Evolution of viscera and muscle fractional protein synthesis rate in lean meat selected hybrids and castrated Duroc pigs fed under moderate crude protein restriction.

Differences in producing performance and organoleptic meat characteristics among pig genotypes and/or producing types are widely known. These parameters are also subjected to the animal's development, feeding and management. Detailed knowledge of the effects of production phase (PP), pig producing type (PT), dietary protein availability and their interactions on nutrient digestibility, nitrogen balance and protein metabolism is essential information to improve precision feeding techniques. The experiment was a 2 (PP) × 2 (PT) × 2 (diet) factorial design conducted with 32 male pigs, 16 entire F2 pigs progeny of Pietrain sires and Duroc × Landrace dams, and 16 castrated purebred Durocs belonging to two production phases (growing: 29.5 ± 3.19 v. fattening: 88.6 ± 6.26 kg BW), and assigned to one of two dietary CP levels, either standard (SP: 17% in growing and 15% in fattening) or low (LP: 15% in growing and 13% in fattening). Viscera and muscle fractional protein synthesis rates (FSRs; %/day) were conducted through a single infusion of 15% L-[ring-2H5]-phenylalanine, with subsequent blood sampling from 12 to 40 min, and sample collection of liver, duodenum, biceps femoris and longissimus dorsi skeletal muscles after sacrifice. Fattening animals acquired a greater feed ingestion capacity, average daily gain (P < 0.01) and apparent ileal digestibility, whereas growing pigs showed higher FSRs in both viscera (duodenum and liver) and in longissimus dorsi. F2 pigs showed higher average daily gain, nitrogen retention rates and FSR in liver and longissimus dorsi (P < 0.01). Nevertheless, apparent ileal digestibility in all essential amino acids was lower in F2 compared with Duroc pigs (P < 0.05). Protein metabolism was barely influenced by dietary CP content, although animals fed LP registered the lowest apparent ileal digestibility for CP and also for most of the essential amino acids compared with SP-fed pigs. This information may reveal differences in amino acid requirements between both PTs, with Duroc pigs receiving excess of dietary amino acids.

Study of nitrogen fluxes across conventional solid floor cubicle and compost-bedded pack housing systems in dairy cattle barns located in the Mediterranean area: Effects of seasonal variation.

The aim of this study was to determine the effect of housing system (or manure management system) and season on manure N recovery and volatilization using an N mass balance. Dietary, milk, and manure N were monitored together with outside temperatures in 6 dairy barns. Three barns were designed as conventional freestalls (cubicle, CUB) with an automatic manure scraper system and concrete floor, in which the gutter in the middle was continuously scraped (every 2-4 h) and the slurry was conveyed toward an open-air concrete pool. The other 3 barns were designed as a loose housing system (HS) with a compost-bedded pack (CB) and conventional confinement housing provided with a feed alley that was cleaned mechanically (2-3 times per day). The farms under study were located near Lleida in the center of the Ebro valley, in northeastern Spain. Nitrogen recovery was measured twice under farm-like conditions either during spring-summer (3 mo of increasing temperatures) or fall-winter (3 mo of decreasing temperatures). The number of cows per barn ranged from 99 to 473, and average age, mean lactation, and parturition intervals were 4.1 yr, 2.43 lactations, and 426.6 d, respectively. In spring-summer, animals ate more [26.3 vs. 23.8 kg of dry matter (DM)/d] and produced more milk (34.6 vs. 31.3 kg/d ± 0.68). However, milk composition did not change. Stored manure from the CB system showed a higher DM concentration with respect to the CUB system (379.15 vs. 97.65 g/kg of fresh matter); however, N (31.45 vs. 40.2), NH3-N (5.3 vs. 18.9) and its ratios with phosphorus (NH3-N:P, 3.52 vs. 5.2) and potassium (NH3-N:K, 0.615 vs. 2.69) showed the opposite trend. No differences were found in N intake (653 vs. 629.5 g/d) or milk N secretion (190 vs. 177.8 g/d for CUB and CB barns, respectively) although net N recovery of the excreted N (Nintake - NMilk) was significantly lower in manure in CB barns than in CUB systems (193.8 vs. 389.3 g/d). The proportion of N irreversible loss in relation to the N intake was higher in CB than in CUB barns (42.3 vs. 11.0%). There was no clear association between season and irreversible N losses; however, the housing system was pivotal in the association between N recovery in manure and irreversible losses by volatilization.

Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study.

OBJECTIVES: To investigate the incidence of clinical, ultrasonographic and biochemical findings related to pre-eclampsia (PE) in pregnancies with COVID-19, and to assess their accuracy to differentiate between PE and the PE-like features associated with COVID-19. DESIGN: A prospective, observational study. SETTING: Tertiary referral hospital. PARTICIPANTS: Singleton pregnancies with COVID-19 at >20+0  weeks. METHODS: Forty-two consecutive pregnancies were recruited and classified into two groups: severe and non-severe COVID-19, according to the occurrence of severe pneumonia. Uterine artery pulsatility index (UtAPI) and angiogenic factors (soluble fms-like tyrosine kinase-1/placental growth factor [sFlt-1/PlGF]) were assessed in women with suspected PE. MAIN OUTCOME MEASURES: Incidence of signs and symptoms related to PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, abnormal UtAPI and increased sFlt-1/PlGF. RESULTS: Thirty-four cases were classified as non-severe and 8 as severe COVID-19. Five (11.9%) women presented signs and symptoms of PE, all five being among the severe COVID-19 cases (62.5%). However, abnormal sFlt-1/PlGF and UtAPI could only be demonstrated in one case. One case remained pregnant after recovery from severe pneumonia and had a spontaneous resolution of the PE-like syndrome. CONCLUSIONS: Pregnant women with severe COVID-19 can develop a PE-like syndrome that might be distinguished from actual PE by sFlt-1/PlGF, LDH and UtAPI assessment. Healthcare providers should be aware of its existence and monitor pregnancies with suspected pre-eclampsia with caution. TWEETABLE ABSTRACT: This study shows that a pre-eclampsia-like syndrome could be present in some pregnancies with severe COVID-19.

Assessing prediction accuracy for outcomes of ventilator-associated events and infections in critically ill children: a prospective cohort study.

OBJECTIVES: To assess the prediction accuracy of the 2008 US Centers for Disease Control and Prevention (CDC) definitions for ventilator-associated pneumonia (VAP)/ventilator-associated tracheobronchitis (VAT), 2013 CDC definitions for ventilator-associated events (VAE) and a new VAE algorithm in the paediatric (Ped) population, the Ped-VAE. METHODS: We performed a prospective 13-month cohort study at a multidisciplinary paediatric intensive care unit (PICU). Primary endpoints were duration of ventilation episode, PICU or hospitalization length of stay from episode and episode mortality. Episodes without VAE (or VAP/VAT) served as comparison groups. RESULTS: One hundred eight episodes of ventilation (99 children) with 2554 ventilator-days were assessed. In episodes not meeting 2008 CDC definitions, a median of 6 ventilator-days (PICU stay 11 days) was documented (with eight deaths), not significantly different from episodes not meeting VAE or Ped-VAE definitions. Using 2008 CDC criteria, 11 (10.2%) respiratory infections (eight tracheobronchitis) were identified, seven VAEs using 2013 CDC criteria (6.4%) and 29 (26.8%) using Ped-VAE criteria (relative risk vs. 2008 CDC criteria 2.58; 95% confidence interval 1.36-4.91). In contrast with their comparison groups, episodes meeting 2008 CDC criteria did not significantly predict outcomes, whereas VAEs (only four possible VAPs) were associated with significantly more ventilation and PICU length of stay (12-day/8-day increase) and sevenfold increase in mortality. Ped-VAE did not increase mortality, but it was associated with 4-day increase in ventilation and PICU length of stay, with ten possible VAPs, and atelectasis (9/12) as the main paediatric ventilator-associated condition. CONCLUSIONS: The 2008 CDC criteria did not predict outcomes, whereas VAE only identified very severe events. The Ped-VAE algorithm had more accuracy predicting outcomes by characterizing lower oxygenation changes and identifying hypoxaemia severity, a major driver of management.

Nutritional strategies to cope with reduced litter weight gain and total tract digestibility in lactating sows.

Twelve lactating sows were used to evaluate the effects of reducing dietary crude protein (CP) (14% vs. 12%) and increasing neutral detergent fibre (NDF) levels (18% vs. 22%) on litter performance, total tract apparent digestibility and manure composition in a 4 × 4 latin square arrangement during a 36-day lactation period. Diets were isoenergetic (2.9 Mcal ME/kg) and had similar total lysine content (0.9%). In addition, a second aim was to compare a reference external marker method (Cr2 O3 ) with an internal feed marker [acid-insoluble ash (AIA)] for the calculation of apparent total tract digestibility of nutrients in lactating sows. The reduction of dietary CP level in lactating sows had no effect on either live-weight or backfat thickness or apparent total tract digestibility of nutrients. However, the piglets' average daily gain (ADG) was reduced in low dietary CP diets, which suggests that sows reduced milk production due to an underestimation of certain essential amino acid requirements (e.g. valine). The increase of dietary NDF level did not affect sow and litter performance. Nevertheless, the total tract apparent digestibility of organic matter, CP and carbohydrates was reduced, and ether extract digestion was increased in high NDF compared to normal NDF diets equally balanced for ME and lysine content. The coefficients of total tract apparent digestibility of nutrients in lactating sows were greater when using AIA compared to Cr2 O3 marker, regardless of dietary CP or NDF level, but their coefficients of variation were lower in the former than in the latter. In lactating sows, a trade-off between litter performance and nutrient digestion is established when reducing dietary CP or increasing NDF levels while maintaining similar lysine content through synthetic amino acids and balancing metabolizable energy through dietary fat sources.

Defecto diafragmático, cardiopatía congénita, agonadismo: un nuevo caso de síndrome de PAGOD / Diaphragmatic defect, congenital heart disease, agonadism: a new case of PAGOD syndrome

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Servicio de Cuidados Intensivos Pediátricos del Hospital Vall d´Hebron: Diez años de soporte vital extracorpóreo / Pediatric Intensive Care Sevice of the Hosptial Vall d´hebron: Ten years of extracorporeal life support

La medicina intensiva se ha caracterizado desde sus inicios pro dar soporte no tanto a una patología específica sino al paciente que presenta fallo de la función de uno o varios órganos. Tradicionalmente, dicho enfoque ha consistido en optimiar la función de los órganos mediante el empleo de fármacos específicos (diuréticos, inotropos ... ) y de dispositivos mecániicos (ventilación mecánica). El cambio de paradigma de la última década consiste en pasar de apoyar al órgano enfermo a sustituir completamente su función, a la espera de la recuperación de la misma o bien de realización de un trasplante de ógano. Dicha sustitución de la función de órgano se inició en las Unidades de hemodiálisis, trasladándose después a las unidades de cuidados intensivos en forma de técnicas de depuración renal continua. Los desarrollos tecnológicos más recientes han permitido aplicar el mismo enfoque al fallo respiratorio y/o cardiaco refractarios mediante el empleo de la oxigenación con membrana extracorpórea y/o de los dispositivos de asistencia ventricular. La Unidad de Cuidados Intensivos Pediátricos del Hospital Vall d´Hebron inició su programa de Soporte Vital Extracorpóreo en el año 2002, habiendo superado en la actualidad el centenar de tratamietno con estas técnicas. La experiencia acumulada y los resultados actuales nos permiten afirmar que no encontramos en una nueva etapa en la que estas técnicas se han convertido en un cuidado estándar que ha transformado nuestra manera de afrontar la atención al niño críticamente enfermo (AU)

Intensive care medicine is characterized not by the care of a specific set of diseases but by treating those patients who present single or multiple organ failure. The trditional approach has been to optimize organ function by using specific drugs (diuretics, inotropes…) or mechanical devices (mechanical ventilation). During the last decade there has been a paradigmatic hange connsisting in substituting the function of the failing organ instead of trying to ameliorate it, until recovery ensues or an organ transplantation can be carried out. The concept of organ function substitution was introduced through haemodialysis in renal wardas and them brought to itnesive care units in the form of continuoud renal replacement therapy. The most recent technological improvements allow us to apply the same strategy to refractory cardiac and/or respiratory failure by means of extracorporeal membrane oxygentation and/or ventricular assist devices. The Extracorporeal Life Support Program at the Pediatric Intensive Care Unit of Vall d´hebron Hospital started in 2002, more than a hundred patints have been treated so far. The experience acquired and the msot recen outcomes attained allow us to state that these techniques have become a standard o care and that they have transformed the way we approach the care of the critically ill child (AU)

Disfunción hepática grave por endotoxemia secundaria a colonización de catéter venoso central / Severe hepatic dysfunction due to endotoxemia secondary to central venous catheter bacterial colonisation

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Effects of an extract of plant flavonoids (Bioflavex) on rumen fermentation and performance in heifers fed high-concentrate diets.

UNLABELLED: To study the effects of an extract of plant flavonoids [Bioflavex (FL)] in cattle fed high-concentrate diets, 2 experiments were designed. In the first experiment, the effects of Bioflavex on the development of rumen acidosis was evaluated in 8 Holstein-Friesian crossbreed heifers (451 kg; SEM 14.3 kg of BW) using a crossover design. Each experimental period lasted 22 d; from d 1 to 20, the animals were fed rye grass, on d 21 the animals were fasted, and on d 22, rumen acidosis was induced by applying 5 kg of wheat without [ CONTROL: (CTR) heifers who did not receive Bioflavex] or with flavonoids [heifers who received FL; 300 mg/kg DM] through a rumen cannula. Rumen pH was recorded continuously (from d 19 to d 22). On d 22, average rumen pH was significantly (P < 0.01) higher in the FL animals (6.29; SEM = 0.031) than it was in the CTR heifers (5.98; SEM = 0.029). After the wheat application, the rumen VFA concentration increased (P < 0.01), the proportion of acetic acid decreased (P < 0.01), and lactate concentration (mmol/L) increased, but the increase was not as great (P = 0.09) in the FL as it was in the CTR heifers (0.41 to 1.35 mmol/L; SEM = 0.24). On d 22, Streptococcus bovis and Selenomonas ruminantium titers increased after the wheat application, but Megasphaera elsdenii titers increased (P < 0.05) only in the FL heifers. In the second experiment, the effect of Bioflavex on the performance and rumen fermentation in finishing heifers was evaluated. Forty-eight Fleckvieh heifers (initial BW = 317 kg; SEM = 5.34) were used in a completely randomized design. Heifers were assigned to 1 of 4 blocks based on their BW and, within each block, assigned to 1 of 2 pens (6 heifers/pen). In addition, 16 heifers (2/pen) were rumen cannulated. Individual BW and group consumption of concentrate and straw were recorded weekly until the animals reached the target slaughter weight. Supplementation with FL did not affect ADG, feed consumption, or feed conversion ratio. Rumen pH and molar proportions of propionate were greater (P < 0.01) and acetate proportion was less in the FL (P < 0.01) than they were in the CTR heifers. Flavonoid supplementation might be effective in improving rumen fermentation and reducing the incidence of rumen acidosis. This effect of flavonoids may be partially explained by increasing the numbers of lactate-consuming microorganisms (e.g., M. elsdenii) in the rumen.

Effect of diet and absence of protozoa on the rumen microbial community and on the representativeness of bacterial fractions used in the determination of microbial protein synthesis.

Accurate estimates of microbial synthesis in the rumen are vital to optimize ruminant nutrition. Liquid- (LAB) and solid-associated bacterial fractions (SAB) harvested from the rumen are generally considered as microbial references when microbial yield is calculated; however, factors that determine their composition are not completely understood. The aim of this study was to evaluate the effect of diet and absence or presence of rumen protozoa on the rumen microbial community. It was hypothesized that these treatments could modify the composition and representativeness of LAB and SAB. Twenty twin lambs (Ovis aries) were used; one-half of the twins were kept protozoa-free, and each respective twin sibling was faunated. At 6 mo of age, 5 animals from each group were randomly allocated to the experimental diets consisting of either alfalfa hay as the sole diet, or 50:50 mixed with ground barley grain. After 15 d of adaptation to the diet, animals were euthanized, rumen and abomasum contents were sampled, and LAB and SAB isolated. The presence of protozoa buffered the effect of diet on the rumen bacterial population. Faunated animals fed alfalfa hay had a greater abundance of F. succinogenes, anaerobic fungi and methanogens, as well as an enhanced rumen bacterial diversity. Cellulolytic bacteria were more abundant in SAB, whereas the abomasal abundance of most of the microorganisms studied was closer to those values observed in LAB. Rumen and abomasal samples showed similar bacterial DNA concentrations, but the fungal and protozoal DNA concentration in the abomasum was only 69% and 13% of that observed in the rumen, respectively, suggesting fungal and protozoal sequestration in the rumen or possible preferential degradation of fungal and protozoal DNA in the abomasum, or both. In conclusion, absence of protozoa and type of diet extensively modified the chemical composition of LAB and SAB as a consequence of changes in the microbial composition of these fractions.

Asistencia ventricular pediátrica: una realidad asistencial con un futuro alentador / Paediatric ventricular assist: a healthcare reality with an encouraging future

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First influenza season after the 2009 pandemic influenza: characteristics of intensive care unit admissions in adults and children in Vall d'Hebron Hospital.

To assess potential differences in epidemiology and management of patients admitted with influenza infection in the intensive care unit (ICU) during the first post-pandemic influenza period. Observational prospective study comparing September 2009-January 2010 with September 2010-January 2011. Variables captured: demographics, co-morbidities, physiological parameters, outcomes and management. Analysis was performed using SPSS v. 13.0; significance was set at p 0.5. Data from 53 patients, 38 adults (age, median 41.5 years; interquartile range (IQR) 32.8-51.3) and 15 children (age, median 2 years, IQR 0.5-9) are presented. Vaccination rates were 0% and 4.3% during the first and second periods, respectively. Differences postpandemic were: 100% of episodes developed after December compared with 16.7% in the 2009 season. Younger children were affected (median age 0.8 years (IQR 0.3-4.8) vs 7 years (IQR 1.25-11.5), p 0.05) and influenza B caused 8.7% of ICU admissions. Influenza A (H1N1) 2009 and respiratory syncytial virus epidemics occurred simultaneously (42.8% of children) and bacterial co-infections doubled (from 10% to 21.7%); the prevalence of co-infections (viral or bacterial) increased from 10% to 39.1% (OR 5.8, 95% CI 1.3-24.8). Respiratory syndromes without chest X-ray opacities reflecting exacerbation of asthma or chronic obstructive pulmonary disease, bronchitis or bronchiolitis increased (from 6.9% to 39.1%, p<0.05) and pneumonia decreased (from 83.3% to 56.5%, p <0.05). Primary viral pneumonia predominated among ICU admissions. Postpandemic ICU influenza developed later, with some cases of influenza B, more frequent bacterial and viral co-infections and more patients with severe acute respiratory infection with normal chest X-ray. Increasing vaccination rates among risk-group individuals is warranted to prevent ICU admission and death.

Incidencia de bacteriemia asociada a catéter venoso central en una unidad de cuidados intensivos / Incidence of central line-associated bloodstream infection in an intensive care unit

Introducción: La bacteriemia asociada a catéter venoso central (BACVC) es una infección nosocomial frecuente. Su incidencia es mayor en los pacientes pediátricos que en los adultos y en aquellos ingresados en unidades de cuidados intensivos (UCI). La morbimortalidad asociada a esta entidad hace de la BACVC un problema de salud importante frente al que es imprescindible desarrollar estrategias de prevención. Pacientes y métodos: Se ha realizado un estudio de intervención en una UCI pediátrica (UCIP) para valorar el impacto de la implantación, en diciembre de 2007, del programa «Bacteriemiazero», que tiene como objetivo la prevención de la BACVC. Se han recogido datos demográficos y variables relacionadas con la hospitalización y la infección de los pacientes desde enero a diciembre de 2007 (antes de la intervención) y desde enero a diciembre de 2008 (después de la intervención), estudiándose 497 pacientes en el primer periodo y 495 en el segundo, y se han comparado los resultados entre ambos periodos. Resultados: Se ha observado una reducción del 30,4% en la tasa de incidencia de BACVC (p = 0,49) en el segundo año de estudio (de 5,5 a 3,8 episodios por 1.000 catéter-días). La ratio de utilización de CVC ha sido de 0,59 y de 0,64, respectivamente. El microorganismo más frecuentemente aislado ha sido Staphylococcus spp. coagulasa negativo. Conclusiones: La implantación de un programa de «bacteriemia 0» que implica tanto a los profesionales de la UCIP como a los de control de la infección nosocomial consigue reducir la incidencia de BACV (AU)

Background: Central line-associated bloodstream infection (CLABSI) is one of the most common nosocomial infections. The incidence is higher in paediatric patients than in adults, especially in those admitted to Intensive Care Units (ICU). CLABSI-related morbidity makes it a majo rhealth problem; therefore it is necessary to develop prevention strategies against it. Patients and methods: An intervention study in a paediatric ICU (PICU) was performed, in order to assess the impact of the introduction of the program «Bacteraemia zero» in December 2007. This program aims to prevent CLABSI. Demographic data and variables related to hospitalization and infection were collected from January to December 2007 (before the intervention) and from January to December 2008 (after the intervention), and were compared. In the first period, 497patients were studied, and 495 in the second. Results: A reduction of 30.4% in the incidence of CLABSI (P = 0.49) in the second year was observed (5.5 to 3.8 episodes per 1000 catheter-days). The CVC use ratio was 0.59 and 0.64, respectively. The most frequently isolated organism was coagulase-negative Staphylococcusspp. Conclusions: The implementation of a «no bacteraemia» program, involving all staff in the PICU as well as the professionals in infection control, reduces the incidence of CLABSI (AU)

Study of the effect of presence or absence of protozoa on rumen fermentation and microbial protein contribution to the chyme.

The aim of this study was to investigate the effect of presence or absence of protozoa on rumen fermentation and efficiency of microbial protein synthesis under different diets. Of 20 twin paired lambs, 1 lamb of each pair was isolated from the ewe within 24 h after birth and reared in a protozoa-free environment (n = 10), whereas their respective twin-siblings remained with the ewe (faunated, n = 10). When lambs reached 6 mo of age, 5 animals of each group were randomly allocated to 1 of 2 experimental diets consisting of either alfalfa hay as the sole diet, or 50:50 mixed with ground barley grain according to a 2 × 2 factorial arrangement of treatments. After 15 d of adaptation to the diet, the animals were euthanized and total rumen and abomasal contents were sampled to estimate rumen microbial synthesis using C(31) alkane as flow marker. Different ((15)N and purine bases) and a novel (recombinant DNA sequences) microbial markers, combined with several microbial reference extracts (rumen protozoa, liquid and solid associated bacteria) were evaluated. Absence of rumen protozoa modified the rumen fermentation pattern and decreased total tract OM and NDF digestibility in 2.0 and 5.1 percentage points, respectively. The effect of defaunation on microbial N flow was weak, however, and was dependent on the microbial marker and microbial reference extract considered. Faunated lambs fed with mixed diet showed the greatest rumen protozoal concentration and the least efficient microbial protein synthesis (29% less than the other treatments), whereas protozoa-free lambs fed with mixed diet presented the smallest ammonia concentration and 34% greater efficiency of N utilization than the other treatments. Although (15)N gave the most precise estimates of microbial synthesis, the use of recombinant DNA sequences represents an alternative that allows separate quantification of the bacteria and protozoa contributions. This marker showed that presence of protozoa decrease the bacterial-N flow through the abomasum by 33%, whereas the protozoa-N contribution to the microbial N flow increased from 1.9 to 14.1% when barley grain was added to the alfalfa hay. Absolute data related to intestinal flow must be treated with caution because the limitations of the sampling and maker system employed.