing levels of lysine. In addition, there was a significant sex x pST interaction such that pST reduced the sex difference in FCR. Growth rate was faster in boars than in gilts and was increased by pST at the higher levels of dietary lysine. Similarly, FCR was lower for boars than for gilts and was decreased by pST at the higher dietary lysine levels. The optimum growth rate and FCR were defined as the lysine level at which growth rate and FCR were 95% and 105%, respectively, of the lysine plateau. The optimum growth rate and FCR were achieved at similar dietary lysine contents and were approximately 0.35 and 0.52 g available lysine/MJ of DE for control and pST-treated pigs, respectively. Protein deposition in the carcass increased exponentially with increasing dietary lysine level, was higher in boars than in gilts, and was increased by pST at the higher dietary lysine contents. Sex had no effect on dietary lysine required to maximize protein deposition. The dietary lysine contents required to ensure 95% of plateau protein deposition of 104 and 153 g/d were 0.39 and 0.55 g available lysine/MJ of DE for control and pST-treated pigs, respectively. The increase in lysine requirement with pST seems to be commensurate with the increase in protein deposition.

Leptin expression in offspring is programmed by nutrition in pregnancy.

Birth weight is a determinant of blood leptin concentrations in adults. Since nutrition during pregnancy can affect birth weight, the hypothesis that feed intake during pregnancy alters leptin expression in progeny was examined. Leptin mRNA was measured in subcutaneous adipose tissue and leptin protein was measuredin blood plasma from 59 day old female pigs whose mothers were fed at the same restricted rate except that half were permitted to consume 35% more feed during the second quarter of pregnancy. Leptin mRNA abundance in adipose tissue (P=0.015) and plasma leptin concentration (P=0.01) were higher in progeny from mothers provided with more feed. Body weight at birth was negatively correlated with the abundance of leptin mRNA in subcutaneous fat at 59 days of age (P=0.01). This study shows for the first time that maternal nutrition during pregnancy programs postnatal leptin expression in offspring.

Treatment of underfed pigs with GH throughout the second quarter of pregnancy increases fetal growth.

Circulating growth hormone (GH) concentrations increase in pregnancy and administration of GH during early-mid pregnancy increases fetal growth in well-fed pigs. To determine whether increased maternal GH could promote fetal growth when feed availability is restricted, fifteen cross-bred primiparous sows (gilts) were fed at approximately 30% of ad libitum intake, from mating onwards and were injected daily i.m. with recombinant porcine GH (pGH) at doses of 0, 13.4+/-0.3 and 25.6+/-0.5 microg/kg live weight from day 25 to day 51 of pregnancy (term approximately 115 days). Treatment with pGH increased maternal backfat loss between day 25 and day 51 of pregnancy, and increased maternal plasma IGF-I concentrations measured at day 51 of pregnancy. Fetal body weight, length and skull width at day 51 of pregnancy were increased by maternal treatment with pGH. Fetal plasma glucose concentrations were increased and maternal/fetal plasma glucose concentration gradients were decreased by maternal pGH treatment at 13.4, but not 25.6 microg/kg.day. Fetal plasma concentrations of urea were decreased by both levels of pGH treatment. Overall, fetal weight was negatively correlated with fetal plasma concentrations of urea, positively correlated with maternal plasma alpha-amino nitrogen concentrations and unrelated to glucose concentrations in either maternal or fetal plasma. This suggests that the availability of amino acids, not glucose, limits fetal growth in the first half of pregnancy in underfed gilts, and that maternal GH treatment may improve amino acid delivery to the fetus.

Epinephrine transiently increases amino acid disappearance to lower amino acid levels in humans.

BACKGROUND: Infusion of epinephrine decreases plasma amino acid concentrations. However, the mechanism by which this decrement occurs is not well characterized. METHODS: Epinephrine was infused (40 ng/kg/min) for 2 hours into eight normal healthy adults. The essential amino acid tracers L-[1-(13)C]leucine and L-[phenyl-2H5]phenylalanine were infused before and during the epinephrine infusion and blood samples obtained to determine amino acid rates of appearance and disappearance from the time course of change in amino acid concentration and tracer enrichments. RESULTS: Epinephrine infusion decreased plasma leucine and phenylalanine concentrations over a period of 30 to 90 minutes after the start of the epinephrine infusion. Epinephrine infusion induced an immediate decrement in tracer enrichments. These changes defined sharp increases in both rate of appearance and rate of disappearance. By 30 minutes of epinephrine infusion, the rate of amino acid appearance from proteolysis had returned to baseline, but the rate of amino acid disappearance remained elevated for 90 minutes before returning to baseline. It was the protracted increase in amino acid disappearance that was responsible for the lowering of plasma amino acid concentrations. After this acute response, rates of amino acid appearance and disappearance returned to normal whereas plasma amino acid levels remained suppressed. CONCLUSIONS: Epinephrine transiently affects both rates of amino acid appearance and disappearance, with the net effect being increased in amino acid disappearance. However, epinephrine lowers amino acid concentrations beyond the period that it affects kinetics. These results suggest that the effect of epinephrine on amino acid metabolism is not detrimental and that epinephrine allows amino acid metabolism to proceed normally but at lower concentrations of amino acids.

The relationship between endogenous insulin-like growth factors and growth in pigs.

Previous studies have reported conflicting data on gender differences in plasma IGF-I in postnatal pigs. There is also debate over the role of IGF-II in regulation of postnatal growth. We have, therefore, determined the concentrations of plasma IGF-I, IGF-II, and IGF-binding protein-3 (IGFBP-3) in boars, barrows, and gilts and related these to postnatal growth characteristics. Plasma concentrations of IGF-I were higher in boars than in gilts or barrows from 13 wk. of age, and plasma IGF-II levels were generally higher in barrows than in boars or gilts. Plasma IGFBP-3 levels were higher in boars than in gilts or barrows at most ages. Between 15 and 23 wk. of age, IGF-I and IGFBP-3, but not IGF-II, were positively associated with growth rate, voluntary feed intake, and gain:feed ratio. Plasma IGF-II, but not IGF-I or IGFBP-3, was positively associated with backfat depth during this period. These results support the hypothesis that circulating IGF-I and IGF-II are regulators of lean and adipose tissue growth, respectively.

Hyponatremia in ultradistance triathletes.

PURPOSE: Hyponatremia ([plasma sodium] <135 mmol x L(-1)) is a potentially serious complication of ultraendurance sports. However, the etiology of this condition is still uncertain. This observational cohort study aimed to determine prospectively the incidence and etiology of hyponatremia in an ultradistance triathlon. METHODS: The subjects consisted of 605 of the 660 athletes entered in the New Zealand Ironman triathlon (3.8-km swim, 180-km cycle, and 42.2-km run). Subjects were weighed before and after the race. A blood sample was drawn for measurement of plasma sodium concentration after the race. RESULTS: Complete data on pre- and postrace weights and plasma sodium concentrations were available in 330 race finishers. Postrace plasma sodium concentrations were inversely related to changes in body weight (P = 0.0001). Women (N = 38) had significantly lower plasma sodium concentrations (133.7 vs 137.4 mmol x L(-1); P = 0.0001) than men (N = 292) and lost significantly less relative weight (-2.7 vs -4.3%; P = 0.0002). Fifty-eight of 330 race finishers (18%) were hyponatremic; of these only 18 (31%) sought medical care for the symptoms of hyponatremia (symptomatic). Eleven of the 58 hyponatremic athletes had severe hyponatremia ([plasma sodium] < 130 mmol x L(-1)); seven of these 11 severely hyponatremic athletes were symptomatic. The relative body weight change of the 11 severely hyponatremic athletes ranged from 2.4% to +5%; eight (73%) of these athletes either maintained or gained weight during the race. In contrast, relative body weight changes in the 47 athletes with mild hyponatremia ([plasma sodium] 130-134 mmol x L(1)) were more variable, ranging from -9.25% to +2.2%. CONCLUSIONS: Hyponatremia is a common biochemical finding in ultradistance triathletes but is usually asymptomatic. Although mild hyponatremia was associated with variable body weight changes, fluid overload was the cause of most (73%) cases of severe, symptomatic hyponatremia.

Effects of L-carnitine fed during lactation on sow and litter performance.

Sows of differing parities and genetics were used at different locations to determine the effects of feeding added L-carnitine during lactation on sow and litter performance. In Exp. 1, sows (n = 50 PIC C15) were fed a lactation diet (1.0% total lysine, .9% Ca, and .8% P) with or without 50 ppm of added L-carnitine from d 108 of gestation until weaning (d 21). No differences in litter weaning weight, survivability, sow ADFI, or sow weight and last rib fat depth change were observed. Number of pigs born alive in the subsequent farrowing were not different (P>.10). In Exp. 2, parity-three and -four sows (n = 115 Large White cross) were used to determine the effect of feeding 0, 50, 100, or 200 ppm of added L-carnitine during lactation (diet containing .9% total lysine, 1.0% Ca, and .8% P) on sow and litter performance. No improvements in the number of pigs or litter weights at weaning were observed (P>.10). Sows fed added L-carnitine had increased weight loss (linear; P<.04), but no differences (P>.10) were observed in last rib fat depth change or subsequent reproductive performance. In Exp. 3, first-parity sows (n = 107 PIC C15) were fed a diet with or without 50 ppm of added L-carnitine during lactation (diet containing 1.0% total lysine). Sows fed added L-carnitine tended (P<.10) to have fewer stillborn and mummified pigs than controls (.42 vs .81 pigs). No differences were observed for litter weaning weight, survivability, or subsequent farrowing performance. Feeding 50 to 200 ppm of added L-carnitine during lactation had little effect on sow and litter performance.

Epinephrine produces a prolonged elevation in metabolic rate in humans.

BACKGROUND: Epinephrine increases the metabolic rate and contributes to the hypermetabolic state in severe illness. OBJECTIVE: We sought to determine the effect of prolonged elevation of epinephrine on resting energy expenditure (REE). DESIGN: Thirteen healthy men were placed on a well-defined diet for 5 d. Beginning on the morning of the second diet day, the subjects were infused for 24 h with saline, then for 23 h with epinephrine (0.18 nmol x kg(-1) x min(-1)) to increase plasma epinephrine concentrations into the high physiologic range (4720 +/- 340 pmol/L). REE and the respiratory quotient (RQ) were measured by indirect calorimetry in the postabsorptive state at the same time every morning. RESULTS: Infusion of epinephrine significantly increased heart rate and systolic blood pressure, but the response was transient (values after 23 h of epinephrine infusion were not significantly different from those on the day saline was infused). Infusion of epinephrine significantly increased REE by 12% and increased the RQ. These changes were apparent at the end of the 23-h infusion (REE: 97.5 +/- 2.3 kJ x kg(-1) x d(-1) with saline infusion and 108.9 +/- 2.3 kJ x kg(-1) x d(-1) with epinephrine infusion; RQ: 0.832 +/- 0.012 with saline infusion and 0.879 +/- 0.013 with epinephrine infusion). REE returned to baseline by 24 h after the epinephrine infusion ended, but the postabsorptive RQ remained modestly elevated. Infusion of epinephrine also produced a transient increase in urine flow and in urinary nitrogen excretion. This diuresis was compensated for by a drop in urine volume and nitrogen excretion after the epinephrine infusion was stopped. CONCLUSIONS: Epinephrine produced a prolonged increase in REE in healthy subjects. The fuel for this increase in REE, determined by the RQ, was from increased carbohydrate oxidation, not from that of fat or protein.

Porcine somatotropin, dietary protein and energy effects on arginase and transaminase activities in pigs.

Two experiments were conducted with cross-bred barrows to determine the effect of somatotropin administration on liver enzyme activities. In the first experiment, pigs growing from 26 to 55 kg body weight were given two doses of pituitary porcine somatotropin (pST; 0 and 100 micrograms per kg body weight) and three levels of dietary energy (60, 80 and 100% of free choice intake). In the second experiment, pigs growing from 30 to 60 kg body weight were given two doses of recombinant porcine somatotropin (rpST; 0 and 100 micrograms per kg body weight) and five levels of dietary crude protein (110, 150, 190, 230 and 270 g crude protein/kg diet). Liver arginase (ARG, EC 3.5.3.1) and aspartate aminotransferase (AAT, EC 2.6.1.1) activities were then determined in organ samples taken at slaughter time. Dietary energy did not change liver ARG. Activities of both ARG and AAT increased as dietary crude protein increased. Both pST and rpST decreased ARG, AAT and serum utrea nitrogen. There was a lack of interaction between rpST therapy and dietary protein on either ARG or AAT activities, suggesting that set nutritional states are not required for expression of pST effects.

The effect of dietary lysine and valine fed during lactation on sow and litter performance.

Sows (98 first parity and 104 second parity) were used to determine the effects of dietary lysine and valine on lactation performance. Treatments were arranged in a 2 x 3 factorial with two levels of lysine (.80 or 1.20%) and three valine:lysine ratios (80, 100, or 120% of lysine). For all sows, increasing dietary lysine increased litter weaning weight (P < .001) and litter weight gain (P < .002) and reduced sow weight loss (P < .001). Litter weight gain tended (P = .22) to increase with increasing dietary valine, but the increase was not significant. Data were separated into two groups: sows that weaned 10 or more pigs and sows that weaned fewer than 10 pigs. For sows that weaned 10 or more pigs, litter weaning weight (P < .001) and litter weight gain (P < .001) increased and sow BW loss decreased (P < .001) when dietary lysine increased from .80 to 1.20%. For sows that weaned fewer than 10 pigs, increasing lysine had no effect (P < .77) on litter growth rate. For sows weaning 10 or more pigs, litter weaning weights (linear, P < .04; quadratic, P < .06) and litter weight gain increased (linear, P < .04; quadratic, P < .02) as dietary valine increased. For sows that weaned fewer than 10 pigs, maximum litter weight gain was observed at a valine:lysine ratio of 100% (quadratic, P < .13). These results demonstrate the need to increase dietary lysine and valine as litter weaning weights increase. High-producing sows that wean 10 or more pigs require increased dietary lysine and valine to maximize litter growth rate and minimize sow weight loss compared with sows weaning fewer than 10 pigs. The independent increases in litter weaning weights from adding lysine and valine suggest separate modes of action for these amino acids in high-producing sows.