Nefrotoxicidad y hematotoxicidad un año después de cuatro ciclos de terapia con péptidos marcados con radionúclidos (PRRT) y su impacto en la planificación del tratamiento futuro. Un análisis retrospectivo / Nephrotoxicity and hematotoxicity one year after four cycles of peptide receptor radionuclide therapy (PRRT) and its impact on future treatment planning. A retrospective analysis

Introducción: La nefrotoxicidad y la hematotoxicidad después de la terapia con péptidos marcados con radionúclidos (PRRT) se han descrito en múltiples estudios usando diferentes actividades acumulativas, número de ciclos o péptidos marcados con radionúclidos. Aunque los tumores neuroendocrinos (NET) altamente diferenciados con metástasis tienen una larga supervivencia libre de progresión, pueden progresar. Analizamos los efectos secundarios a largo plazo en un esquema de tratamiento homogéneo en pacientes con PRRT y su impacto en el futuro tratamiento oncológico en caso de progresión. Métodos: De nuestra base de datos se analizaron 89 de 384 pacientes que recibieron la misma PRRT (Lu-177-DOTATATE o Y-90-DOTATOC) cuatro veces cada 10 a 12 semanas y un seguimiento a los 12 meses. Un paciente recibió tres y 11 pacientes recibieron dos veces cuatro ciclos de PRRT, lo que dio lugar a 102 casos. Se compararon el índice de filtrado glomerular estimado (FGe), la Hb, los glóbulos blancos y las plaquetas antes del primer ciclo de terapia y un año después del cuarto ciclo. La clasificación del FGe se realizó según la clasificación de la enfermedad renal crónica (ERC) y la clasificación de la hematotoxicidad según los Criterios Terminológicos Comunes para Eventos Adversos (CTCAE). También se evaluó el impacto de la edad, el sexo, la actividad acumulada y el tipo de PRRT en la toxicidad a largo plazo. Resultados: El grado 1-2 del FGe se redujo de 87/102 al inicio a 71 casos en el seguimiento (p < 0,001). Antes del tratamiento se encontró grado 3a en 13, grado 3b en 2, y en el seguimiento grado 3a en 25, grado 3b en cinco casos, y grado 4 en 1 caso. La anemia antes de la PRRT y en el seguimiento fue de grado 0 en 63 vs. 48 (p < 0,001), de grado 1 en 36 vs. 48, y de grado 2 en tres vs. seis casos. En el recuento de glóbulos blancos y plaquetas no se produjeron cambios significativos en la clasificación (AU)

Introduction: Nephro- and hematotoxicity after peptide receptor radionuclide therapy (PRRT) have been described in multiple studies with heterogeneous cumulative activities, number of cycles or radiolabelled peptides. Though highly differentiated metastasized neuroendocrine tumours (NET) have long progression free survival, they may progress. We analysed long-term side effects in a homogenous treatment schedule in PRRT-patients and their impact on future oncologic treatment in case of progression. Methods: From our database 89/384 patients receiving the same PRRT (Lu-177-DOTATATE or Y-90-DOTATOC) 4 times every 10 to 12 weeks and a follow-up at 12 months were analysed. One patient had three and 11 patients had two times four PRRT-cycles resulting in 102 cases. eGFR, Hb, WBC and platelets before the first and one year after the fourth therapy cycle were compared. eGFR-Grading was done according to chronic kidney disease classification (CKD) and grading of hematotoxicity according to Common Terminology Criteria for Adverse Events (CTCAE). Impact of age, gender, cumulative activity, type of PRRT on long-term-toxicity was also assessed. Results: eGFR grade 1-2 dropped from 87/102 at the baseline to 71 cases at follow-up (p<0.001). Before treatment grade 3a was found in 13, grade 3b in 2 cases, and at follow-up grade 3a in 25, grade 3b in 5, and grade 4 in 1 case. Anaemia prior to PRRT and at follow-up was grade 0 in 63 versus 48 (p<0.001), grade 1 in 36 versus 48, and grade 2 in three versus six cases. In white blood cell count and platelets, there were no significant changes in grading occurring. Subgroup analysis revealed that only in the age group 65 and older was there a higher incidence for anaemia (p=0.006) (AU)

Nephrotoxicity and hematotoxicity one year after four cycles of peptide receptor radionuclide therapy (PRRT) and its impact on future treatment planning. A retrospective analysis. / Nefrotoxicidad y hematotoxicidad un año después de cuatro ciclos de terapia con péptidos marcados con radionúclidos (PRRT) y su impacto en la planificación del tratamiento futuro. Un análisis retrospectivo.

INTRODUCTION: Nephro- and hematotoxicity after peptide receptor radionuclide therapy (PRRT) have been described in multiple studies with heterogeneous cumulative activities, number of cycles or radiolabelled peptides. Though highly differentiated metastasized neuroendocrine tumours (NET) have long progression free survival, they may progress. We analysed long-term side effects in a homogenous treatment schedule in PRRT-patients and their impact on future oncologic treatment in case of progression. METHODS: From our database 89/384 patients receiving the same PRRT (Lu-177-DOTATATE or Y-90-DOTATOC) 4 times every 10 to 12 weeks and a follow-up at 12 months were analysed. One patient had three and 11 patients had two times four PRRT-cycles resulting in 102 cases. eGFR, Hb, WBC and platelets before the first and one year after the fourth therapy cycle were compared. eGFR-Grading was done according to chronic kidney disease classification (CKD) and grading of hematotoxicity according to Common Terminology Criteria for Adverse Events (CTCAE). Impact of age, gender, cumulative activity, type of PRRT on long-term-toxicity was also assessed. RESULTS: eGFR grade 1-2 dropped from 87/102 at the baseline to 71 cases at follow-up (p<0.001). Before treatment grade 3a was found in 13, grade 3b in 2 cases, and at follow-up grade 3a in 25, grade 3b in 5, and grade 4 in 1 case. Anaemia prior to PRRT and at follow-up was grade 0 in 63 versus 48 (p<0.001), grade 1 in 36 versus 48, and grade 2 in three versus six cases. In white blood cell count and platelets, there were no significant changes in grading occurring. Subgroup analysis revealed that only in the age group 65 and older was there a higher incidence for anaemia (p=0.006). CONCLUSIóN: In roughly 20% of cases an increase in grading of nephro- or hematotoxicity is observed. In those patients, except in one, toxicity findings were mild or moderate one year after completion of four cycles of PRRT with either Y-90- or Lu-177-SST-analogues. In terms of safety, PRRT has no critical impact on further oncologic treatment options in the case of disease progression.

Comparación entre la PET/TC con 18F-DOPA y la PET/TC con 68Ga-DOTATOC para la localización del paraganglioma maligno extra-adrenal y el feocromocitoma / 68Ga-DOTATOC PET/CT in the localization of metastatic extra-adrenal paraganglioma and pheochromocytoma compared with 18F-DOPA PET/CT

Objetivo: La PET con 18F-fluoro-L-dihidroxifenilalanina (18F-DOPA) ofrece alta sensibilidad y especificidad en el diagnóstico del paraganglioma extraadrenal no maligno (PGL) y el feocromocitoma (FEO), pero menor sensibilidad en la enfermedad metastásica. Estos tumores son de origen neuroendocrino y pueden detectarse mediante PET con 68Ga-DOTA-Tyr3-octreótido (68Ga-DOTA-TOC). Por tanto, comparamos 68Ga-DOTA-TOC y 18F-DOPA como radiotrazadores para PET/TC para el diagnóstico de PGL extradrenal metastásico y FEO. Las imágenes tomográficas anatómicas y funcionales fusionadas se utilizaron como estándar de referencia. Métodos: Se incluyó en el estudio a un total de 6 varones y 4 mujeres (rango de edad de 22 a 72 años), con PGL metastásico y FEO anatómica y/o histológicamente demostrados. De entre estos pacientes, 2 varones padecían FEO y los 8 pacientes restantes PGL extraadrenal metastásico. La evaluación comparativa incluyó imagen morfológica con TC e imagen funcional mediante PET con 68Ga-DOTA-TOC y 18F-DOPA. Se analizaron los resultados de las imágenes por lesión. Se midió el valor máximo de captación estandarizado (SUVmáx) de cada modalidad de imagen funcional en las lesiones tumorales concordantes. Resultados: En comparación con la imagen anatómica, la tasa de detección por lesión mediante PET con 68Ga-DOTA-TOC fue del 100% (McNemar, p<0,01), y la de PET con 18F-DOPA fue del 82,3% (McNemar, p<0,8) para PGL extraadrenal metastásico y FEO. En general, la PET con 68Ga-DOTA-TOC identificó 67 lesiones, la imagen anatómica identificó 62 lesiones y la PET con 18F-DOPA identificó 56 lesiones. El valor SUVmáx (media±DE) de todas las lesiones concordantes fue de 29,3±19,9 para la PET con 68Ga-DOTA-TOC, y de 12,3±9,1 para la PET con 18F-DOPA (prueba U de Mann-Whitney, p<0,0001). Conclusión: La PET con 68Ga-DOTA-TOC proporciona un índice de detección más elevado en el PGL extra-adrenal metastásico y PHEO, en comparación con la PET con 18F-DOPA, e incluso con la TC diagnóstica, particularmente en lo referente a lesiones óseas. La imagen funcional/anatómica combinada (PET/TC con 68Ga-DOTA-TOC) permite detectar la extensión exacta del tumor en estas entidades tumorales infrecuentes, especialmente en caso de correlación anatómica incierta

Objective: 18F-Fluoro-L-dihydroxyphenylalanine (18F-DOPA) PET offers high sensitivity and specificity in the imaging of non-malignant extra-adrenal paraganglioma (PGL) and pheochromocytoma (PHEO) but lower sensitivity in metastatic disease. These tumours are of neuroendocrine origin and can be detected by 68Ga-DOTA-Tyr3-octreotide (68Ga-DOTA-TOC) PET. Therefore, we compared 68Ga-DOTA-TOC and 18F-DOPA as radiolabels for PET/CT imaging for the diagnosis of metastatic extra-adrenal PGL and PHEO. Combined cross-sectional imaging was the reference standard. Methods: A total of 6 men and 4 women (age range 22-72 years) with anatomical and/or histologically proven metastatic PGL and PHEO were included in this study. Of these patients, 2 male patients suffered from PHEO, while the remaining 8 patients were diagnosed as metastatic extra-adrenal PGL disease. Comparative evaluation included morphological imaging with CT and functional imaging with 68Ga-DOTA-TOC and 18F-DOPA PET. The imaging results were analyzed on a per-lesion basis. The maximum standardized uptake value (SUVmax) of each functional imaging modality in concordant tumour lesions was measured. Results: Compared with anatomical imaging, the per-lesion detection rate of 68Ga-DOTA-TOC was 100% (McNemar, P<0.01), and that of 18F-DOPA PET was 82.3% (McNemar, P<0.8) in metastatic extra-adrenal PGL and PHEO. Overall, 68Ga-DOTA-TOC PET identified 67 lesions; anatomical imaging identified 62 lesions, and 18F-DOPA PET identified 56 lesions. The SUVmax (mean±SD) of all concordant lesions was 29.3±19.9 for 68Ga-DOTA-TOC PET and 12.3±9.1 for 18F-DOPA PET (Mann-Whitney U test, P<0.0001). Conclusion: 68Ga-DOTA-TOC PET offers the highest detection rate in metastatic extra-adrenal PGL and PHEO compared to 18F-DOPA PET and even to diagnostic CT, particularly in bone lesions. Combined functional/anatomical imaging (68Ga-DOTA-TOC PET/CT) enables exact tumour extension to be detected in these rare tumour entities, especially in the case of unclear anatomical correlation

Effects of ruminal degradability of ensiled whole crop maize varieties on feed intake and milk production of dairy cows.

The feed value of whole crop maize silage (WCMS) depends on nutrient composition, ruminal degradability and whole tract digestibility. However, as the ruminal degradation rate is involved in physical regulation of feed intake, ruminal degradability of WCMS may also affect feed intake and milk production of dairy cows. Thus, the aim of this study was to examine relationships between nutrient composition, ruminal degradability, and whole tract digestibility of WCMS and feed intake and milk production of dairy cows. Nine varieties were tested in 3 consecutive years. Nutrient composition analyses included proximate analysis and determination of cell wall constituents. Whole tract digestibility was determined in vivo using wethers and ruminal degradability was examined in situ using four rumen-fistulated steers. Feed intake and milk production were measured using nine cows per variety. Cows were fed a ration consisting of 75.0% WCMS, 8.5% hay and 16.5% soya bean meal (dry matter basis) ad libitum. Variety did not influence nutrient composition, except for the concentration of ADF (ADFom), ADL and utilisable CP (uCP). In contrast, variety had a significant effect (P < 0.05) on ruminal degradability of NDF (aNDFom) and on whole tract digestibility of organic matter (OM) and non-fibre carbohydrates. Dry matter intake (DMI) of WCMS tended to be affected by variety (0.05

68Ga-DOTATOC PET/CT in the localization of metastatic extra-adrenal paraganglioma and pheochromocytoma compared with 18F-DOPA PET/CT. / Comparación entre la PET/TC con 18F-DOPA y la PET/TC con 68Ga-DOTATOC para la localización del paraganglioma maligno extra-adrenal y el feocromocitoma.

OBJECTIVE: 18F-Fluoro-L-dihydroxyphenylalanine (18F-DOPA) PET offers high sensitivity and specificity in the imaging of non-malignant extra-adrenal paraganglioma (PGL) and pheochromocytoma (PHEO) but lower sensitivity in metastatic disease. These tumours are of neuroendocrine origin and can be detected by 68Ga-DOTA-Tyr3-octreotide (68Ga-DOTA-TOC) PET. Therefore, we compared 68Ga-DOTA-TOC and 18F-DOPA as radiolabels for PET/CT imaging for the diagnosis of metastatic extra-adrenal PGL and PHEO. Combined cross-sectional imaging was the reference standard. METHODS: A total of 6 men and 4 women (age range 22-72 years) with anatomical and/or histologically proven metastatic PGL and PHEO were included in this study. Of these patients, 2 male patients suffered from PHEO, while the remaining 8 patients were diagnosed as metastatic extra-adrenal PGL disease. Comparative evaluation included morphological imaging with CT and functional imaging with 68Ga-DOTA-TOC and 18F-DOPA PET. The imaging results were analyzed on a per-lesion basis. The maximum standardized uptake value (SUVmax) of each functional imaging modality in concordant tumour lesions was measured. RESULTS: Compared with anatomical imaging, the per-lesion detection rate of 68Ga-DOTA-TOC was 100% (McNemar, P<0.01), and that of 18F-DOPA PET was 82.3% (McNemar, P<0.8) in metastatic extra-adrenal PGL and PHEO. Overall, 68Ga-DOTA-TOC PET identified 67 lesions; anatomical imaging identified 62 lesions, and 18F-DOPA PET identified 56 lesions. The SUVmax (mean±SD) of all concordant lesions was 29.3±19.9 for 68Ga-DOTA-TOC PET and 12.3±9.1 for 18F-DOPA PET (Mann-Whitney U test, P<0.0001). CONCLUSION: 68Ga-DOTA-TOC PET offers the highest detection rate in metastatic extra-adrenal PGL and PHEO compared to 18F-DOPA PET and even to diagnostic CT, particularly in bone lesions. Combined functional/anatomical imaging (68Ga-DOTA-TOC PET/CT) enables exact tumour extension to be detected in these rare tumour entities, especially in the case of unclear anatomical correlation.

Genetic analysis of efficiency traits in Austrian dairy cattle and their relationships with body condition score and lameness.

This study is part of a larger project whose overall objective was to evaluate the possibilities for genetic improvement of efficiency in Austrian dairy cattle. In 2014, a 1-yr data collection was carried out. Data from 6,519 cows kept on 161 farms were recorded. In addition to routinely recorded data (e.g., milk yield, fertility, disease data), data of novel traits [e.g., body weight (BW), body condition score (BCS), lameness score, body measurements] and individual feeding information and feed quality were recorded on each test-day. The specific objective of this study was to estimate genetic parameters for efficiency (related) traits and to investigate their relationships with BCS and lameness in Austrian Fleckvieh, Brown Swiss, and Holstein cows. The following efficiency (related) traits were considered: energy-corrected milk (ECM), BW, dry matter intake (DMI), energy intake (INEL), ratio of milk output to metabolic BW (ECM/BW0.75), ratio of milk output to DMI (ECM/DMI), and ratio of milk energy output to total energy intake (LE/INEL, LE = energy in milk). For Fleckvieh, the heritability estimates of the efficiency (related) traits ranged from 0.11 for LE/INEL to 0.44 for BW. Heritabilities for BCS and lameness were 0.19 and 0.07, respectively. Repeatabilities were high and ranged from 0.30 for LE/INEL to 0.83 for BW. Heritability estimates were generally lower for Brown Swiss and Holstein, but repeatabilities were in the same range as for Fleckvieh. In all 3 breeds, more-efficient cows were found to have a higher milk yield, lower BW, slightly higher DMI, and lower BCS. Higher efficiency was associated with slightly fewer lameness problems, most likely due to the lower BW (especially in Fleckvieh) and higher DMI of the more-efficient cows. Body weight and BCS were positively correlated. Therefore, when selecting for a lower BW, BCS is required as additional information because, otherwise, no distinction between large animals with low BCS and smaller animals with normal BCS would be possible.

The use of mid-infrared spectrometry to estimate the ration composition of lactating dairy cows.

The composition of cow milk is strongly affected by the feeding regimen. Because milk components are routinely determined using mid-infrared (MIR) spectrometry, MIR spectra could also be used to estimate an animal's ration composition. The objective of this study was to determine whether and how well amounts of dry matter intake and the proportions of concentrates, hay, grass silage, maize silage, and pasture in the total ration can be estimated using MIR spectra at an individual animal level. A total of 10,200 milk samples and sets of feed intake data were collected from 90 dairy cows at 2 experimental farms of the Agricultural Research and Education Centre in Raumberg-Gumpenstein, Austria. For each run of analysis, the data set was split into a calibration and a validation data set in a 40:60 ratio. Estimated ration compositions were calculated using a partial least squares regression and then compared with the respective observed ration compositions. In separate analyses, the factors milk yield and concentrate intake were included as additional predictors. To evaluate accuracy, the coefficient of determination (R2) and ratio to performance deviation were used. The highest R2 values (for kg of dry matter intake/for % of ration) for the individual feedstuffs were as follows: pasture, 0.63/0.66; grass silage, 0.32/0.43; concentrate intake, 0.39/0.34; maize silage, 0.32/0.33; and hay, 0.15/0.16. Estimation of groups of feedstuffs (forages, energy-dense feedstuffs) mostly resulted in R2 values >0.50. Including the parameters milk yield or concentrate intake improved R2 values by up to 0.21, with an average improvement of 0.04. The results of this study indicate that not all ration components may be estimated equally accurately. Even if some estimates are good on average, there may be strong deviations between estimated and observed values in individual data sets, and therefore individual estimates should not be overemphasized. Further research including pooled samples (e.g., bulk milk, farm samples) or variations in ration composition is called for.

[Ultrasound-guided interventions on the peripheral nervous system]. / Ultraschallgesteuerte Interventionen am peripheren Nervensystem.

CLINICAL/METHODICAL ISSUE: Up to the advent of high-resolution ultrasound, interventions on the peripheral nervous system, including local anesthesia and pain treatment were performed without visual guidance, which in some cases led to treatment failure or local tissue and nerve damage. METHODICAL INNOVATIONS: Progress in the field of ultrasound has enabled the functional visualization, anesthesia and anti-inflammatory or neurolytic treatment of many peripheral nerves, such as the brachial plexus, nerves of the upper and lower extremities and various nerves of the trunk. Contrast medium-guided biopsies have also become feasible. ACHIEVEMENTS: This article discusses the general prerequisites for such interventions and details the visualization and the interventional algorithms for interventions on the brachial plexus, on large nerves often affected by compression neuropathies, such as the median, ulnar, sciatic and femoral nerves and small nerves, such as the lateral cutaneous nerves of the thigh. Furthermore, contrast medium-aided biopsies of intraneural and perineural masses are discussed. Finally, the treatment of stump neuromas via phenol instillation is described. PRACTICAL RECOMMENDATIONS: Innovations in high-resolution ultrasound allow the reliable and safe diagnosis and treatment of various pathologies of the peripheral nervous system with few side effects. Compared to older methods, which did not use visual guidance ultrasound provides higher success rates and lower adverse event rates in many instances.

Metabolic adaptation and reticuloruminal pH in periparturient dairy cows experiencing different lipolysis early postpartum.

Metabolic adaptation includes an array of concerted metabolic and endocrine events that enable dairy cows bridging the period of energy deficit at the onset of lactation. The present study evaluated metabolic, endocrine and reticuloruminal pH changes in 30 (25 Holstein and five Simmental) periparturient dairy cows experiencing variable lipolysis early postpartum. Cows were fed the same close-up and fresh lactation diets and kept in the same management conditions. Blood samples were collected at day 14, and day 4, relative to expected parturition, and at day 2, and day 21 postpartum, and serum metabolites and hormones related to glucose and lipid metabolism, as well as concentrations of several liver enzymes and acute phase proteins were determined. Additionally, reticuloruminal pH was monitored every 10 min over the last 3 days of the observation period. BW and milk yields were recorded and balances of energy and protein were assessed. Based on serum concentration of non-esterified fatty acids (NEFA) postpartum, cows were retrospectively classified into low (n=8), medium (n=11), and high (n=11) lipolysis groups, with NEFA levels of 0.7 mmol/l, respectively. Overall, elevated NEFA concentrations in the High group went along with a higher ratio of NEFA to cholesterol and reduced insulin sensitivity. While serum glucose, energy deficit and BW loss did not differ, cows of the High group exhibited increased lactate concentrations in the serum, compared with the Medium group. No differences in liver enzymes and acute phase proteins were evidenced among fat mobilization groups, whereas concentration of serum billirubin was lowest in the Low group after parturition. Data of milk yield and milk energy output showed no differences among groups, despite divergences in calculated energy balance and BW change postpartum. Cows of the Low group tended to increase dry matter intake but also showed longer time duration of pH below 6.0 in the reticulorumen (on average 299 min/day compared with 99 and 91 min/day for Medium and High groups, respectively). Differences in metabolic, endocrine and reticuloruminal pH responses indicate diverse metabolic adaptation strategies of early-lactation cows to cope with energy deficit postpartum.

Doppler-guided haemorrhoidal artery ligation with suture mucopexy compared with suture mucopexy alone for the treatment of Grade III haemorrhoids: a prospective randomized controlled trial.

AIM: Novel minimally invasive techniques aimed to reposition the haemorrhoidal zone have been established for prolapsing haemorrhoids. We present a prospective randomized controlled trial to evaluate the efficacy of additional Doppler-guided ligation of submucosal haemorrhoidal arteries (DG-HAL) in patients with symptomatic Grade III haemorrhoids. The trial was registered as ClinicalTrials.gov identifier NCT02372981. METHOD: All consecutive patients with symptomatic Grade III haemorrhoids were randomly allocated to one of the two study arms: (i) Group A, DG-HAL with mucopexy or (ii) Group B, mucopexy alone. End-points were postoperative pain, faecal incontinence, bleeding, residual prolapse and alterations of the vascularization of the anorectal vascular plexus. Vascularization of the anorectal vascular plexus was assessed by transperineal contrast enhanced ultrasound. Patients recorded their symptoms in a diary maintained for a month. RESULTS: Forty patients were recruited and randomized to the two study groups. Patients in Group A had less pain in the first two postoperative weeks. At the 12-month follow-up, two patients in Group A (10%) and one in Group B (5%) showed recurrent Grade III haemorrhoids (P = 0.274). No significant morphological changes were observed in the transperineal ultrasound findings between the preoperative assessment and the assessment at 1 and 6 months in either group (P > 0.05). CONCLUSION: Mucopexy techniques for treating prolapsing haemorrhoids are effective, but DG-HAL does not add significantly to the results achieved by mucopexy. Repositioning the haemorrhoidal zone is the key to success, and mucopexy should be placed at the sites of the largest visible prolapse.

Microbial populations and fermentation profiles in rumen liquid and solids of Holstein cows respond differently to dietary barley processing.

AIMS: To evaluate the effects of treating barley grain with lactic acid (LA) and heat on postprandial dynamics of 19 microbial taxa and fermentation in the rumen of dairy cows. METHODS AND RESULTS: This study was designed as a double 3 × 3 Latin square with six rumen-cannulated cows and three diets either containing untreated control barley or barley treated with 1% LA and 1% LA and heat (LAH, 55°C). Microbial populations, pH and volatile fatty acids were assessed in rumen liquid and solids during the postprandial period. Propionate increased and butyrate decreased in rumen solids of cows fed LA and LAH treated barley compared to the control barley. The LA but not LAH treatment depressed Fibrobacter succinogenes in rumen liquid and solids, whereas the opposite effect was observed for Ruminococcus albus in both fractions and Ruminococcus flavefaciens in rumen solids. LA promoted Ruminobacter amylophilus with the effect being more pronounced with LAH. The Lactobacillus group and Megasphaera elsdenii increased in both fractions with LA but not with LAH. CONCLUSIONS: LA and LAH treatment of barley differently altered ruminal abundance of certain bacterial taxa and fungi and increased propionate fermentation in rumen solids, whereby LA and LAH effects were consistent and mostly independent of the rumen fraction and time after barley feeding. SIGNIFICANCE AND IMPACT OF THE STUDY: Results provided evidence that LA and LAH treatment of barley can enhance rumen propionate fermentation without adversely affecting rumen pH. As propionate is the major contributor to gluconeogenesis in ruminants, the present barley treatment may have practical application to enhance energy supply in dairy cows.

Long-term reticuloruminal pH dynamics and markers of liver health in early-lactating cows of various parities fed diets differing in grain processing.

The present study aimed to investigate the long-term effect of feeding barley grain steeped in lactic acid (La) with or without thermal treatment on reticuloruminal pH dynamics and metabolic activity of the liver in 12 primiparous and 18 multiparous early-lactating dairy cows. All cows were included on d 21 postpartum and sampled until d 90 postpartum. Cows were fed a diet based on differently processed ground barley grain: untreated grain (control diet, CON), or grain treated with 1% La alone for 24 h before feeding (La), or with an additional oven-heating at 55°C for 12 h (LaH). The reticuloruminal pH and temperature were measured via indwelling sensors that allowed for continuous (every 10min) and long-term measurement from d 21 to 80 postpartum. Blood samples were taken on d 21, 40, and 90 of lactation and analyzed for liver enzymes aspartate aminotransferase (AST), gamma-glutamyltransferase, and glutamate dehydrogenase, as well as bilirubin, bile acids, and serum amyloid A. Dry matter intake was higher in multiparous cows (20.7±0.27 kg/d) compared with primiparous cows (18.2±0.33 kg/d), but was not affected by dietary treatment. Overall, the relatively short duration (51±5min/d) of reticuloruminal pH <5.8 suggests low risk of subacute ruminal acidosis throughout the experiment. Results indicated that La treatment of barley, with or without heat, lowered the time duration of pH <5.8 compared with CON, but only in primiparous cows (from 118±13 to 46±11 and 25±11min/d for CON, La, and LaH, respectively). In multiparous cows, the opposite effect of feeding the La-treated barley on time duration of pH <5.8 (11±8 vs. 46±9 vs. 57±9min/d for CON, La, and LaH, respectively) was observed. Multiparous cows generally showed higher pH readings and shorter periods in which the ruminal pH dropped below the threshold of pH 5.8. The reticuloruminal temperature was not affected by dietary treatment, whereas parity affected the time duration of reticuloruminal temperature >39.5°C, being 60±19min/d shorter in primiparous cows. The measured activities of the liver enzymes AST, gamma-glutamyltransferase, and glutamate dehydrogenase, as well as bilirubin, bile acids, and the acute phase protein serum amyloid A, were not affected by grain feeding. Additionally, only one small effect of parity on investigated serum variables was noticed, showing slightly but significantly higher values of AST in multiparous (80.5±1.4 U/L) compared with primiparous cows (76.0±1.7 U/L). In conclusion, our results indicate greater risk for primiparous cows to develop subacute ruminal acidosis-like conditions during early lactation than multiparous cows. The study also suggests limited benefits of feeding processed barley grain with La with or without thermal treatment to modulate ruminal tolerance of grain feeding, whereby differing effects in primiparous cows were observed compared with multiparous cows.

[Assessment of quality indicators with routine data: Presentation of a feasibility test in ten specialist clinics for psychiatry and psychotherapy]. / Erhebung von Qualitätsindikatoren anhand von Routinedaten : Darstellung eines Machbarkeitstests in 10 Fachkliniken für Psychiatrie und Psychotherapie.

BACKGROUND: Prior to nationwide implementation, the feasibility of newly developed quality indicators must be assessed. The aim of this multicenter feasibility test was an evaluation of the measurability of cross-sectoral quality indicators for depression and schizophrenia by means of routine data. METHODS: The feasibility of the quality indicators was assessed in ten specialist clinics for psychiatry and psychotherapy by means of retrospective analyses of anonymous routine data. The data were extracted from the routine clinical documentation of the hospital information systems and the data from the admission and discharge sheets of the basic documentation in psychiatry (BADO) were additionally used for some clinics. Analyses were conducted for all cases of adults diagnosed with depression or schizophrenia within predefined assessment periods. RESULTS: In total five indicators for depression and nine indicators for schizophrenia were assessed and evaluated as measurable or measurable to a limited extent, sometimes with slight adaptations in the operationalization of the indicator. Due to variations in documentation, some indicators could not be calculated for all clinics. Most indicators could be collated with the data from the BADO. CONCLUSION: An assessment of indicators that measure quality-relevant aspects of care in depression and schizophrenia, is partially feasible by means of current routine data documentation analysis from the participating clinics. However, differing documentation methodologies in the participating clinics impeded a uniform assessment; therefore, for the implementation of nationwide minimum standards for the quality assurance of mental healthcare, a uniform cross-sectoral documentation methodology should be adapted to consensus and relevant quality indicators. The BADO appears to be a suitable instrument for this purpose.

[Depressive symptoms in schizophrenia]. / Depression bei Schizophrenie.

Patients with schizophrenia suffer frequently from comorbid depressive symptoms. However, there is a paucity of studies regarding prevalence, clinical diagnostic and treatment in the field. For this review, we performed a focused literature analysis to identify recommendation for the treatment and diagnosis of schizophrenia with comorbid depression. Furthermore, we searched different schizophrenia guidelines for specific treatment recommendations. Due to the complex and heterogeneous picture of depressive symptoms in schizophrenia, the application of standardized assessment tools is recommended. For these purposes, the CDSS (Calgary depression rating scale for Schizophrenia) is such an established tool. In summary, there is only limited evidence for specific treatment recommendations. A change in antipsychotic treatment should usually be preferred before an antidepressant is introduced. In the group of antidepressants, SSRI seem to have some advantages, but most clinical and scientific experience is available for tricyclic antidepressants. Due to the limited original contributions and studies with sufficient methodology, further interventional trials are needed to give specific recommendations with high evidence grades.

Metabolic parameters and their relationship to energy balance in multiparous Simmental, Brown Swiss and Holstein cows in the periparturient period as influenced by energy supply pre- and post-calving.

A study was conducted to evaluate the effects of three energy supply (E) levels [low (L), medium (M), high (H)], both pre-partum (PRE) and post-partum (POST), and their interactions on metabolic parameters and energy balance (EB) in dairy cows of three breeds. In both phases, E levels applied to a total of 81 multiparous cows of breeds Simmental (SI), Brown Swiss (BS) and Holstein-Friesian (HF; n = 27 for each breed) were 75%, 100% and 125% of recommendations of the German Society of Nutrition Physiology, using a 3 × 3 factorial arrangement of treatments. During the pre-calving period, serum concentrations of non-esterified fatty acids (NEFA) were higher for L(PRE) cows, and glucose concentrations were elevated for H(PRE) cows. During the lactation period, NEFA concentrations were greatest for treatment L(POST). Mean concentrations of ß-hydroxybutyrate (BHB) were highest for cows of the L(POST) treatment, intermediate for M(POST) and lowest for H(POST). Glucose concentrations were lower for L(POST) cows. SI cows had lower BHB concentrations both pre- and post-calving and higher glucose concentrations during early lactation than the other breeds. BHB concentration POST was highest for BS cows. Restricted feeding PRE resulted in a better energy status of cows fed above energy requirements POST (E(PRE) × E(POST) interaction). HF cows had a higher EB pre-calving, whereas SI cows had a less negative EB during early lactation, compared with the other breeds respectively. Correlations of serum NEFA, BHB and glucose concentrations with EB were strongest during the transition period. Results suggest that controlling energy intake during the dry period might be advantageous for the energy status of dairy cows after calving, whereas energy restriction in early lactation leads to metabolic stress. Evidence is provided of a clear relationship between EB and the blood metabolites NEFA and BHB, especially in the transition period.

Ultrasound imaging of the axillary nerve and its role in the diagnosis of traumatic impairment.

PURPOSE: The axillary nerve (AN) is frequently injured during shoulder trauma and imaging is required to define the site and extent of nerve injury. However, the AN has a rather complex course through several soft tissue compartments of the shoulder and axilla. Therefore, imaging of the nerve with MRI and sonography is troublesome. Thus detection and sonographic assessment bases on thorough knowledge of local topography. MATERIALS AND METHODS: This investigation aimed at defining reliable anatomical landmarks for AN-sonography in 5 volunteers and later validating the proposed sonographic examination protocol in 10 unselected patients. RESULTS: With strict adherence to the proposed examination algorithm, sonography of the AN was feasible in all volunteers and patients. Furthermore, sonographic findings correlated nicely with the golden standard "surgical exploration" concerning severity and topography of neural impairment. CONCLUSION: Based on our study results we propose our algorithm for AN-sonography as the first-line imaging tool for the assessment of axillary nerve trauma.

Influence of energy and nutrient supply pre and post partum on performance of multiparous Simmental, Brown Swiss and Holstein cows in early lactation.

A study was conducted to evaluate the effects of pre partum (PRE) and post partum (POST) dietary energy and nutrient supply (E) and their interactions on feed intake, performance and energy status in dairy cows of three breeds. In this experiment, the effects of three energy and nutrient supply levels (low (L), medium (M), high (H)), both pre-calving and post-calving, were investigated, using a 3×3 factorial arrangement of treatments. In both phases (84 days pre- and 105 days post-calving) E levels applied to a total of 81 multiparous cows of breeds Simmental (SI), Brown Swiss (BS) and Holstein-Friesian (HF; n=27 for each breed), were 75%, 100% and 125% of recommendations of the German Society of Nutrition Physiology (GfE). Dry matter intake (DMI) was restricted, if energy intake exceeded target values. Pre partum DMI and energy intake were different as designed, liveweight and body condition score (BCS) of SI cows were higher, but EB was lower, compared to BS and HF cows. Milk yield and composition were influenced by all three main experimental factors (EPRE, EPOST, breed). Energy-corrected milk yield was 25.6, 28.6 and 30.1 kg/day for LPRE, MPRE and HPRE as well as 21.5, 30.1 and 32.6 kg/day for LPOST, MPOST and HPOST, respectively. Numerically, only for milk protein content the interactions EPRE×EPOST and EPRE×breed reached significance. Impact of energy supply pre-calving was more pronounced when cows had lower energy supply post-calving and vice versa. On the other hand, milk yield response of cows to energy supply above requirements was greater for cows that were fed on a low energy level pre partum. Impact of energy level pre partum was higher for HF cows, showing that their milk production relies to a greater extent on mobilization of body reserves. Increasing energy supply pre partum led to a more negative energy balance post partum, mainly by increasing milk yield and content, whereas feed intake was slightly reduced. Increasing energy supply post partum enhanced milk yield as well as milk protein and lactose content. Calculated energy balance corresponded well with liveweight and BCS change. Response of milk yield to increasing energy supply followed the principle of diminishing returns, since energy was increasingly partitioned to body retention. Increasing energy supply pre partum enhances milk yield and content post partum, but exacerbates negative energy balance and its consequences.

Phthalates and their metabolites in breast milk--results from the Bavarian Monitoring of Breast Milk (BAMBI).

Phthalates have long been used as plasticizers to soften plastic products and, thus, are ubiquitous in modern life. As part of the Bavarian Monitoring of Breast Milk (BAMBI), we aimed to characterize the exposure of infants to phthalates in Germany. Overall, 15 phthalates, including di-2-ethylhexyl phthalate (DEHP), di-n-butyl phthalate (DnBP), di-isobutyl phthalate (DiBP), di-isononyl phthalate (DiNP), three primary metabolites of DEHP [mono-(2-ethylhexyl) phthalate (MEHP), mono-isobutyl phthalate (MiBP), and mono-n-butyl phthalate (MnBP)], and two secondary metabolites of DEHP were analyzed in 78 breast milk samples. We found median concentrations of 3.9 ng/g for DEHP, 0.8 ng/g for DnBP, and 1.2 ng/g for DiBP, while other parent phthalates were found in only some or none of the samples at levels above the limit of quantitation. In infant formula (n=4) we observed mean values of 19.7 ng/g (DEHP), 3.8 ng/g (DnBP), and 3.6 ng/g (DiBP). For MEHP, MiBP, and MnBP, the median values in breast milk were 2.3 µg/l, 11.8 µg/l, and 2.1 µg/l, respectively. The secondary metabolites were not detected in any samples. Using median and 95th percentile values, we estimated an "average" and "high" daily intake for an exclusively breast-fed infant of 0.6 µg/kg body weight (b.w.) and 2.1 µg/kg b.w., respectively, for DEHP, 0.1 µg/kg b.w. and 0.5 µg/kg b.w. for DnBP, and 0.2 µg/kg b.w. and 0.7 µg/kg b.w. for DiBP. For DiNP, intake values were 3.2 µg/kg b.w. and 6.4 µg/kg b.w., respectively, if all values in milk were set half of the detection limit or the detection limit. The above-mentioned "average" and "high" intake values corresponded to only about 2% to 7%, respectively, of the recommended tolerable daily intake. Thus, it is not likely that an infant's exposure to phthalates from breast milk poses any significant health risk. Nevertheless, other sources of phthalates in this vulnerable phase have to be considered. Moreover, it should be noted that for infants nourished with formula, phthalate intake is of the same magnitude or slightly higher (DEHP) than for exclusively breast-fed infants.