Gain and loss of subcutaneous and abdominal adipose tissue depot mass of German Holstein dairy cows with different body conditions during the transition period.

Subcutaneous adipose tissue (SCAT) and abdominal adipose tissue (AAT) depots are mobilized during the fresh cow period (FCP) and early lactation period (ELP) to counteract the negative energy balance (NEB). Earlier studies suggested that fat depots contribute differently to lipomobilization and may vary in functionality. Differences between the adipose depots might influence the development of metabolic disorders. Thus, the gain and loss of subcutaneous and abdominal adipose depot masses in Holstein cows with lower and higher body condition (mean body condition scores: 3.48 and 3.87, respectively) were compared in the period from d -42 to d 70 relative to parturition in this study. Animals of the 2 experimental groups represented adequately conditioned and overconditioned cows. Estimated depot mass (eDM) of SCAT, AAT, retroperitoneal, omental, and mesenteric adipose depots of 31 pluriparous German Holstein cows were determined via ultrasonography at d -42, 7, 28, and 70 relative to parturition. The cows were grouped according to the eDM of SCAT on d -42 [low body condition (LBC) group: n = 16, mean eDM 8.6 kg; high body condition (HBC) group: n = 15, mean eDM 15.6 kg]. Average daily change (prepartum gain and postpartum loss) in depot masses during dry period (DP; from d -42 to d 7), FCP (d 7 to d 28), and ELP (d 28 to d 70) were calculated and daily dry matter intake and lactation performance recorded. Cows of this study stored about 2 to 3 times more fat in AAT than in SCAT depots. After parturition, on average more adipose tissue mass was lost from the AAT than the SCAT depot (0.23 kg/d vs. 0.14 kg/d). Cows with high compared with low body condition had similar gains in AAT (0.33 kg/d) and SCAT (0.14 kg/d) masses during the DP but mobilized significantly more adipose tissue mass from both depots after calving (AAT, HBC vs. LBC: 0.30 vs. 0.17 kg/d; SCAT, HBC vs. LBC: 0.19 vs. 0.10 kg/d). Correlation analysis indicated a functional disparity between AAT and SCAT. In the case of AAT (R2 = 0.36), the higher the gain in adipose mass during DP, the higher the loss in FCP, but this was not the case for SCAT. During FCP, a greater NEB resulted in greater loss of mass from SCAT (R2 = 0.18). In turn, greater mobilization of SCAT mass led to a higher calculated feed efficiency (R2 = 0.18). However, AAT showed no such correlations. On the other hand, during ELP, loss of both SCAT and AAT mass correlated positively with feed efficiency (R2 = 0.35 and 0.33, respectively). The results indicate that feed efficiency may not be an adequate criterion for performance evaluation in cows during NEB. Greater knowledge of functional disparities between AAT and SCAT depots may improve our understanding of excessive lipomobilization and its consequences for metabolic health and performance of dairy cows during the transition period.

Influence of conjugated linoleic acids and vitamin E on milk fatty acid composition and concentrations of vitamin A and α-tocopherol in blood and milk of dairy cows.

The objective of this trial was to investigate the influences of conjugated linoleic acid (CLA) and vitamin E (Vit. E) and their interactions on fatty acid composition and vitamins in milk (α-tocopherol, retinol and ß-carotene) as well as on α-tocopherol in blood of pluriparous cows from week 6 ante partum until week 10 post-partum (p.p.). We assigned 59 pluriparous German Holstein cows to four treatment groups with the treatment factors CLA and Vit. E at two levels in a 2 × 2 factorial design. Milk fatty acid composition and milk vitamins were analysed on lactation days 7 and 28. α-tocopherol in blood serum was analysed on days -42, -7, 1, 7, 14, 28 and 70 relative to parturition. Milk concentration of α-tocopherol was influenced by Vit. E (p < .001) and CLA (p = .034). Percentage of cis-9, trans-11 CLA in total milk fat was influenced by treatment with CLA (p < .001), while for percentage of trans-10, cis-12 CLA an interaction between treatment and day (p = .019), driven by an increase in both CLA groups from day 7 to day 28, was found. Serum ratios of α-tocopherol to cholesterol were influenced by Vit. E (p < .001). Results suggest that treatment with CLA during late pregnancy and early lactation is suitable to enhance the proportion of trans-10, cis-12 CLA in milk and thereby influencing nutritional properties. As treatment with Vit. E did not have an impact on milk fatty acid composition, it might be possible to increase the antioxidative capacity of the dairy cow without affecting milk properties. Consequently, combined treatment with CLA and Vit. E might elicit synergistic effects on the cow and milk quality by increasing the proportion of CLA in milk fat as well as the excretion of Vit. E and the Vit. E levels in serum.

Influence of conjugated linoleic acids and vitamin E on biochemical, hematological, and immunological variables of dairy cows during the transition period.

The objective of this experiment was to determine the effects of conjugated linoleic acid (CLA) and vitamin E as well as their interaction on biochemical and hematological variables and on leukocyte populations and their functionality. We assigned 59 German Holstein cows between the 2nd and 9th lactation to 4 dietary groups in a 2 × 2 factorial design with the factors CLA and vitamin E. Six weeks before calving the cows had a BCS of 3.7 to provoke a higher risk of developing ketosis, which might impair their immune function. Blood samples for analyses were taken on d -42, -14, -7, -3, 1, 3, 7, 10, 14, 21, 28, 35, 42, 56, and 70 relative to parturition. Furthermore, peripheral blood mononuclear cells were cultured on d -42, -7, 1, 7, 14, 28, and 70 relative to calving. Most variables were characterized by a high variation between d 7 antepartum and d 7 postpartum. Treatments did not elicit any effect, with the exception of vitamin E, which increased serum urea concentrations and decreased monocyte percentages. Haptoglobin, aspartate-aminotransferase, red blood cell count, leukocyte percentage and populations, as well as peripheral blood mononuclear cells were influenced by parity. In conclusion, the impairment of immune function caused by calving was more severe in cows in ≥3rd parity than in younger cows. However, neither vitamin E nor CLA supplementation was successful to stabilize parity or parturition related variance in hematological and immunological traits.

Influence of conjugated linoleic acid and vitamin E on performance, energy metabolism, and change of fat depot mass in transitional dairy cows.

The objective of this experiment was to determine the effects of conjugated linoleic acid (CLA) and vitamin E as well as their interaction on performance variables and lipomobilization during late pregnancy and early lactation (wk 6 antepartum until wk 10 postpartum). For this purpose, 59 pluriparous German Holstein cows were assigned to 4 dietary groups in a 2 × 2 design with the factors CLA and vitamin E at 2 levels. For this trial, we selected cows with a high body condition score because they are more likely to mobilize fat and consequently are at a higher risk of developing ketosis. Furthermore, concentrate proportions were adjusted to provoke ketosis. Lactation performance variables were analyzed in 3 periods (d 42 antepartum until calving, 1 to 21 d in milk, 22 to 70 d in milk). Dry matter intake and net energy intake were reduced in animals receiving CLA. Milk fat content was reduced in the CLA group compared with the control group (4.83 vs. 5.46% in period 2; 3.36 vs. 4.57% in period 3). In the vitamin E and the CLA + vitamin E groups, reduction of milk fat content was observed in period 3 (3.76 vs. 4.57% compared with the control group). Milk yield was not affected by treatment. ß-Hydroxybutyrate concentrations and liver lipid contents were not influenced by CLA or vitamin E. Moreover, longitudinal changes of adipose tissue depot mass were not affected by dietary treatments. Results suggest that the effects CLA had on milk composition were compensated by an increased milk yield and a decreased dry matter intake. Reduced milk energy output in CLA-treated animals was compensated by a reduced dry matter intake. Therefore, the net energy balance was not affected by either treatment. Consequently, we found no group effect on the mobilization of adipose tissue.

The role of azithromycin in healthcare-associated pneumonia treatment.

WHAT IS KNOWN AND OBJECTIVE: Healthcare-associated pneumonia (HCAP) is an important presentation among hospitalized patients. Standardized definitions of this entity are almost a decade old, and practice patterns have shifted from published guidelines to include empiric coverage with a macrolide, such as azithromycin. Azithromycin is oftentimes included in the empiric treatment regimen for HCAP because of the importance of appropriate empiric antimicrobial coverage, the perceived concern regarding atypical organisms, potential anti-inflammatory effects of the medication, and positive clinical data among patients with Streptococcal bacteremia. METHODS: In this review, we systematically investigate data for each of these topics along with clinical data examining the role of azithromycin in HCAP. RESULTS AND DISCUSSION: Our findings indicate that atypical organisms are rare in HCAP, that the anti-inflammatory actions of azithromycin - although promising - have not produced consistently positive effects in many chronic or acute conditions, and that the data available for azithromycin use in bacteremia are of low quality. A single-centre cohort indicated that the clinical benefits of azithromycin did not extend to HCAP compared to community-acquired pneumonia. WHAT IS NEW AND CONCLUSION: Additionally, there are newer data emphasizing the potential cardiotoxicity of azithromycin, particularly among patients at high risk. All of these data indicate that azithromycin should not be part of the standard empiric treatment for HCAP.

[Seminal vesicle sparing radical perineal prostatectomy]. / Samenblasenerhaltende radikale perineale Prostatektomie.

BACKGROUND: The early and mid-term oncological and functional results of a seminal vesicle sparing modification of perineal nerve sparing radical prostatectomy (SV-RPP) was compared to the classical perineal (RPP) and retroperitoneal (RRP) approaches. MATERIALS AND METHODS: From July 2003 to December 2007, 702 radical prostatectomies (417 RPP, 285 RRP) were performed by 3 surgeons (mean follow-up 17 months, range 0-48 months). RPP was chosen under the following conditions: PSA<10 ng/ml, Gleason sum<7 and volume<50 ml. A seminal vesicle sparing technique (SV-RPP) was used in 47% of the RPPs. RESULTS: With a significantly shorter average operation (OR) time (SV-RPP 90 min, RPP 144 min, RRP 165 min), transfusion rate (SV-RPP 3%, RPP 9.1%, RRP 11.9%) and rate of anastomotic leaks at day 10 (SV-RPP 6.4%, RPP 10.3%, RRP 27.8%) the pT2 positive surgical margin rate with SV-RPP (3.4%) was significantly lower than with RPP (9.6%) and RPP (8.4%). For pT2-R0 tumors PSA relapse>0.2 ng/ml occurred in 12.5%, 13.6% and 8.2%, respectively (not significant). Continence rates (0-1 pad) for SV-RPP were significantly better compared to RPP and RRP after 4 weeks (59.3%, 41.0% and 45.4%, respectively) and 12 months (95.7%, 86.4% and 86.8%, respectively) CONCLUSIONS: SV-RPP represents an improved perineal technique with respect to intraoperative and postoperative complications whilst maintaining an oncological outcome comparable to RPP and RRP. Leaving seminal vesicles in situ did not result in increased PSA relapse rates.

Update on talc, bleomycin, and the tetracyclines in the treatment of malignant pleural effusions.

Talc has been used to treat malignant pleural effusions (MPE) for over 30 years and is usually considered to be the most effective chemical agent for pleurodesis. Clinicians, aware of limited reports of serious adverse effects attributed to talc, have generally reserved it for selected patients who are refractory to first-line chemical sclerosants. Tetracycline and bleomycin have therefore been cited as the preferred agents for the treatment of MPE. Clinical studies reported over the last 5 years reflect a continuing interest in talc as a chemical sclerosant and provide evidence of its effectiveness with minimal side effects. Comparisons with other agents are necessary to evaluate further the application of talc insufflation in the thoracoscopy suite and talc slurry at the patient's bedside. As clinicians continue to debate the relative merits of various pleurodesis agents, talc appears to be a reasonable choice for the treatment of MPE.

Extramedullary erythropoiesis in human liver grafts.

Extramedullary erythropoiesis in the adult is very rare and is generally confined to situations of severe bone marrow irritation or replacement. In this study, we describe the occurrence of intrahepatic erythropoiesis in patients who have received a liver allograft and who have no evidence of bone marrow dysfunction. By routinely performed transplant aspiration cytology (TAC), marked intrahepatic erythropoiesis could be detected in 39 of 312 patients (12.5%) with liver allograft. In 19 patients, including 5 of 8 (63%) after combined liver and kidney transplantation, intrahepatic erythropoiesis occurred within the first 3 weeks after surgery. Twenty patients showed intrahepatic erythropoiesis between 3 weeks and 4 months after transplantation. Erythropoiesis was usually transient, lasting between 1 and 3 weeks. Cytologically, mature as well as immature erythroblasts of GlyA+ CD36+ CD45- phenotype could be detected in the grafts, whereas they were absent in blood; histologically, the cells could be localized to the sinusoids of the liver. There was no clear correlation of preoperative or postoperative hemoglobin levels, graft function, kidney function, and immunosuppressive medication with the presence or absence of erythropoiesis. Moreover, serum levels of erythropoietin (EPO) and stem cell factor (SCF) in patients with and without intrahepatic erythropoiesis in the early postoperative phase did not show significant differences. These findings show that intrahepatic erythropoiesis can occur transiently in human liver allografts and suggest that systemic stimuli as well as local factors may contribute to it.

Dynamic intracavity gradients: a 'new' hemodynamic abnormality in the spectrum of secondary left ventricular hypertrophy.

The effect of provocation on left ventricular (LV) outflow was studied by continuous-wave Doppler echocardiography in 93 patients with LV hypertrophy (LVH), either due to pressure overload or hypertrophic cardiomyopathy (HCM), and in 39 healthy volunteers. In 50 patients with LVH, outflow acceleration (gradients ranging from 19 to 130 mm Hg) was induced or accentuated by at least one provocative situation independently of LVH aetiology. In normal persons LV outflow remained unchanged. Calcium antagonist treatment reduced outflow acceleration. It is concluded that dynamic LV gradients are a non-specific flow abnormality in the spectrum of LVH that merits consideration.