Kawasaki disease for the paediatric dermatologist: skin manifestations and new insights into the pathophysiology.

Early diagnosis of Kawasaki disease (KD) is critical to allow prompt initiation of treatment and avoid cardiac complications. All children with KD have fever accompanied by clinical signs, with four of the five classic criteria for complete KD being mucocutaneous, thus creating an important role for dermatologists. Moreover, dermatologists must be familiar with other dermatological findings that are not included in the American Heart Association classification criteria but can support the diagnosis, particularly in incomplete forms of the disease. We review the skin manifestations described for KD and perform an overview of pathophysiological advances and new treatments.

Characterization of circulating immune cells in acute Kawasaki disease suggests exposure to different antigens.

Kawasaki disease (KD) is an acute pediatric vasculitis of unknown etiology that can cause coronary artery aneurysms, and is the leading cause of acquired heart disease in children. We studied aspects of the innate and adaptive immune response in 17 acute KD children prior to treatment with intravenous immunoglobulin. Distinct patterns within the innate immune response correlated with specific clinical features. Proinflammatory myeloid dendritic cells (mDC) were abundant in four of 17 (23·5%) subjects who were older and manifested severe inflammation with clinical myocarditis and elevated hepatobiliary enzyme levels. Of the nine subjects with low levels of anti-inflammatory, tolerogenic mDC, six had enlarged cervical lymph nodes at diagnosis. In contrast, the adaptive immune repertoire varied greatly with no discernible patterns or associations with clinical features. Two subjects with aneurysms had numerous circulating CD8+ T cells. Ten subjects showed low CD4+ T cell numbers and seven subjects had CD4+ T cells in the normal range. CD4+ T cells expressed interleukin-7 receptor (IL-7R), suggesting repeated antigenic stimulation. Thymic-derived regulatory T cells (nTreg ) and peripherally induced regulatory T cells (iTreg ) were also enumerated, with the majority having the nTreg phenotype. Natural killer (NK) and NK T cell numbers were similar across all subjects. Taken together, the results of the immune monitoring suggest that KD may have multiple triggers that stimulate different arms of the innate and adaptive compartment in KD patients. Thus, it is possible that diverse antigens may participate in the pathogenesis of KD.

Cardiovascular imaging in children and adults following Kawasaki disease.

Kawasaki disease (KD) is a paediatric vasculitis with coronary artery aneurysms (CAA) as its main complication. Two guidelines exist regarding the follow-up of patients after KD, by the American Heart Association and the Japanese Circulation Society. After the acute phase, CAA-negative patients are checked for cardiovascular risk assessment or with ECG and echocardiography until 5 years after the disease. In CAA-positive patients, monitoring includes myocardial perfusion imaging, conventional angiography and CT-angiography. However, the invasive nature and high radiation exposure do not reflect technical advances in cardiovascular imaging. Newer techniques, such as cardiac MRI, are mentioned but not directly implemented in the follow-up. Cardiac MRI can be performed to identify CAA, but also evaluate functional abnormalities, ischemia and previous myocardial infarction including adenosine stress-testing. Low-dose CT angiography can be implemented at a young age when MRI without anaesthesia is not feasible. CT calcium scoring with a very low radiation dose can be useful in risk stratification years after the disease. By incorporating newer imaging techniques, detection of CAA will be improved while reducing radiation burden and potential complications of invasive imaging modalities. Based on the current knowledge, a possible pathway to follow-up patients after KD is introduced. Key Points • Kawasaki disease is a paediatric vasculitis with coronary aneurysms as major complication. • Current guidelines include invasive, high-radiation modalities not reflecting new technical advances. • Cardiac MRI can provide information on coronary anatomy as well as cardiac function. • (Low-dose) CT-angiography and CT calcium score can also provide important information. • Current guidelines for follow-up of patients with KD need to be revised.

Pregnancy in women with a history of Kawasaki disease: management and outcomes.

OBJECTIVE: To characterise the obstetrical management and outcomes in a series of women with a history of Kawasaki disease (KD) in childhood. DESIGN: Retrospective case series. SETTING: Tertiary healthcare setting in the USA. POPULATION: Women with a history of KD in childhood. METHODS: Women completed a detailed health questionnaire and participated in research imaging studies as part of the San Diego Adult KD Collaborative Study. MAIN OUTCOME MEASURES: Obstetrical management, complications during pregnancy and delivery, and infant outcomes. RESULTS: Ten women with a history of KD in childhood carried a total of 21 pregnancies to term. There were no cardiovascular complications during labour and delivery despite important cardiovascular abnormalities in four of the ten subjects. Pregnancy was complicated by pre-eclampsia and the post-partum course was complicated by haemorrhage in one subject each. Two of the 21 progeny subsequently developed KD. CONCLUSIONS: Women with important cardiovascular sequelae from KD in childhood should be managed by a team that includes both a maternal-fetal medicine specialist and a cardiologist. Pre-pregnancy counselling should include delineation of the woman's current functional and structural cardiovascular status and appropriate adjustment of medications, but excellent outcomes are possible with appropriate care. Review of the English and Japanese literature on KD and pregnancy revealed the occurrence of myocardial infarction during pregnancy in women with missed KD and aneurysms that were not diagnosed until their acute event. Our study highlights the need for counselling with regard to the increased genetic risk of KD in offspring born to these mothers.

Immune-monitoring in Kawasaki disease patients treated with infliximab and intravenous immunoglobulin.

The expansion of regulatory T cells (Treg ) controls inflammation in children with acute Kawasaki disease (KD). Blockade of tumour necrosis factor (TNF)-α is an emerging therapy for KD patients with refractory inflammation, but there is concern that this therapy could impede the host immune regulation. To define the effect of TNF-α blockade, we conducted ex-vivo immune-monitoring in KD subjects who participated in a randomized, double-blind, placebo-controlled clinical trial of the addition of infliximab to standard intravenous immunoglobulin (IVIG) therapy. We enumerated circulating myeloid and plasmocytoid dendritic cells (DC), regulatory T cells (Treg ) and memory T cells (Tmem ) in 14 consecutive, unselected KD patients (seven treated with IVIG, seven with IVIG + infliximab) at three time-points: (i) acute phase prior to treatment, (ii) subacute phase and (iii) convalescent phase. Myeloid DC (mDC), but not plasmacytoid DC (pDC), were numerous in the peripheral blood in acute KD subjects and decreased in the subacute phase in both IVIG(-) and IVIG (+) infliximab-treated groups. The co-stimulatory molecule for antigen presentation to T cells and CD86 decreased in mDC from acute to subacute time-points in both treatment groups, but not in the single patient who developed coronary artery aneurysms. We also defined tolerogenic mDC that expand in the subacute phase of KD not impaired by infliximab treatment. Treg and Tmem expanded after treatment with no significant differences between the two groups. Treatment of KD patients with infliximab does not adversely affect generation of tolerogenic mDC or the development of T cell regulation and memory.

Technical note: Use of near-infrared reflectance spectroscopy to predict intake and digestibility in bulls and steers.

Multiple fecal samples were collected from growing Angus bulls (264 to 419 kg of BW, 3.0 to 11.4 kg/d of DMI) to predict DMI of a corn-silage-based diet. Contemporaneous digestion trials were conducted with the same diet in 12 steers in yr 1 to 3 and bulls in yr 4. Near-infrared spectra from fecal samples (n = 730 from 282 growing bulls, n = 240 from 36 steers and 12 bulls for digestion trials) were obtained from dried and ground fecal samples, and modified partial least squares regression was used to develop equations to predict DMI and DM digestibility (DMD). Although mean predicted DMI of the growing bulls (7.52 ± 0.04 kg/d or 22.4 ± 0.1 g/kg of BW) was within 2% of mean measured DMI (7.63 ± 0.06 kg/d or 22.7 ± 0.1 g/kg of BW), the mean of paired differences within samples (0.11 ± 0.04 kg/d or 0.3 ± 0.1 g/kg of BW) was greater (P < 0.01) than zero. Measured DMD (72.3 ± 0.5%) was identical (P < 0.97) to predicted DMD (72.3 ± 0.5%), and DMD for bulls in the digestion trial did not differ (P < 0.27) from DMD for steers. Prediction of intake requires incorporation of some measured values from the set of fecal samples to be predicted. Lack of similarity between spectra of fecal grab samples from the growing bulls and daily fecal collection of steers and bulls in the digestion trials in this study indicates the need for further verification before prediction of DMD with fecal grab samples.

Intake and digestibility of 'coastal' bermudagrass hay from treated swine waste using subsurface drip irrigation.

Waste handling systems for confined swine production in the upper South (approximately 32-37 degrees N and 79-93 degrees W) depend mainly on anaerobic lagoons and application of the waste effluent to cropland. The main objective of this study was to evaluate the quality of 'Coastal' bermudagrass [Cynodon dactylon (L.) Pers.] hay receiving effluent generated from a raw swine waste treatment system designed to reduce P and K concentrations and delivered by subsurface drip irrigation (SDI) compared with hay produced from commercial N fertilizer. Eight treatments, consisting of commercial N fertilizer or effluent, each irrigated at two irrigation rates (75 and 100% of estimated evapotranspiration) and two lateral spacings (0.6 and 1.2 m), were compared with a control treatment of commercial N fertilizer without irrigation. Three harvests were taken in each of 2 yr and five of the six evaluated using wether sheep (30-45 kg). Greatest dry matter intake (DMI) per unit body weight occurred for the control vs. all irrigated treatments (1.94 vs. 1.77 kg 100(-1) kg; P = 0.02; SEM = 0.11). Among irrigated treatments, DMI was greatest from commercial N vs. effluent (1.81 vs. 1.71 kg 100(-1) kg; P = 0.05; SEM = 0.11). Dry matter intake was similar for the 75% rate treatments and the non-irrigated treatment (mean, 1.87 kg 100(-1) kg) but was reduced for the 100% rate (1.94 vs. 1.72 kg 100(-1) kg; P = 0.03; SEM = 0.11). Hay from the 75% rate was more digestible than hay from the 100% rate (527 vs. 508 g kg(-1); P = 0.03; SEM = 21). The SDI system functioned well, and lateral spacing did not alter hay quality. Treated waste from a raw waste treatment system was readily delivered by SDI at the recommended rate to produce bermudagrass hay of adequate quality for ruminant production systems.

ASAS Centennial Paper: utilization of pasture and forages by ruminants: a historical perspective.

Pastures, forages, and grasslands dominate the landscape across the United States and support a large ruminant population that supplies the nation with value-added animal products. A historical perspective is presented of the innovations as they occurred in the Journal of Animal Science over the past 100 yr in pasture and forage research. Consideration was given to both animal and pasture perspectives. Areas given consideration from the animal perspective were schemes for feedstuff analysis, experimental design and statistics, forage sample preservation, indirect methods of measuring intake and digestion, TDN and energy, nutritive value, harvested forage, and innovations in the grazing environment. Areas given consideration from the forage perspective were a framework for forage-animal interface research, determining pasture yield, choice of stocking method, grazing management, partitioning of forage DM, near-infrared reflectance spectroscopy technology, antiquality constituents, and forage sample preservation. Finally, the importance was discussed of applying research results from the forage-animal interface to general ruminant nutrition research beyond the interface that is focused on altered diets.

Effect of feeding corn, hull-less or hulled barley on fermentation by mixed cultures of ruminal microorganisms.

Increased demands for corn grain warrant the evaluation of alternative grain types for ruminant production systems. This study was conducted to determine the effects of hulled and hull-less barley (Hordeum vulgare L.) cultivars compared with corn (Zea mays L.) as an alternative grain type on fermentation in cultures of mixed ruminal microorganisms. Three continuous fermentors were fed 14 g of dry feed per day (divided equally between 2 feedings) consisting of alfalfa (Medicago sativa L.) hay pellets (40% of dry matter) and 1) ground corn, 2) hulled barley, or 3) hull-less barley concentrate (60% of dry matter) in each fermentor. Following an adaptation period of 5 d, culture samples were taken at 2 h after the morning feeding on d 6, 7, and 8 of each period for analysis. A second run of the fermentors followed the same treatment sequence to provide replication. Culture pH was reduced with corn (5.55) and did not differ between barley cultivars (average pH 5.89). Total volatile fatty acid concentration and acetate to propionate ratio were not different across grain type or barley cultivar with the exception of greater total volatile fatty acid concentrations with hull-less barley. Corn produced less methane (14.6 mmol/d) and ammonia-N (7.3 mg/100 mL) compared with barley (33.1 mmol/d and 22 mg/100 mL, respectively); methane was greater with hull-less barley but ammonia-N concentration was similar between the 2 barley cultivars. Hull-less barley had greater digestibility compared with hulled barley, and corn had reduced digestibility compared with barley. Concentrations of C18:0 were greater and those of C18:1 and C18:2 lesser in cultures fed hulled and hull-less barley compared with corn. Our data indicate that grain type and barley cultivar have an impact on ruminal fermentation. The lesser starch concentration of barley minimized the drop in culture pH and improved digestibility.

The interaction of harvesting time of day of switchgrass hay and ruminal degradability of supplemental protein offered to beef steers.

The objective of this study was to evaluate an interaction between harvest at 0600 (AM) vs. 1800 (PM) with high (HI) or low (LO) ruminal degradability of a protein supplement to change voluntary intake, digestion, or N retention by steers offered switchgrass (Panicum virgatum L.) hay. Black steers (255 +/- 14 kg of BW) were blocked by BW, and then randomly assigned (5 steers each) to AM/HI, PM/HI, AM/LO, or PM/LO treatment groups. Steers were group-housed in covered, outdoor pens with individual feeding gates. After adaptation and standardization, intake was measured for 21 d followed by a digestion trial (5 d of total collection). Steers were offered 767 (LO) or 825 (HI) g/d of supplement to provide 268 g of CP/d. Compared with AM, PM had greater (P = 0.01) concentrations of total nonstructural carbohydrate (TNC, 71 vs. 56 g/kg of DM), and lesser concentrations of NDF (760 vs. 770 g/kg of DM, P = 0.02), ADF (417 vs. 427 g/kg of DM, P = 0.02), and CP (55.9 vs. 58.6 g/ kg of DM, P = 0.07). Protein fractions A, B(2), and B(3) were similar for AM and PM, but HI contained more (P < 0.02) A (694 vs. 296 g/kg of protein) and less B(2) (174 vs. 554 g/kg of protein) fraction than LO. Harvest interacted with supplement to increase (P = 0.07) ad libitum digestible DMI for steers offered PM/HI (11.4 g/kg of BW daily) compared with steers offered PM/LO (10.2 g/kg of BW daily), but there was no difference for steers offered AM/LO or AM/HI (10.7 g/kg of BW). Apparent digestibilities of DM (594 vs. 571 g/kg of intake), NDF (591 vs. 562 g/kg of intake), ADF (585 vs. 566 g/kg of intake), and N (651 vs. 632 g/kg of intake) were greater (P < 0.04) for PM than for AM. Apparent digestibility of N was greater (P = 0.02) for HI (652 g/ kg of intake) vs. LO (631 g/kg of intake). Interactions between harvest and supplement for apparent digestibilities of NDF (P = 0.09) and ADF (P = 0.03) were due to no change or an increase in digestibility in response to increased ruminal degradability of supplement in steers offered PM harvest, whereas increased ruminal degradability of supplement decreased digestibility of NDF and ADF in steers offered AM harvest. Treatments did not affect hay intake (3.93 kg/d), N retained (15.8 g/d), or plasma urea N (5.25 mM) during ad libitum intake. Greater TNC in PM vs. AM harvest was not sufficient by itself to increase total voluntary DMI, but greater protein degradability interacted with harvest time to increase ruminal fiber digestibility and digestible DMI of beef steers offered PM vs. AM harvest.

Urea metabolism in beef steers grazing Bermudagrass, Caucasian bluestem, or gamagrass pastures varying in plant morphology, protein content, and protein composition.

Pastures of Bermudagrass (Cynodon dactylon, BG), Caucasian bluestem (Bothriochloa caucasica, CBS), and gamagrass (Tripsacum dactyloides, GG) were evaluated from the perspectives of forage composition, selection during grazing, and N metabolism in beef steers. All pastures were fertilized with 78 kg/ha of N approximately 60 and 30 d before sample collection. In 2000 and 2001, 12 steers (250 kg of BW) were blocked based on BW and then assigned randomly to a replicated, randomized complete block design, with 2 pastures of each forage and 2 steers per pasture. Three other steers with esophageal fistulas were used to collect masticate samples to represent intake preferences. Herbage mass was >1,900 kg/ha. After at least 14 d of adaptation, urine and blood samples were collected for determination of serum urea N and percentage of urinary N in the form of urea. One steer per pasture (6 steers per year) was infused i.v. with (15,15)N urea for 50 h before collecting urine for 6 h to measure urea N enrichment, urea entry rate, urinary urea excretion, gut urea recycling, and return of urea N to the ornithine cycle. The canopy leaf:stem DM ratio differed (P = 0.01) among BG (0.50), CBS (1.01), and GG (4.00). Caucasian bluestem had less CP (% of DM) than GG or BG in the canopy (9.6 vs. 12.0 or 12.3, P = 0.07) and in the masticate (9.8 vs. 14.7 or 13.9, P = 0.04). Bermudagrass had less true protein (% of CP) than CBS or GG in the canopy (72.9 vs. 83.3 or 83.0, P = 0.07) and in the masticate (73.7 vs. 85.8 or 88.0, P = 0.04). Compared with GG and BG, CBS had less serum urea N (10.1 or 12.2 vs. 2.5 mM, P = 0.01), urea entry rate (353 or 391 vs. 209 mmol of N/h, P = 0.07), and urinary urea excretion (105 or 95 vs. 18 mmol of N/h, P = 0.04), and a greater return of urea N to the ornithine cycle as a proportion of gut urea recycling (0.109 or 0.118 vs. 0.231, P = 0.02). Urea production and recycling in these steers responded more to the N concentration in the grasses than to differences in plant protein fractions. There was no evidence of improved N capture by the steers due to changes in the leaf:stem ratio among the grasses at the herbage mass evaluated.

Afternoon harvest increases readily fermentable carbohydrate concentration and voluntary intake of gamagrass and switchgrass baleage by beef steers.

Our objective was to determine if harvest in the morning (AM, 0600) vs. the afternoon (PM, 1800) affects composition and voluntary DMI of gamagrass (GG) or switchgrass (SG) stored as baleage. Iuka GG (Tripsacum dactyloides L.) and Alamo SG (Panicum virgatum L.) were cut with a mower-conditioner, immediately round-baled, wrapped in plastic, and stored as baleage. Beef steers (255 +/- 7 kg of BW) were assigned (5 steers/treatment) to GG/AM, GG/PM, SG/AM, or SG/PM. Ad libitum intake was measured for 21 d (7-d adjustment and 14-d intake estimate) followed by 7-d adjustment and 5-d digestion and N balance study. Chewing behavior was recorded during the balance study. Compared with AM, PM had more (P < 0.01) starch (9.3 vs. 4.7 g/kg of DM), total nonstructural carbohydrate (30.4 vs. 19.0 g/kg of DM), and monosaccharides (17.1 vs. 11.2 g/kg of DM). Compared with AM, PM had less (P = 0.05) acetate (13.0 vs. 18.6 g/kg of DM) and propionate (0.29 vs. 0.82 g/kg of DM) and tended (P < 0.13) to have less lactate (2.9 vs. 3.5 g/kg of DM) and butyrate (3.9 vs. 5.1 g/kg of DM). Compared with SG, GG had more (P = 0.01) DM (324 vs. 242 g/kg of baleage), CP (114 vs. 97 g/kg of DM), lactate (4.8 vs. 1.6 g/kg of DM), starch (9.4 vs. 4.7 g/kg of DM), total nonstructural carbohydrate (34.2 vs. 15.2 g/kg of DM), and monosaccharides (20.8 vs. 7.4 g/kg of DM). However, GG had a lower (P = 0.01) pH (5.32 vs.5.79) and less (P < 0.01) ethanol (18.7 vs. 27.3 g/kg of DM), acetate (12.3 vs. 19.2 g/kg of DM), propionate (0.00 vs. 1.11 g/kg of DM), and butyrate (0.6 vs. 8.4 g/kg of DM). Daily DMI (2.16 vs. 1.83% of BW) and digestible DMI (1.15 vs. 0.95% of BW) were greater (P = 0.03) for PM than AM. Plasma urea N concentrations at the end of the ad libitum intake phase were greater (P = 0.01) for AM (3.91 mM) than for PM (2.31 mM) and greater (P = 0.07) for GG (3.51 mM) than for SG (2.71 mM). Steers fed PM spent more time eating (P = 0.04) and less time resting (P = 0.01) during meals than steers fed AM. Apparent digestibility of DM and fiber components was not affected (P < 0.18) by treatment. Apparent digestibility and retention of N decreased from PM to AM for SG, but increased for GG (P = 0.05). Retention of N as a percentage of N intake or N digested decreased more from PM to AM for SG than for GG (P < 0.05). We conclude that increased nonstructural carbohydrate content of the PM harvest of these grasses stored as baleage caused increased voluntary intake and improved use of dietary N by beef steers.

Family-based association analysis implicates IL-4 in susceptibility to Kawasaki disease.

Several compelling lines of evidence suggest an important influence of genetic variation in susceptibility to Kawasaki disease (KD), an acute vasculitis that causes coronary artery aneurysms in children. We performed a family-based genotyping study to test for association between KD and 58 genes involved in cardiovascular disease and inflammation. By analysis of a cohort of 209 KD trios using the transmission disequilibrium test, we documented the asymmetric transmission of five alleles including the interleukin-4 (IL-4) C(-589)T allele (P=0.03). Asymmetric transmission of the IL-4 C(-589)T was replicated in a second, independent cohort of 60 trios (P=0.05, combined P=0.002). Haplotypes of alleles in IL-4, colony-stimulating factor 2 (CSF2), IL-13, and transcription factor 7 (TCF7), all located in the interleukin gene cluster on 5q31, were also asymmetrically transmitted. The reported associations of KD with atopic dermatitis and allergy, elevated serum IgE levels, eosinophilia, and increased circulating numbers of monocyte/macrophages expressing the low-affinity IgE receptor (FCepsilonR2) may be related to effects of IL-4. Thus, the largest family-based genotyping study of KD patients to date suggests that genetic variation in the IL-4 gene, or regions linked to IL-4, plays an important role in KD pathogenesis and disease susceptibility.

Dry matter intake and digestion of alfalfa harvested at sunset and sunrise.

The preference exhibited by animals in selecting one feed over another is important only if the preferred diet is consumed daily in larger quantities, digested to a greater extent, or both. Six alfalfa (Medicago sativa L.) hays were harvested in pairs at sunset (PM) and sunrise (AM) on consecutive days at three harvest dates. A previous study of these hays demonstrated differences in ruminant preference favoring PM harvests. This study evaluated the effects of time of cutting and harvest date on voluntary DMI and nutrient digestibility. The hays were field-cured, baled, and chopped before evaluation for intake and digestibility. Studies were conducted for sheep (Ovis aries), goats (Capra hircus), and cattle (Bos taurus). Goats, but not steers or sheep, demonstrated differences in nutrient digestibility between PM- and AM-cut hays. Goats consumed more PM than AM hay (2.97 vs. 2.83 kg/100 kg of BW; P = 0.07) and digested it to a greater extent (0.710 vs. 0.696; P = 0.03), resulting in greater digestible DMI (2.11 vs. 1.97 kg/100 kg of BW; P = 0.03). Sheep consumed (mean = 2.52 kg/100 kg of BW; P = 0.59) and digested (mean = 0.681; P = 0.25) PM- and AM-cut hays similarly. Steers consumed larger quantities of PM-than AM-cut hay (2.90 vs. 2.62 kg/100 kg of BW; P = 0.11), but digestion did not differ with cutting time (mean = 0.660; P = 0.75). Difference values (composition of fed hay minus composition of orts) indicated that sheep and goats selected from the feed offered similarly, whereas steers selected differently. Difference values for CP averaged 94 and 101 g/kg for goats and sheep and 32 g/kg for steers (P < 0.01), and difference values for NDF averaged 185 and 196 g/kg for goats and sheep and 73 g/kg for steers (P

The influence of high-nitrogen forages on the voluntary feed intake of sheep.

The objective of this research was to examine the effect of high concentrations of nonprotein nitrogen (NPN) on the voluntary food intake of sheep fed high-quality grasses. Wether lambs (n = 6 per treatment) were fed dried switchgrass (Panicum virgatum L.; Exp. 1) or dried tall fescue (Festuca arundinacea Schreb.; Exp. 2). In both experiments, urea was added to the dried forage at 0 (control), 12, or 24 g of N/kg of DM to increase the NPN concentration. Acid detergent fiber concentrations were 305 g/kg of DM in both experiments, although DM digestibility was 663 and 618 g/ kg of DM in Exp. 1 and Exp. 2, respectively. Voluntary feed intake of the control forage was 28.2 and 19.1 g/ kg of BW in Exp. 1 and Exp. 2, respectively, and decreased for the high-urea treatments to 25.2 and 16.2 g/kg of BW in Exp. 1 (P = 0.07) and Exp 2 (P = 0.03), respectively. Total feed N concentrations increased from 29.5 g to 45.7 g of N/kg of DM in Exp. 1 (P < 0.01) and from 28.4 to 55.9 g of N/kg of DM in Exp. 2 (P < 0.01). Nonprotein N concentrations increased from 28.3 to 53.8% of the total N in switchgrass diets (Exp. 1; P < 0.01), and from 26.4 to 64.0% in tall fescue diets (Exp. 2; P < 0.01). Plasma urea concentrations of the lambs increased from 3.1 to 6.6 mM (Exp. 1; P < 0.01) and from 2.9 to 5.8 mM (Exp. 2; P < 0.01) as the amount of urea added to the diets increased. These changes resulted in an increase in plasma osmolality from 298 to 307 mOsm/kg (Exp. 1; P = 0.04), and from 299 to 307 mOsm/kg (Exp. 2; P = 0.06). Increasing feed N and NPN concentrations through the addition of urea caused a significant decrease in the voluntary feed intake of sheep fed tall fescue and switchgrass. These responses showed no significant cause-and-effect relationship between voluntary feed intake, plasma urea concentrations, and plasma osmolality.

Fermentation of eastern gamagrass (Tripsacum dactyloides [L.] L.) by mixed cultures of ruminal microorganisms with or without supplemental corn.

Five dual-flow fermentors (700 mL) were used to determine the effects of eastern gamagrass (Tripsacum dactyloides [L.] L.) diets on microbial metabolism by mixed rumen cultures. Fermentors were incubated with filtered ruminal contents and allowed to adapt for 4 d to diets followed by 3 d of sample collection. Five dietary treatments were tested: 1) gamagrass hay (GH) + no corn (GHNC), 2) gama grass silage (GS) + no corn (GSNC), 3) GS + low corn (GSLC), 4) GS + medium corn (GSMC); and 5) GS + high corn (GSHC). The experiment was conducted as a randomized complete block design with five treatments and three replications. Total VFA concentrations were not affected by diets. Corn addition linearly decreased (P < 0.001) molar proportion of acetate. In contrast, molar proportion of propionate was reduced in GSLC (cubic effect, P < 0.001) but remained similar across other diets. Corn supplementation linearly increased molar proportion of butyrate (P < 0.001). The acetate + butyrate-to-propionate ratio was highest in cultures offered GSLC (cubic effect, P < 0.001) but similar across other diets. Feeding GSNC resulted in a higher ruminal pH compared with GHNC (P < 0.03). Increasing the level of corn supplementation in GS linearly decreased culture pH (P < 0.001). All diets resulted in similar methane production, with the exception of GSMC, which lowered methane output (quadratic effect, P < 0.004). Total substrate fermented to VFA and gas tended to be greater with GHNC than with GSNC (P < 0.06) and linearly increased with the addition of corn (P < 0.004). Neutral detergent fiber digestibility was similar between GH and GS and was not affected by supplemental corn. Microbial N flow increased in cultures offered GSHC (quadratic effect, P < 0.02). Corn supplementation at the medium and high level linearly decreased C 18:0 (P < 0.02) and increased trans-C18:1 (P < 0.004). Including corn at the high level with GS did not have a detrimental effect on fermentation in dual-flow fermentors.

Kawasaki disease: the mystery continues.

Kawasaki disease (KD) is an acute vasculitis of infancy and early childhood that continues to baffle researchers and clinicians alike. Although the acute illness resolves spontaneously, permanent damage to the coronary arteries occurs in 20-25% of untreated children. The cause of KD remains unknown and there is no specific laboratory test to identify affected children. Nonetheless, high dose intravenous g-globulin plus aspirin administered within the first 10 days of fever significantly reduces the risk of coronary artery damage by unknown mechanisms. KD thus presents a unique dilemma: the disease may be difficult to recognize, there is no diagnostic laboratory test, there is an extremely effective therapy, and there is a 25% chance of serious cardiovascular damage or death if the therapy is not administered. This review will highlight some of the many unanswered questions about KD.

Nitrogen metabolism of beef steers fed endophyte-free tall fescue hay: effects of ruminally protected methionine supplementation.

Level of nitrogen (N) intake and ruminally protected methionine supplementation were evaluated in eight Angus growing steers (initial BW 253+/-21 kg, final BW 296+/-21 kg) in a replicated 4+/-4 Latin square design. The steers were fed two endophyte-free tall fescue (Festuca arundinacea) hays that contained 2.2 (LO) or 2.8% (HI) of DM as N and were either supplemented or not with ruminally protected methionine (10 g metabolizable methionine/d). Diets were fed to provide adequate energy for 0.5 kg ADG and sufficient protein for maintenance (LO), or protein to support 0.5 kg ADG (HI). Following at least 14 d of adjustment, N balance was measured for 6 d. Isotopic urea was infused (15N15N-urea, 0.164 mmol urea N/h) via a jugular catheter for 56 h and urine was collected from 48 to 56 h to measure urea kinetics. Jugular blood was collected during the balance trial, and serum was analyzed for serum urea N (SUN). By design, daily N intake was greater (P < 0.05) for HI (112 g) than for LO (89 g). Compared with LO, steers when fed HI had greater (P < 0.05) daily DMI (4,217 vs 4,151 g), fecal N (34.4 vs 31.2 g), N digested (77.1 vs 57.7 g), urine N (48.3 vs 37.5 g), urine urea N excretion (34.6 vs 24.8 g), and N retained (29.8 vs 21.1 g). When fed HI steers also had higher (P < 0.05) urine urea N concentration (276 vs 219 mM), SUN (8.7 vs 6.7 mM), N digestibility (69.1 vs 64.9%), percentage of urinary N present as urea (71.5 vs 66.7%, P < 0.053), and rate of urea N production (59.6 vs 49.2 g/d) but lower (P < 0.05) percentage of urea N produced that was returned to the ornithine cycle (15.03 vs 19.2 1%) than when fed LO. Methionine supplementation decreased daily urine N (41.2 vs 44.6 g, P = 0.10) and increased both the amount of N retained daily (27.9 vs 23.7 g, P < 0.089) and the percentage of N digested that was retained (40.4 vs 34.6%, P < 0.094). In summary, supplemental methionine met a specific dietary limitation by increasing the amount of digested N that was retained by the steers.