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Roberts KJ, Goodfellow LT, Battey-Muse CM, Hoerr CA, Carreon ML, Sorg ME, Glogowski J, Girard TD, MacIntyre NR, Hess DR. AARC Clinical Practice Guideline: Spontaneous Breathing Trials for Liberation From Adult Mechanical Ventilation. Respir Care 2024:respcare.11735. [PMID: 38443142 DOI: 10.4187/respcare.11735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Despite prior publications of clinical practice guidelines related to ventilator liberation, some questions remain unanswered. Many of these questions relate to the details of bedside implementation. We, therefore, formed a guidelines committee of individuals with experience and knowledge of ventilator liberation as well as a medical librarian. Using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, we make the following recommendations: (1) We suggest that calculation of a rapid shallow breathing index is not needed to determine readiness for a spontaneous breathing trial (SBT) (conditional recommendation; moderate certainty); (2) We suggest that SBTs can be conducted with or without pressure support ventilation (conditional recommendation, moderate certainty); (3) We suggest a standardized approach to assessment and, if appropriate, completion of an SBT before noon each day (conditional recommendation, very low certainty); and (4) We suggest that FIO2 should not be increased during an SBT (conditional recommendation, very low certainty). These recommendations are intended to assist bedside clinicians to liberate adult critically ill patients more rapidly from mechanical ventilation.
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Affiliation(s)
| | - Lynda T Goodfellow
- American Association for Respiratory Care/Daedalus Enterprises, Irving, Texas; and Georgia State University, Atlanta, Georgia
| | | | | | | | - Morgan E Sorg
- Boise State University, Boise, Idaho; and Bunnell, Inc, Salt Lake City, Utah
| | | | - Timothy D Girard
- Center for Research, Investigation, and Systems Modeling of Acute Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Dean R Hess
- American Association for Respiratory Care/Daedalus Enterprises, Irving, Texas; and Massachusetts General Hospital, Boston, Massachusetts
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2
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Suc V, Starck J, Levy Y, Soreze Y, Rambaud J, Léger PL. Predictive value of microcirculation for pediatric extracorporeal membrane oxygenation weaning test: A monocentric prospective observational study. Artif Organs 2024. [PMID: 38647271 DOI: 10.1111/aor.14754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is widely used for children treated for refractory respiratory failures or refractory cardiogenic shock. Its duration depends on organ functions recovery. Weaning is decided using macro-circulatory tools, but microcirculation is not well evaluated. Sidestream dark-field video imaging is used to assess the perfusion of the sublingual microvascular vessels. The aim of this study was to assess the predictive value of microcirculatory indices in ECMO weaning. METHODS This prospective monocentric study examined pediatric patients at Trousseau Hospital between March 2017 and December 2020. The study included all patients from 35 weeks of gestational age to 18 years old who were treated with ECMO. Children were divided into two groups: one with stability after weaning and the other with instability after weaning. We collected clinical and biological data, ventilation parameters, extracorporeal membrane oxygenation parameters, and drugs used at admission and after the weaning test. Microcirculations videos were taken after weaning trials with echocardiography and blood gas monitoring. RESULTS The study included 30 patients with a median age of 29 days (range: 1-770 days) at admission, including 18 patients who received venoarterial ECMO (60%). There were 19 children in the stability group and 11 in the instability group. Macrocirculatory and microcirculatory indices showed no differences between groups. The microvascular flow index was subnormal in both groups (2.3 (1.8-2.4) and 2.3 (2.3-2.6), respectively; p = 0.24). The microvascular indices were similar between cases of venovenous and venoarterial ECMO and between age groups. CONCLUSION Microcirculation monitoring at the weaning phase did not predict the failure of ECMO weaning.
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Affiliation(s)
- Violette Suc
- Neonatal and Pediatric Intensive Care Unit, Trousseau Hospital, AP-HP, Paris, France
| | - Julie Starck
- Neonatal and Pediatric Intensive Care Unit, Trousseau Hospital, AP-HP, Paris, France
| | - Yael Levy
- Neonatal and Pediatric Intensive Care Unit, Trousseau Hospital, AP-HP, Paris, France
- Medicine Department, Sorbonne University, Paris, France
| | - Yohan Soreze
- Neonatal and Pediatric Intensive Care Unit, Trousseau Hospital, AP-HP, Paris, France
- Medicine Department, Sorbonne University, Paris, France
| | - Jerome Rambaud
- Neonatal and Pediatric Intensive Care Unit, Trousseau Hospital, AP-HP, Paris, France
- Medicine Department, Sorbonne University, Paris, France
| | - Pierre-Louis Léger
- Neonatal and Pediatric Intensive Care Unit, Trousseau Hospital, AP-HP, Paris, France
- Medicine Department, Sorbonne University, Paris, France
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3
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Kacır A, Karabayir N, Karademir F, Başıbüyük M, Öcal Ö, Büke Ö, Bilgin DD. Impact of Dysphoric Milk Ejection Reflex on Mental Health. Breastfeed Med 2024. [PMID: 38647520 DOI: 10.1089/bfm.2024.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Objective: Postpartum mental health, significantly influences breastfeeding. Dysphoric milk ejection reflex (D-MER) is defined as negative emotional reaction to milk ejection, such as unpleasant feelings, anger-irritability or a strange feeling in the stomach. This study investigates the impacts of D-MER on mothers experiencing negative emotions during breastfeeding. Method: This cross-sectional, descriptive study was conducted between July 1 and September 30, 2023 among surveyed mothers with babies of ages 0-2 experiencing discomfort while breastfeeding. Mothers reached out through Instagram and Facebook and completed a semi-structured 45-question survey using a Google form. Results: Out of 141 mothers, 27.7% (n: 39) had D-MER findings. Common emotions included tension (48%), exhaustion (43%), intolerance (41%), hypersensitivity (35%), and restlessness (33%). Symptoms reported to begin within the first month of breastfeeding in 59% of D-MER cases. Nausea was reported in 30% of mothers. The most common conditions that increased the severity of D-MER symptoms were insomnia, stress and breast fullness. Sleeping or resting, being alone, doing something else, drinking cold water, listening to music and talking to mothers who had similar experiences helped the mothers relax. In cases with D-MER findings, about 17.9% considered stopping breastfeeding, with 7.7% stopping. The postpartum depression score was ≥13 in 59% of D-MER cases. Conclusion: D-MER, which can cause early cessation of breastfeeding, may also be associated with the mother's mental health problems. Raising awareness about D-MER and equipping health professionals on this subject are important in the continuity of breastfeeding.
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Affiliation(s)
- Aybüke Kacır
- Social Pediatrics PhD Programme, Faculty of Medicine, Istanbul Medipol University, Fatih, Turkey
| | - Nalan Karabayir
- Pediatrics Department, International School of Medicine, Istanbul Medipol University, Fatih, Turkey
| | - Ferhat Karademir
- Pediatrics Department, Faculty of Medicine, Istanbul Medipol University, Fatih, Turkey
| | - Mine Başıbüyük
- Social Pediatrics PhD Programme, Faculty of Medicine, Istanbul Medipol University, Fatih, Turkey
| | - Özlem Öcal
- Social Pediatrics PhD Programme, Faculty of Medicine, Istanbul Medipol University, Fatih, Turkey
| | - Övgü Büke
- Social Pediatrics PhD Programme, Faculty of Medicine, Istanbul Medipol University, Fatih, Turkey
| | - Demet Deniz Bilgin
- Social Pediatrics PhD Programme, Faculty of Medicine, Istanbul Medipol University, Fatih, Turkey
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Kamalaporn H, Preutthipan A, Coates AL. Weaning strategies for children on home invasive mechanical ventilation. Pediatr Pulmonol 2024. [PMID: 38593235 DOI: 10.1002/ppul.27008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/11/2024]
Abstract
Children who require home mechanical ventilation (HMV) with an artificial airway or invasive mechanical ventilation (HMV) have a possibility of successful weaning due to the potential of compensatory lung growth. Internationally accepted guidelines on how to wean from HMV in children is not available, we summarize the weaning strategies from the literature reviews combined with our 27-year experience in the Pediatric Home Respiratory Care program at the tertiary care center in Thailand. The readiness to wean is considered in patients with hemodynamic stability, having effective cough measured by maximal inspiratory pressure, requiring a fraction of inspired oxygen (FiO2) < 40%, positive end expiratory pressure <5 cmH2O, and acceptable arterial blood gases. The strategies of weaning is start weaning during the daytime while the child is awake and close monitoring is feasible. Disconnect time is gradually increased through naps and sleeping hours. Weaning from the conventional mechanical ventilator to Bilevel PAP or CPAP are optional. Factors affected the successful weaning are mainly the underlying diseases, complications, growth and development, caregivers, and resources. Weaning should be stopped during acute illness or increased work of breathing. The readiness for decannulation could be determined by using the speaking devices, tracheostomy capping, and measurement of end-expiratory pressure. Polysomnography and airway evaluation by bronchoscopy are recommended before decannulation. Weaning when the child is ready is crucial because living with HMV can be challenging and stressful. Failure to remove a tracheostomy when indicated can result in delayed speech, social problems as well as risk for infection.
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Affiliation(s)
- Harutai Kamalaporn
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Aroonwan Preutthipan
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Allan L Coates
- The Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Canada
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5
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Becker R, Rigsby M, Suchi M, Lerner DG, Chugh A. Dupilumab in adolescent eosinophilic esophagitis: Experience with fibrostenosis and EGID with esophageal involvement. J Pediatr Gastroenterol Nutr 2024. [PMID: 38587127 DOI: 10.1002/jpn3.12187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024]
Abstract
We evaluated patients aged 12-20 on dupilumab 300 mg weekly for treatment of eosinophilic esophagitis (EoE) who had ≥1 follow-up endoscopy at a tertiary care pediatric hospital (n = 18). Fifty percent had inflammatory EoE (n = 9), 22% had fibrostenotic EoE (n = 4), and 28% had non-EoE eosinophilic gastrointestinal disease (EGID) with esophageal involvement (n = 5). Ninety-four percent discontinued topical corticosteroids (TCS) 2-4 weeks after starting dupilumab. Eighty-nine percent of inflammatory EoE patients had histological response (<15 eosinophils/high-powered field) after an average of 19.1 weeks. One hundred percent of patients with fibrostenotic disease exhibited histological response after 16.8 weeks. Of patients with non-EoE EGID, 60% achieved esophageal histological response after an average of 40.1 weeks. In a small cohort, dupilumab was very effective for adolescent inflammatory and fibrostenotic EoE despite rapid weaning of TCS. Dupilumab was also somewhat effective for non-EoE EGID with esophageal involvement; however, a longer duration of therapy was required.
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Affiliation(s)
- Robert Becker
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Division of Pediatric Gastroenterology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mariah Rigsby
- Division of Pediatric Gastroenterology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mariko Suchi
- Department of Pathology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Diana G Lerner
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Division of Pediatric Gastroenterology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ankur Chugh
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Division of Pediatric Gastroenterology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
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Tang N, Li Y, Li Y, Xu S, Wang M, Wang B, Liu Y, Zhang S, Wu H, Zhang X, Zhou B, Li Z. Motilin, a Novel Orexigenic Factor, Involved in Feeding Regulation in Yangtze Sturgeon ( Acipenser dabryanus). Biomolecules 2024; 14:433. [PMID: 38672450 DOI: 10.3390/biom14040433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Motilin is a gastrointestinal hormone that is mainly produced in the duodenum of mammals, and it is responsible for regulating appetite. However, the role and expression of motilin are poorly understood during starvation and the weaning stage, which is of great importance in the seeding cultivation of fish. In this study, the sequences of Yangtze sturgeon (Acipenser dabryanus Motilin (AdMotilin)) motilin receptor (AdMotilinR) were cloned and characterized. The results of tissue expression showed that by contrast with mammals, AdMotilin mRNA was richly expressed in the brain, whereas AdMotilinR was highly expressed in the stomach, duodenum, and brain. Weaning from a natural diet of T. Limnodrilus to commercial feed significantly promoted the expression of AdMotilin in the brain during the period from day 1 to day 10, and after re-feeding with T. Limnodrilus the change in expression of AdMotilin was partially reversed. Similarly, it was revealed that fasting increased the expression of AdMotilin in the brain (3 h, 6 h) and duodenum (3 h), and the expression of AdMotilinR in the brain (1 h) in a time-dependent manner. Furthermore, it was observed that peripheral injection of motilin-NH2 increased food intake and the filling index of the digestive tract in the Yangtze sturgeon, which was accompanied by the changes of AdMotilinR and appetite factors expression in the brain (POMC, CART, AGRP, NPY and CCK) and stomach (CCK). These results indicate that motilin acts as an indicator of nutritional status, and also serves as a novel orexigenic factor that stimulates food intake in Acipenser dabryanus. This study lays a strong foundation for the application of motilin as a biomarker in the estimation of hunger in juvenile Acipenser dabryanu during the weaning phase, and enhances the understanding of the role of motilin as a novel regulator of feeding in fish.
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Affiliation(s)
- Ni Tang
- Department of Aquaculture, College of Animal Science and Technology, Sichuan Agricultural University, Chengdu 611130, China
| | - Ya Li
- Department of Aquaculture, College of Animal Science and Technology, Sichuan Agricultural University, Chengdu 611130, China
| | - Yingzi Li
- Department of Aquaculture, College of Animal Science and Technology, Sichuan Agricultural University, Chengdu 611130, China
| | - Shaoqi Xu
- Department of Aquaculture, College of Animal Science and Technology, Sichuan Agricultural University, Chengdu 611130, China
| | - Mei Wang
- Department of Aquaculture, College of Animal Science and Technology, Sichuan Agricultural University, Chengdu 611130, China
| | - Bin Wang
- Fisheries Research Institute, Sichuan Academy of Agricultural Sciences, Chengdu 610066, China
| | - Yanling Liu
- Department of Aquaculture, College of Animal Science and Technology, Sichuan Agricultural University, Chengdu 611130, China
| | - Shupeng Zhang
- Department of Aquaculture, College of Animal Science and Technology, Sichuan Agricultural University, Chengdu 611130, China
| | - Hongwei Wu
- Department of Aquaculture, College of Animal Science and Technology, Sichuan Agricultural University, Chengdu 611130, China
| | - Xin Zhang
- Department of Aquaculture, College of Animal Science and Technology, Sichuan Agricultural University, Chengdu 611130, China
| | - Bo Zhou
- Fisheries Research Institute, Sichuan Academy of Agricultural Sciences, Chengdu 610066, China
| | - Zhiqiong Li
- Department of Aquaculture, College of Animal Science and Technology, Sichuan Agricultural University, Chengdu 611130, China
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7
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Hermens JAJ, van Til JA, Meuwese CL, van Dijk D, Donker DW. Clinical decision making for VA ECMO weaning in patients with cardiogenic shock A formative qualitative study. Perfusion 2024; 39:39S-48S. [PMID: 38651581 DOI: 10.1177/02676591241236643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Weaning and liberation from VA ECMO in cardiogenic shock patients comprises a complex process requiring a continuous trade off between multiple clinical parameters. In the absence of dedicated international guidelines, we hypothesized a great heterogeneity in weaning practices among ECMO centers due to a variety in local preferences, logistics, case load and individual professional experience. This qualitative study focused on the appraisal of clinicians' preferences in decision processes towards liberation from VA ECMO after cardiogenic shock while using focus group interviews in 4 large hospitals. The goal was to provide novel and unique insights in daily clinical weaning practices. As expected, we found we a great heterogeneity of weaning strategies among centers and professionals, although participants appeared to find common ground in a clinically straightforward approach to assess the feasibility of ECMO liberation at the bedside. This was shown in a preference for robust, easily accessible parameters such as arterial pulse pressure, stable cardiac index ≥2.1 L/min, VTI LVOT and 'eyeballing' LVEF.
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Affiliation(s)
- J A J Hermens
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J A van Til
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - C L Meuwese
- Department of Intensive Care Medicine and Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - D van Dijk
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - D W Donker
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
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Hosseini SH, Mirzaei-Alamouti H, Mansouryar M, Vazirigohar M, Rezamand P, Mahjoubi E, Ramezankhani J, Aschenbach JR. Response to Incremental Replacement of Palm Oil with Fish Oil in Starter Diet on Growth Performance, Plasma Metabolites, Ruminal Fermentation, and Behavior of Dairy Calves. Animals (Basel) 2024; 14:1061. [PMID: 38612300 PMCID: PMC11010903 DOI: 10.3390/ani14071061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
The objective of this study was to evaluate the effects of the incremental levels of n-3 fatty acids (FA) in starter feed (SF) on growth and metabolic performance of milk-fed calves. From day 3 of age, 30 female calves (39.4 ± 3.1 kg of body weight) were randomly assigned to one of three dietary treatments: (1) SF supplemented with 3.3% palm fatty acids (PO), (2) SF supplemented with 1.7% of PO and 1.9% fish oil (PFO), or (3) SF supplemented with 3.9% fish oil (FO). Chopped straw (7.5% of DM) was included in the SF of all treatments as total mixed ration (TMR). Diets had similar energy and protein contents. Total n-3 FA (% of total FA) and n-6/n-3 of PO, PFO, and FO were 1.90, 6.80, and 11.8 and 15.5, 4.50, and 2.70, respectively. The BW was greater for calves receiving FO (60.2 ± 0.3 kg) compared with PFO (58.7 ± 0.3 kg; p = 0.007) and tended to be greater for calves receiving FO vs. PO (59.0 ± 0.3 kg; p = 0.050). Because there was no interaction effect between diet × week of experiment, the greater BW of FO could not be attributed to the dietary treatment. Accordingly, average daily gain, total dry matter intake (DMI), starter DMI, and gain to intake ratio (G:FI) did not differ among dietary treatments during the entire period of the study (p > 0.05). Dietary treatments did not impact body size parameters such as body length, body girth, withers height, heart girth, hip height, and width (p > 0.05). Neither ruminal fermentation parameters nor blood variables were influenced by supplementing the types of oil at different time points. Calves' behavioral parameters, such as standing, lying, eating, and ruminating, were not influenced by different dietary treatments (p > 0.05). The number of days with abnormal fecal score was not different among dietary groups (p > 0.05). Overall, our findings suggest that changing the n-6/n-3 ratio in starter feed by incremental replacement of palm fatty acid with fish oil at a moderate supplemental level of ~3% of DM may not affect the growth and metabolic performance of young calves under non-challenged conditions.
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Affiliation(s)
- Seyed Hadi Hosseini
- Department of Animal Science, Faculty of Agriculture, University of Zanjan, Zanjan 45371-38111, Iran; (S.H.H.)
| | - Hamidreza Mirzaei-Alamouti
- Department of Animal Science, Faculty of Agriculture, University of Zanjan, Zanjan 45371-38111, Iran; (S.H.H.)
- Institute of Veterinary Physiology, Freie Universität Berlin, Oertzenweg 19b, 14163 Berlin, Germany;
| | - Morteza Mansouryar
- Zist Dam Group, University Incubator Center, University of Zanjan, Zanjan 45371-38791, Iran
| | - Mina Vazirigohar
- Institute of Veterinary Physiology, Freie Universität Berlin, Oertzenweg 19b, 14163 Berlin, Germany;
- Zist Dam Group, University Incubator Center, University of Zanjan, Zanjan 45371-38791, Iran
| | - Pedram Rezamand
- Department of Animal and Veterinary Science, University of Idaho, Moscow, ID 83844-2330, USA
| | - Ehsan Mahjoubi
- Department of Animal Science, Faculty of Agriculture, University of Zanjan, Zanjan 45371-38111, Iran; (S.H.H.)
| | - Jafar Ramezankhani
- Department of Animal Science, Faculty of Agriculture, University of Zanjan, Zanjan 45371-38111, Iran; (S.H.H.)
| | - Jörg R. Aschenbach
- Institute of Veterinary Physiology, Freie Universität Berlin, Oertzenweg 19b, 14163 Berlin, Germany;
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Rohde S, Miera O, Sliwka J, Sandica E, Amodeo A, Veen K, de By TMMH, Bogers AJJC, Schweiger M. Durable left ventricular assist device explantation following recovery in paediatric patients: Determinants and outcome after explantation. Eur J Cardiothorac Surg 2024; 65:ezae126. [PMID: 38613845 DOI: 10.1093/ejcts/ezae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/31/2024] [Accepted: 04/11/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVES Myocardial recovery in children supported by a durable left ventricular assist device is a rare, but highly desirable outcome because it could potentially eliminate the need for a cardiac transplant and the lifelong need for immunosuppressant therapy and the risk of complications. However, experience with this specific outcome is extremely limited. METHODS All patients < 19 years old supported by a durable left ventricular assist device from the European Registry for Patients with Mechanical Circulatory Support database were included. Participating centres were approached for additional follow-up data after explantation. Associated factors for explantation due to myocardial recovery were explored using Cox proportional hazard models. RESULTS The incidence of recovery in children supported by a durable left ventricular assist device was 11.7% (52/445; median duration of support, 122.0 days). Multivariable analyses showed body surface area (hazard ratio 0.229; confidence interval 0.093-0.565; P = 0.001) and a primary diagnosis of myocarditis (hazard ratio 4.597; confidence interval 2.545-8.303; P < 0.001) to be associated with recovery. Left ventricular end-diastolic diameter in children with myocarditis was not associated with recovery. Follow-up after recovery was obtained for 46 patients (88.5%). Sustained myocardial recovery was reported in 33/46 (71.7%) at the end of the follow-up period (28/33; >2 year). Transplants were performed in 6/46 (11.4%) (in 5 after a ventricular assist device was reimplanted). Death occurred in 7/46 (15.2%). CONCLUSIONS Myocardial recovery occurs in a substantial portion of paediatric patients supported with durable left ventricular assist devices, and sustainable recovery is seen in around three-quarters of them. Even children with severely dilated ventricles due to myocarditis can show recovery. Clinicians should be attentive to (developing) myocardial recovery. These results can be used to develop internationally approved paediatric weaning guidelines.
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Affiliation(s)
- Sofie Rohde
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Eugen Sandica
- Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Antonio Amodeo
- Heart Failure, Transplant and MCS Unit, Bambino Gesù Children Hospital & Research Institute, Rome, Italy, Catholic University of Sacred Heart, Department of Cardiac Surgery, Rome, Italy
| | - Kevin Veen
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Ad J J C Bogers
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Martin Schweiger
- Children's Hospital Zurich, Pediatric Heart Centre, Department for congenital heart surgery, Zurich, Switzerland
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10
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Lin YH, Chang TC, Liu CF, Lai CC, Chen CM, Chou W. The intervention of artificial intelligence to improve the weaning outcomes of patients with mechanical ventilation: Practical applications in the medical intensive care unit and the COVID-19 intensive care unit: A retrospective study. Medicine (Baltimore) 2024; 103:e37500. [PMID: 38518051 PMCID: PMC10956977 DOI: 10.1097/md.0000000000037500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/14/2024] [Indexed: 03/24/2024] Open
Abstract
Patients admitted to intensive care units (ICU) and receiving mechanical ventilation (MV) may experience ventilator-associated adverse events and have prolonged ICU length of stay (LOS). We conducted a survey on adult patients in the medical ICU requiring MV. Utilizing big data and artificial intelligence (AI)/machine learning, we developed a predictive model to determine the optimal timing for weaning success, defined as no reintubation within 48 hours. An interdisciplinary team integrated AI into our MV weaning protocol. The study was divided into 2 parts. The first part compared outcomes before AI (May 1 to Nov 30, 2019) and after AI (May 1 to Nov 30, 2020) implementation in the medical ICU. The second part took place during the COVID-19 pandemic, where patients were divided into control (without AI assistance) and intervention (with AI assistance) groups from Aug 1, 2022, to Apr 30, 2023, and we compared their short-term outcomes. In the first part of the study, the intervention group (with AI, n = 1107) showed a shorter mean MV time (144.3 hours vs 158.7 hours, P = .077), ICU LOS (8.3 days vs 8.8 days, P = .194), and hospital LOS (22.2 days vs 25.7 days, P = .001) compared to the pre-intervention group (without AI, n = 1298). In the second part of the study, the intervention group (with AI, n = 88) exhibited a shorter mean MV time (244.2 hours vs 426.0 hours, P = .011), ICU LOS (11.0 days vs 18.7 days, P = .001), and hospital LOS (23.5 days vs 40.4 days, P < .001) compared to the control group (without AI, n = 43). The integration of AI into the weaning protocol led to improvements in the quality and outcomes of MV patients.
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Affiliation(s)
- Yang-Han Lin
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Ting-Chia Chang
- Division of Chest Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan, Yong-Kang District, Tainan City, Taiwan
| | - Chung-Feng Liu
- Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Yong-Kang District, Tainan City, Taiwan
| | - Chin-Ming Chen
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Willy Chou
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Jialixing Jiaxing Village, Jiali District, Tainan City, Taiwan
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11
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Nour BA, El-Rahman AMA, Hameed SAEAE, Mohsen N, Mohamed A, El-Bayoumi MA, Abdel-Hady HE. Lung and diaphragm ultrasound as predictors of successful weaning from nasal continuous positive airway pressure in preterm infants. Pediatr Pulmonol 2024. [PMID: 38501314 DOI: 10.1002/ppul.26933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/02/2024] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Assessment of the utility of lung and diaphragm ultrasound in the prediction of successful weaning from nasal continuous positive airway pressure (NCPAP) in preterm infants. STUDY DESIGN This prospective cohort study was conducted on preterm infants who were considered ready for weaning off NCPAP. Lung and diaphragm ultrasound were performed just before and 3 h after weaning off NCPAP. The primary outcome was to evaluate the accuracy of lung ultrasound (LUS) in predicting successful weaning from NCPAP. RESULTS Out of 65 enrolled preterm infants, 30 (46.2%) were successfully weaned from NCPAP to room air. The successful weaning group had higher gestational ages, lower incidences of previous invasive mechanical ventilation, and treated hemodynamically significant patent ductus arteriosus before the trial weaning. A LUS score of ≤6, measured before discontinuation of NCPAP, exhibited a predictive sensitivity of 80% and specificity of 75% for successful weaning (Area under the curve (AUC) = 0.865, ≤.001). When the LUS score was assessed 3 h after weaning from NCPAP, a cutoff point of ≤7 predicted successful weaning with a sensitivity and specificity of 90% and 60% respectively (AUC = 0.838, p ≤ .001). The diaphragmatic thickness fraction (DTF) was significantly lower in the successful weaning group. After adjustment for various factors, LUS score remained the only independent predictor of successful weaning. CONCLUSION LUS score before weaning from NCPAP has a good sensitivity and specificity for predicting successful weaning from NCPAP in preterm infants. Diaphragmatic excursion and DTF were not good predictors.
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Affiliation(s)
- Basma Ahmed Nour
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | | - Nada Mohsen
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | | | - Hesham Elsayed Abdel-Hady
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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12
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Vogt A, Barth K, Waiblinger S, König von Borstel U. Can a gradual weaning and separation process reduce weaning distress in dam-reared dairy calves? A comparison with the two-step method. J Dairy Sci 2024:S0022-0302(24)00542-3. [PMID: 38490545 DOI: 10.3168/jds.2024-23809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
The weaning and separation phase remains one of the biggest challenges for cow-calf-contact systems, but a gradual process that better mimics the naturally occurring reduction in milk intake has not yet been scientifically investigated. Therefore, the aim of our study was to compare behavioral and physiological indicators of distress in 3 mo-old dam-reared dairy calves (with previous full-time cow-calf contact) weaned and separated either via gradual reduction of contact time with the dam (GR, 1 week half day contact, 1 week morning contact, 1 week fence-line contact before complete separation, n = 18) or via 2-step weaning using a nose flap (NF, 2 weeks access to dam with a nose flap, 1 week fence-line contact before complete separation, n = 18). Behavior was recorded 1 week before (or for lying 3 weeks before) weaning start and during the 3 week weaning and separation period with direct observations on 4 d per week or via accelerometers (locomotor play, lying behavior). Blood and fecal samples were taken twice per week from weaning start until 3 weeks after weaning start. Calves were weighed weekly. Statistical analysis was conducted using (generalized) linear mixed models. Over the whole weaning and separation phase, NF calves showed a stronger decrease in the number of lying bouts, amount of locomotor play and average daily weight gains, as well as a higher increase in total mixed ration feeding time compared with GR calves, whereas GR calves vocalized more often and showed more searching behavior than NF calves. Also, the neutrophil:lymphocyte ratio of NF calves was elevated on d 3 after insertion of the nose flaps compared with baseline, but showed no change for GR calves on any sampling day. Overall, results point toward a favorable effect of a gradual weaning strategy on reduction of weaning and separation distress in dam-reared dairy calves, but the method requires further improvement from the protocol used in our study.
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Affiliation(s)
- Anina Vogt
- Division of Animal Husbandry, Behaviour and Welfare, Justus-Liebig-University of Giessen, 35392 Giessen, Germany.
| | - Kerstin Barth
- Institute of Organic Farming, Johann Heinrich von Thünen Institute, Federal Research Institute for Rural Areas, Forestry and Fisheries, 23847 Westerau, Germany
| | - Susanne Waiblinger
- Institute of Animal Welfare Science, University of Veterinary Medicine, 1210 Vienna, Austria
| | - Uta König von Borstel
- Division of Animal Husbandry, Behaviour and Welfare, Justus-Liebig-University of Giessen, 35392 Giessen, Germany
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13
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Cangiano LR, Lamers K, Olmeda MF, Villot C, Hodgins DC, Mallard BA, Steele MA. Developmental adaptations of γδ T cells and B cells in blood and intestinal mucosa from birth until weaning in Holstein bull calves. J Dairy Sci 2024; 107:1734-1750. [PMID: 37806632 DOI: 10.3168/jds.2023-23943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023]
Abstract
This study aimed to characterize the development of systemic and colon tissue resident B and γδ T cells in newborn calves from birth until weaning. At birth, calves have limited capacity to initiate immune responses, and the immune system gradually matures over time. Gamma delta (γδ) T cells are an important lymphocyte subset in neonatal calves that confer protection and promote immune tolerance. A total of 36 newborn calves were enrolled in a longitudinal study to characterize how systemic and colon tissue resident B and γδ T cells develop from birth until weaning. Blood and colon biopsy samples were collected on d 2, 28, and 42 to determine the proportions of various B and γδ T cell subsets by flow cytometry. We classified γδ T cells into different functional subsets according to the level of expression intensity of the coreceptors WC1.1 (effector function) and WC1.2 (regulatory function). Furthermore, naive B cells were classified based on the expression IgM receptor, and activation state was determined based on expression of CD21 and CD32, 2 receptors with opposing signals involved in B cell activation in early life. Additional colon biopsy samples were used for 16S sequencing, and microbial diversity data are reported. At birth, γδ T cells were the most abundant lymphocyte population in blood, accounting for 58.5% of the lymphocyte pool, after which the proportions of these cells declined to 38.2% after weaning. The proportion of γδ T cells expressing WC1.1 decreased by 50% from d 2 to d 28, whereas no change was observed in the expression of WC1.2. In the colon, there was a 50% increase of γδ T cells after weaning and the proportion of WC1.2+ γδ T cells doubled from d 28 to 42. The proportion of IgM+ B lymphocytes in blood increased from 23.6% at birth to 30% after weaning, were the proportion of B cells expressing CD21 increased by 25%, while the proportion of B cells expressing CD32 decreased by 30%. While no changes were observed for the overall proportion of IgM+ B lymphocytes in the colon, there was a 6-fold increase in the proportion of CD21+ B cells from pre- (d 28) to postweaning (d 42). Microbial diversity increased from d 2 of life to 28 and declined abruptly after weaning. The reduction in microbial diversity during weaning was negatively correlated with the increase in all γδ T cell subsets and CD21+ B cells. These data suggest that developmental adaptations after birth coordinate expansion of γδ T cells to provide early systemic protection, as well as to steer immune tolerance, while B cells mature over time. Additionally, the increase of colonic γδ T cells on d 42 suggests a protective role of these cells during weaning.
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Affiliation(s)
- L R Cangiano
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53706; Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - K Lamers
- Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - M F Olmeda
- Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - C Villot
- Lallemand Animal Nutrition, F-31702 Blagnac, France, and Milwaukee, WI 53218
| | - D C Hodgins
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph ON, N1G-2W1 Canada
| | - B A Mallard
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph ON, N1G-2W1 Canada
| | - M A Steele
- Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada.
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14
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Ranieri M. [Denormalizing smoking, a public health issue for society and hospitals alike]. Soins Psychiatr 2024; 45:33-36. [PMID: 38527871 DOI: 10.1016/j.spsy.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Since the industrialization of tobacco production in the last century, tobacco has been a popular product in all walks of life. Its harmful effects, now well recognized, have led to the implementation of increasingly active health policies. Its place in public life is increasingly controlled. This approach aims to prevent the continuation of risky behaviours associated with its use. Hospitals are becoming a model for the denormalization of smoking.
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Affiliation(s)
- Maria Ranieri
- Unité de coordination de tabacologie, CERTA, Département de psychiatrie et addictologie, Hôpital Paul-Brousse, AP-HP, 12 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.
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15
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Hartl WH, Kopper P, Xu L, Heller L, Mironov M, Wang R, Day AG, Elke G, Küchenhoff H, Bender A. Relevance of Protein Intake for Weaning in the Mechanically Ventilated Critically Ill: Analysis of a Large International Database. Crit Care Med 2024; 52:e121-e131. [PMID: 38156913 PMCID: PMC10876180 DOI: 10.1097/ccm.0000000000006155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVES The association between protein intake and the need for mechanical ventilation (MV) is controversial. We aimed to investigate the associations between protein intake and outcomes in ventilated critically ill patients. DESIGN Analysis of a subset of a large international point prevalence survey of nutritional practice in ICUs. SETTING A total of 785 international ICUs. PATIENTS A total of 12,930 patients had been in the ICU for at least 96 hours and required MV by the fourth day after ICU admission at the latest. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We modeled associations between the adjusted hazard rate (aHR) of death in patients requiring MV and successful weaning (competing risks), and three categories of protein intake (low: < 0.8 g/kg/d, standard: 0.8-1.2 g/kg/d, high: > 1.2 g/kg/d). We compared five different hypothetical protein diets (an exclusively low protein intake, a standard protein intake given early (days 1-4) or late (days 5-11) after ICU admission, and an early or late high protein intake). There was no evidence that the level of protein intake was associated with time to weaning. However, compared with an exclusively low protein intake, a standard protein intake was associated with a lower hazard of death in MV: minimum aHR 0.60 (95% CI, 0.45-0.80). With an early high intake, there was a trend to a higher risk of death in patients requiring MV: maximum aHR 1.35 (95% CI, 0.99-1.85) compared with a standard diet. CONCLUSIONS The duration of MV does not appear to depend on protein intake, whereas mortality in patients requiring MV may be improved by a standard protein intake. Adverse effects of a high protein intake cannot be excluded.
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Affiliation(s)
- Wolfgang H Hartl
- Department of General, Visceral, and Transplantation Surgery, University Medical Center, Campus Grosshadern, LMU Munich, Munich, Germany
| | - Philipp Kopper
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
- Munich Center for Machine Learning, LMU Munich, Munich, Germany
| | - Lisa Xu
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
| | - Luca Heller
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
| | - Maxim Mironov
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
| | - Ruiyi Wang
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
| | - Andrew G Day
- Clinical Evaluation Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Gunnar Elke
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Helmut Küchenhoff
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
| | - Andreas Bender
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
- Munich Center for Machine Learning, LMU Munich, Munich, Germany
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16
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Wood MK, Mason RM, Burk SV, Birmingham SSW. α-Casozepine supplementation shows no effect on foals' growth and cortisol levels before and after weaning. J Am Vet Med Assoc 2024; 262:1-5. [PMID: 38171089 DOI: 10.2460/javma.23.09.0545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE The goal of this study was to determine whether oral administration of α-casozepine (Zylkene) supplementation decreases the risk of disease in foals, as measured through salivary cortisol levels, temperature, clinical signs of disease, and body weight before and after weaning. ANIMALS 20 Thoroughbred foals were observed over 10 weeks, beginning 14 days prior to the time of weaning. METHODS Experimental foals were randomly selected and given α-casozepine daily for 10 weeks, while the controls received a placebo with the same frequency as the experimental group. The average daily height and weight gain were calculated to examine the effects of α-casozepine before and after weaning. Salivary cortisol levels were also compared before versus after weaning. RESULTS There was no statistically significant difference in average daily height/weight gain or cortisol levels between the α-casozepine group and the control before and after weaning. However, the α-casozepine group had numerically less of a decline in height and growth compared to the control. This suggests that with further study Zylkene may decrease losses in foal growth rate. CLINICAL RELEVANCE The weaning process is one of the largest stressors in a young horse's life. This abrupt process can contribute to an increased risk of disease and even morbidity. Other major stressors including separation from the mare, diet change, and new social groups can also lead to animal health and welfare concerns, as well as economic losses in weanling foals. However, further study is required to determine the benefits of α-casozepine on equine stress and health.
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Affiliation(s)
- Moriah K Wood
- 1Department of Equine Science, Otterbein University, Westerville, OH
| | | | - Steffanie V Burk
- 1Department of Equine Science, Otterbein University, Westerville, OH
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17
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Gramish J, Hattan A, Aljuhani O, Parameaswari PJ, Alshehri S, Korayem GB, Alkofide H, Alalawi M, Vishwakarma R, Alsowaida YS, Alqahtani R, Binorayir L, Abutaleb M, Alotaibi A, Aljohani M, Aljohani S, Samreen S, Jawhari S, Alanazi R, Al Sulaiman KA. The Impact of Midodrine Tapering Versus Nontapering Regimens on the Clinical Outcomes of Critically Ill Patients: A Retrospective Cohort Study. Ann Pharmacother 2024; 58:223-233. [PMID: 37248667 DOI: 10.1177/10600280231173290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Midodrine has been used in the intensive care unit (ICU) setting to reduce the time to vasopressor discontinuation. The limited data supporting midodrine use have led to variability in the pattern of initiation and discontinuation of midodrine. OBJECTIVES To compare the effectiveness and safety of 2 midodrine discontinuation regimens during weaning vasopressors in critically ill patients. METHODS A retrospective cohort study was conducted at King Abdulaziz Medical City. Included patients were adults admitted to ICU who received midodrine after being unable to be weaned from intravenous vasopressors for more than 24 hours. Patients were categorized into two subgroups depending on the pattern of midodrine discontinuation (tapered dosing regimen vs. nontapered regimen). The primary endpoint was the incidence of inotropes and vasopressors re-initiation after midodrine discontinuation. RESULTS The incidence of inotropes or vasopressors' re-initiation after discontinuation of midodrine was lower in the tapering group (15.4%) compared with the non-tapering group (40.7%) in the crude analysis as well as regression analysis (odd ratio [OR] = 0.15; 95% CI = 0.03, 0.73, P = 0.02). The time required for the antihypertensive medication(s) initiation after midodrine discontinuation was longer in patients who had dose tapering (beta coefficient (95% CI): 3.11 (0.95, 5.28), P = 0.005). Moreover, inotrope or vasopressor requirement was lower 24 hours post midodrine initiation. In contrast, the two groups had no statistically significant differences in 30-day mortality, in-hospital mortality, or ICU length of stay. CONCLUSION AND RELEVANCE These real-life data showed that tapering midodrine dosage before discontinuation in critically ill patients during weaning from vasopressor aids in reducing the frequency of inotrope or vasopressor re-initiation. Application of such a strategy might be a reasonable approach among ICU patients unless contraindicated.
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Affiliation(s)
- Jawaher Gramish
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Hattan
- Pharmaceutical Care Services, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Ohoud Aljuhani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - P J Parameaswari
- Research Support Department, Research and Innovation Center, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Shaden Alshehri
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ghazwa B Korayem
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hadeel Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mai Alalawi
- Department of Pharmaceutical Sciences, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
| | | | - Yazed Saleh Alsowaida
- Department of Clinical Pharmacy, College of Pharmacy, Hail University, Hail, Saudi Arabia
| | - Rahaf Alqahtani
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Luluh Binorayir
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Abutaleb
- Pharmaceutical Care Services, King Fahad Central Hospital, Jazan Health, Jazan, Saudi Arabia
| | - Alanoud Alotaibi
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Majidah Aljohani
- Pharmaceutical Care Division, King Saud Medical City, Riyadh, Saudi Arabia
| | - Sarah Aljohani
- Pharmaceutical Care Services, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sana Samreen
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Suad Jawhari
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Raghad Alanazi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khalid A Al Sulaiman
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Saudi Critical Care Pharmacy Research Platform, Riyadh, Saudi Arabia
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18
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Gravina A, Olivero F, Brindisi G, Comerci AF, Ranucci C, Fiorentini C, Sculco E, Figliozzi E, Tudini L, Matys V, De Canditiis D, Piccioni MG, Zicari AM, Anania C. Dietary Intervention during Weaning and Development of Food Allergy: What Is the State of the Art? Int J Mol Sci 2024; 25:2769. [PMID: 38474015 DOI: 10.3390/ijms25052769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Food allergy (FA) affects approximately 6-8% of children worldwide causing a significant impact on the quality of life of children and their families. In past years, the possible role of weaning in the development of FA has been studied. According to recent studies, this is still controversial and influenced by several factors, such as the type of food, the age at food introduction and family history. In this narrative review, we aimed to collect the most recent evidence about weaning and its role in FA development, organizing the gathered data based on both the type of study and the food. As shown in most of the studies included in this review, early food introduction did not show a potential protective role against FA development, and we conclude that further evidence is needed from future clinical trials.
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Affiliation(s)
- Alessandro Gravina
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | | | - Giulia Brindisi
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Antonia Fortunata Comerci
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Chiara Ranucci
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Cinzia Fiorentini
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Eleonora Sculco
- Department of Translation and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Ethel Figliozzi
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Laura Tudini
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Viviana Matys
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | | | - Maria Grazia Piccioni
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Caterina Anania
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
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Wang Y, Yi Y, Zhang F, Yao YY, Chen YX, Wu CM, Wang RY, Yan M. Lung Ultrasound Score as a Predictor of Failure to Wean COVID-19 Elderly Patients off Mechanical Ventilation: A Prospective Observational Study. Clin Interv Aging 2024; 19:313-322. [PMID: 38404479 PMCID: PMC10887876 DOI: 10.2147/cia.s438714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/06/2024] [Indexed: 02/27/2024] Open
Abstract
Background The lung ultrasound score was developed for rapidly assessing the extent of lung ventilation, and it can predict failure to wean various types of patients off mechanical ventilation. Whether it is also effective for COVID-19 patients is unclear. Methods This single-center, prospective, observational study was conducted to assess the ability of the 12-region lung ultrasound score to predict failure to wean COVID-19 patients off ventilation. In parallel, we assessed whether right hemidiaphragmatic excursion or previously published predictors of weaning failure can apply to these patients. Predictive ability was assessed in terms of the area under the receiver operating characteristic curve (AUC). Results The mean age of the 35 patients in the study was (75 ± 9) years and 12 patients (37%) could not be weaned off mechanical ventilation. The lung ultrasound score predicted these failures with an AUC of 0.885 (95% CI 0.770-0.999, p < 0.001), and a threshold score of 10 provided specificity of 72.7% and sensitivity of 92.3%. AUCs were lower for previously published predictors of weaning failure, and right hemidiaphragmatic excursion did not differ significantly between the two groups. Conclusion The lung ultrasound score can accurately predict failure to wean critically ill COVID-19 patients off mechanical ventilation, whereas assessment of right hemidiaphragmatic excursion does not appear helpful in this regard. Trial Registration https://clinicaltrials.gov/ct2/show/NCT05706441.
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Affiliation(s)
- Ying Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, People’s Republic of China
| | - Yu Yi
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, People’s Republic of China
| | - Fan Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, People’s Republic of China
| | - Yuan-Yuan Yao
- Department of Anesthesiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
| | - Yue-Xiu Chen
- Department of Anesthesiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
| | - Chao-Min Wu
- Department of Anesthesiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
| | - Rui-Yu Wang
- Department of Anesthesiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
| | - Min Yan
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, People’s Republic of China
- Department of Anesthesiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
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20
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Muttini S, Jona Falco J, Cuevas Cairo I, Umbrello M. A High Respiratory Drive Is Associated with Weaning Failure in Patients with COVID-19-Associated Acute Respiratory Distress Syndrome: The Role of the Electrical Activity of the Diaphragm. J Clin Med 2024; 13:1120. [PMID: 38398433 PMCID: PMC10889278 DOI: 10.3390/jcm13041120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/01/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Mechanical ventilation is the main supportive treatment of severe cases of COVID-19-associated ARDS (C-ARDS). Weaning failure is common and associated with worse outcomes. We investigated the role of respiratory drive, assessed by monitoring the electrical activity of the diaphragm (EAdi), as a predictor of weaning failure. METHODS Consecutive, mechanically ventilated patients admitted to the ICU for C-ARDS with difficult weaning were enrolled. Blood gas, ventilator, and respiratory mechanic parameters, as well as EAdi, were recorded at the time of placement of EAdi catheter, and then after 1, 2, 3, 7, and 10 days, and compared between patients with weaning success and weaning failure. RESULTS Twenty patients were enrolled: age 66 (60-69); 85% males; PaO2/FiO2 at admission 148 (126-177) mmHg. Thirteen subjects (65%) were classified as having a successful weaning. A younger age (OR(95%CI): 0.02 (0.01-0.11) per year), a higher PaO2/FiO2 ratio (OR(95%CI): 1.10 (1.01-1.21) per mmHg), and a lower EAdi (OR(95%CI): 0.16 (0.08-0.34) per μV) were associated with weaning success. CONCLUSION In critically ill patients with moderate-severe C-ARDS and difficult weaning from mechanical ventilation, a successful weaning was associated with a lower age, a higher oxygenation, and a lower respiratory drive, as assessed at the bedside via EAdi monitoring.
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Affiliation(s)
- Stefano Muttini
- Neuroscience Intensive Care Unit, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, 20151 Milano, Italy; (S.M.); (J.J.F.)
| | - Jacopo Jona Falco
- Neuroscience Intensive Care Unit, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, 20151 Milano, Italy; (S.M.); (J.J.F.)
| | - Ilmari Cuevas Cairo
- Department of Anaesthesia and Intensive Care Unit, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, 20151 Milano, Italy;
| | - Michele Umbrello
- Department of Intensive care and Anaesthesia, Ospedale Civile di Legnano, ASST Ovest Milanese, 20025 Legnano, Italy
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21
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Barducci RS, Santos AAD, Pacheco LG, Putarov TC, Koch JFA, Callegari MA, Dias CP, de Carvalho RH, da Silva CA. Enhancing Weaned Piglet Health and Performance: The Role of Autolyzed Yeast ( Saccharomyces cerevisiae) and β-Glucans as a Blood Plasma Alternative in Diets. Animals (Basel) 2024; 14:631. [PMID: 38396599 PMCID: PMC10886371 DOI: 10.3390/ani14040631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
The objective of this study was to evaluate the inclusion of the autolyzed yeast (AY) Saccharomyces cerevisiae with or without an immunomodulator (1,3/1,6 β-glucans) as a total/partial substitute for blood plasma (BP) in the diet of post-weaning piglets; zootechnical performance, intestinal health and microbiota, immune responses and energy metabolism were assessed. A total of 240 castrated male and female piglets, with a mean age of 22 days and mean initial weight of 5.24 ± 0.82 kg, were randomly divided into blocks of four treatments with 12 replicates. The dietary inclusions were blood plasma (BP), autolyzed yeast (AY), autolyzed yeast + immunomodulator (AYI) and 50% BP and 50% AY (BPAY). In pre-initial phase II (29-35 days), piglets fed AY showed better feed conversion (FCR = 1.358) than the piglets in the BP (1.484), AYI (1.379) and BPAY (1.442) groups, i.e., 8.49% (0.126), 1.52% (0.021) and 4.50% (0.084), respectively (p = 0.0293). In the total period (21-42 days), better FCR was observed in the AYI (1.458) group, i.e., 4.64% (0.071), 1.15% (0.017) and 4.58% (0.070), than in the BP (1.529), AY (1.475) and BPAY (1.528) groups, respectively (p = 0.0150). In piglets fed AY (n = 3) and BPAY (n = 2), there was a reduction in the number of medications, i.e., 82.35% (-14n) and 88.23% (-15n), respectively (p = 0.0001), compared with that in the BP group (n = 17). In the AY group (73.83 mg/dL), AYI group (69.92 mg/dL), and BPAY group (69.58 mg/dL), piglets exhibited increases in triglyceride levels of 79.32%, 69.83%, and 69.00%, respectively, in comparison to those in the BP group, which had triglyceride levels of 41.17 mg/dL (p = 0.0400). The beta-hydroxybutyrate concentration in the AY group (79.96 ng/μL) was lower by 31.95%, 22.64%, and 5.89% compared to the BP group (117.50 ng/μL), AYI group (103.36 ng/μL), and BPAY group (84.67 ng/μL), respectively (p = 0.0072). In the AYI group, there was modulation of the microbiota, with an increase in the relative abundance of bacteria of the genera Lactobacillus, Collinsella and Bulleidia. AY, associated or not associated with an immunomodulator, is a potential substitute for BP in diets for piglets in the nursery phase, with positive effects on immune, metabolic, and intestinal microbial performance.
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Affiliation(s)
- Robson Sfaciotti Barducci
- Biorigin, Lençóis Paulista 18680-900, SP, Brazil; (R.S.B.); (A.A.D.S.); (L.G.P.); (T.C.P.); (J.F.A.K.)
| | | | - Leticia Graziele Pacheco
- Biorigin, Lençóis Paulista 18680-900, SP, Brazil; (R.S.B.); (A.A.D.S.); (L.G.P.); (T.C.P.); (J.F.A.K.)
| | - Thaila Cristina Putarov
- Biorigin, Lençóis Paulista 18680-900, SP, Brazil; (R.S.B.); (A.A.D.S.); (L.G.P.); (T.C.P.); (J.F.A.K.)
| | - João Fernando Albers Koch
- Biorigin, Lençóis Paulista 18680-900, SP, Brazil; (R.S.B.); (A.A.D.S.); (L.G.P.); (T.C.P.); (J.F.A.K.)
| | | | | | - Rafael Humberto de Carvalho
- Akei Animal Research, Fartura 18870-970, SP, Brazil; (M.A.C.); (C.P.D.); (R.H.d.C.)
- Animal Science Program, Center of Agrarian Sciences, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Caio Abércio da Silva
- Animal Science Program, Center of Agrarian Sciences, State University of Londrina, Londrina 86057-970, PR, Brazil
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22
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Bjerrum K, Grove LMD, Mortensen SS, Fabricius J. Development and Effect Evaluation of an Action-Oriented Interdisciplinary Weaning Protocol for Cuffed Tracheostomy Tubes in Patients with Acquired Brain Injury. Healthcare (Basel) 2024; 12:480. [PMID: 38391855 PMCID: PMC10887695 DOI: 10.3390/healthcare12040480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
The objective was to develop an interdisciplinary weaning protocol (IWP) for patients with tracheostomy tubes due to acquired brain injury, and to effect evaluate implementation of the IWP on decannulation rates and weaning duration. An expert panel completed a literature review in 2018 to identify essential criteria in the weaning process. Based on consensus and availability in clinical practice, criteria for guiding the weaning process were included in the protocol. Using the IWP, dysphagia is graded as either severe, moderate, or mild. The weaning process is guided through a protocol which specified the daily duration of cuff deflation until decannulation, along with recommendations for treatment and rehabilitation interventions. Data from 337 patient records (161 before and 176 after implementation) were included for effect evaluation. Decannulation rate during hospitalization was unchanged at 91% vs. 90% before and after implementation (decannulation rate at 60 days was 68% vs. 74%). After implementation, the weaning duration had decreased compared to before implementation, hazard ratio 1.309 (95%CI: 1.013; 1.693), without any increased risk of tube-reinsertion or pneumonia. Furthermore, a tendency toward decreased length of stay was seen with median 102 days (IQR: 73-138) and median 90 days (IQR: 58-119) (p = 0.061) before and after implementation, respectively. Scientific debate on weaning protocols for tracheostomy tubes are encouraged.
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Affiliation(s)
- Katje Bjerrum
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, 8450 Hammel, Denmark
| | - Linda-Maria Delgado Grove
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, 8450 Hammel, Denmark
| | - Sine Secher Mortensen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, 8450 Hammel, Denmark
| | - Jesper Fabricius
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, 8450 Hammel, Denmark
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23
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Al-Husinat L, Jouryyeh B, Rawashdeh A, Robba C, Silva PL, Rocco PRM, Battaglini D. The Role of Ultrasonography in the Process of Weaning from Mechanical Ventilation in Critically Ill Patients. Diagnostics (Basel) 2024; 14:398. [PMID: 38396437 PMCID: PMC10888003 DOI: 10.3390/diagnostics14040398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/22/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Weaning patients from mechanical ventilation (MV) is a complex process that may result in either success or failure. The use of ultrasound at the bedside to assess organs may help to identify the underlying mechanisms that could lead to weaning failure and enable proactive measures to minimize extubation failure. Moreover, ultrasound could be used to accurately identify pulmonary diseases, which may be responsive to respiratory physiotherapy, as well as monitor the effectiveness of physiotherapists' interventions. This article provides a comprehensive review of the role of ultrasonography during the weaning process in critically ill patients.
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Affiliation(s)
- Lou’i Al-Husinat
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Basil Jouryyeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (B.J.); (A.R.)
| | - Ahlam Rawashdeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (B.J.); (A.R.)
| | - Chiara Robba
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, 16132 Genova, Italy
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941, Brazil; (P.L.S.); (P.R.M.R.)
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941, Brazil; (P.L.S.); (P.R.M.R.)
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
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24
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Kobayashi H, Naito A, Kawagishi K. Transforming Growth Factor α Evokes Aromatase Expression in Gastric Parietal Cells during Rat Postnatal Development. Int J Mol Sci 2024; 25:2119. [PMID: 38396796 PMCID: PMC10889205 DOI: 10.3390/ijms25042119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Estrogen, well known as a female hormone, is synthesized primarily by ovarian aromatase. However, extra-glandular tissues also express aromatase and produce estrogen. It is noteworthy that aromatase in gastric parietal cells begins expression around 20 days after birth and continues secreting considerable amounts of estrogen into the portal vein throughout life, supplying it to the liver. Estrogen, which is secreted from the stomach, is speculated to play a monitoring role in blood triglyceride, and its importance is expected to increase. Nevertheless, the regulatory mechanisms of the aromatase expression remain unclear. This study investigated the influence of transforming growth factor α (TGFα) on gastric aromatase expression during postnatal development. The administration of TGFα (50 μg/kg BW) to male Wistar rats in the weaning period resulted in enhanced aromatase expression and increased phosphorylated ERK1+2 in the gastric mucosa. By contrast, administration of AG1478 (5 mg/kg BW), a protein tyrosine kinase inhibitor with high selectivity for the epidermal growth factor receptor and acting as an antagonist of TGFα, led to the suppression of aromatase expression. In fact, TGFα expression in the gastric fundic gland isthmus began around 20 days after birth in normal rats as did that of aromatase, which indicates that TGFα might induce the expression of aromatase in the parietal cells concomitantly.
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Affiliation(s)
- Hiroto Kobayashi
- Department of Anatomy and Structural Science, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
| | - Akira Naito
- Department of Rehabilitation, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Sendai 981-8551, Japan
| | - Kyutaro Kawagishi
- Department of Anatomy and Structural Science, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
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25
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Ferreira MFL, Hernandez GP, Santos ACR, Bohnert D, Upah N, Ranches J. Effects of electrolyte supplementation on performance and physiological responses of preconditioning beef calves. Transl Anim Sci 2024; 8:txae016. [PMID: 38390271 PMCID: PMC10883704 DOI: 10.1093/tas/txae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
The objective of this study was to evaluate the effects of electrolyte solution supplementation on the performance and physiological responses of beef calves during a 45-d preconditioning phase. Forty Angus × Hereford steers (230.4 ± 4.8 kg body weight [BW]) were sorted into 20 pens (2 steers/pen) following weaning (day 0). Treatments were randomly assigned to pens: (1) control: access to water only and (2) electrolyte: access to water and electrolyte solution supplementation (10% of total daily water intake) from days 1 to 14. Calf BW and blood samples were collected on days 0, 1, 3, 7, 14, 21, and 44 of the study. Blood samples were analyzed for sodium, potassium, albumin, haptoglobin, ceruloplasmin, and cortisol. All variables were analyzed using the MIXED procedure of SAS. Electrolyte solution consumption was estimated at 0.70 kg/calf daily (SEM ± 0.21). Calves assigned to the Electrolyte treatment had greater water and total liquid intake than control (P < 0.05). No effects of treatment were observed on ADG or BW (P > 0.05). Effects of day (P < 0.004), but not treatment or treatment × day were observed for sodium, potassium, albumin, cortisol, ceruloplasmin, and haptoglobin. Electrolyte solution supplementation during the preconditioning period did not improve performance nor influenced stress-related markers, however improved liquid intake.
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Affiliation(s)
- Matheus F L Ferreira
- Eastern Oregon Agricultural Research Center, Oregon State University, Burns, OR 97720, USA
| | - Gracia P Hernandez
- Eastern Oregon Agricultural Research Center, Oregon State University, Burns, OR 97720, USA
| | - Aline C R Santos
- Eastern Oregon Agricultural Research Center, Oregon State University, Burns, OR 97720, USA
| | - David Bohnert
- Eastern Oregon Agricultural Research Center, Oregon State University, Burns, OR 97720, USA
| | | | - Juliana Ranches
- Eastern Oregon Agricultural Research Center, Oregon State University, Burns, OR 97720, USA
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26
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Ortiz Sanjuán JM, Manzanilla EG, Cabrera-Rubio R, Crispie F, Cotter PD, Garrido JJ, Ekhlas D, O’Neill L, Argüello H. Fine-tuning of post- weaning pig microbiome structure and functionality by in-feed zinc oxide and antibiotics use. Front Cell Infect Microbiol 2024; 14:1354449. [PMID: 38384302 PMCID: PMC10879578 DOI: 10.3389/fcimb.2024.1354449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Post-weaning diarrhoea (PWD) is a multifactorial disease that affects piglets after weaning, contributing to productive and economic losses. Its control includes the use of in-feed prophylactic antibiotics and therapeutic zinc oxide (ZnO), treatments that, since 2022, are no longer permitted in the European Union due to spread of antimicrobial resistance genes and pollution of soil with heavy metals. A dysbiosis in the microbiota has been suggested as a potential risk factor of PWD onset. Understanding pig's microbiota development around weaning and its changes in response to ZnO and antibiotics is crucial to develop feasible alternatives to prophylactic and metaphylactic antimicrobial use. Methods This study used shotgun metagenomic sequencing to investigate the environmental and faecal microbiota on 10 farms using (Treated) or not using (ZnO-free) in-feed antibiotics and ZnO during the first 14 days post-weaning (dpw). Environmental samples from clean pens were collected at weaning day (0dpw), and faecal samples at 0, 7 and 14dpw. Diarrhoeic faecal samples were collected at 7dpw when available. Results The analysis of data revealed that the faecal microbiota composition and its functionality was impacted by the sampling time point (microbiota maturation after weaning) but not by the farm environment. Treatment with antibiotics and ZnO showed no effects on diversity indices while the analyses of microbiota taxonomic and functional profiles revealed increased abundance of taxa and metabolic functions associated with Phascolarctobacterium succinatutens or different species of Prevotella spp. on the Treated farms, and with Megasphaera elsdenii and Escherichia coli on the ZnO-free farms. The analysis of diarrhoea samples revealed that the treatment favoured the microbiota transition or maturation from 0dpw to 14dpw in Treated farms, resembling the composition of healthy animals, when compared to diarrhoea from ZnO-free farms, which were linked in composition to 0dpw samples. Discussion The results provide a comprehensive overview of the beneficial effects of ZnO and antibiotics in PWD in the microbiota transition after weaning, preventing the overgrowth of pathogens such as pathogenic E. coli and revealing the key aspects in microbiota maturation that antibiotics or ZnO alternatives should fulfil.
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Affiliation(s)
- Juan M. Ortiz Sanjuán
- Pig Development Department, Teagasc Grassland Research and Innovation Centre, Moorepark, Cork, Ireland
- Grupo de Genómica y Mejora Animal, Departamento de Genética, Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain
| | - Edgar G. Manzanilla
- Pig Development Department, Teagasc Grassland Research and Innovation Centre, Moorepark, Cork, Ireland
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Raúl Cabrera-Rubio
- Teagasc Food Research Centre, Moorepark, Cork, Ireland
- APC Microbiome Institute Science Foundation Ireland (SFI) Research Centre, University College Cork, Cork, Ireland
| | - Fiona Crispie
- Teagasc Food Research Centre, Moorepark, Cork, Ireland
- APC Microbiome Institute Science Foundation Ireland (SFI) Research Centre, University College Cork, Cork, Ireland
| | - Paul D. Cotter
- Teagasc Food Research Centre, Moorepark, Cork, Ireland
- APC Microbiome Institute Science Foundation Ireland (SFI) Research Centre, University College Cork, Cork, Ireland
- VistaMilk Science Foundation Ireland (SFI) Research Centre, Cork, Ireland
| | - Juan J. Garrido
- Grupo de Genómica y Mejora Animal, Departamento de Genética, Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain
| | - Daniel Ekhlas
- Pig Development Department, Teagasc Grassland Research and Innovation Centre, Moorepark, Cork, Ireland
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Lorcan O’Neill
- Pig Development Department, Teagasc Grassland Research and Innovation Centre, Moorepark, Cork, Ireland
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Héctor Argüello
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, León, Spain
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27
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Massirio P, Battaglini M, Bonato I, De Crescenzo S, Calevo MG, Malova M, Caruggi S, Parodi A, Preiti D, Zoia A, Uccella S, Tortora D, Severino M, Rossi A, Traggiai C, Nobili L, Striano P, Ramenghi LA. Early Extra-Uterine Growth Restriction in Very-Low-Birth-Weight Neonates with Normal or Mildly Abnormal Brain MRI: Effects on a 2-3-Year Neurodevelopmental Outcome. Nutrients 2024; 16:449. [PMID: 38337733 PMCID: PMC10856867 DOI: 10.3390/nu16030449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Extra-uterine growth restriction (EUGR) is a common complication and a known risk factor for impaired development in very-low-birth-weight (VLBW) neonates. We report a population of 288 patients with no or with low-grade MRI lesions scanned at a term equivalent age (TEA) born between 2012 and 2018. Griffiths Mental Development Scale II (GMDS II) at 2 and 3 years, preterm complications and weight growth were retrospectively analyzed. EUGR was defined for weight z-score ˂ 10 percentile at TEA, 6 and 12 months of correct age or as z-score decreased by 1-point standard deviation (SDS) from birth to TEA and from TEA to 6 months. Multivariate analysis showed that a higher weight z-score at 6 months is protective for the global developmental quotient (DQ) at 2 years (OR 0.74; CI 95% 0.59-0.93; p = 0.01). EUGR at 6 months was associated with worse locomotor, personal/social, language and performance DQ at 2 years and worse language and practical reasoning DQ at 3 years. In conclusion, a worse weight z-score at 6 months of age seems to be an independent risk factor for significantly reduced GMDS in many areas. These results suggest that we should invest more into post-discharge nutrition, optimizing family nutritional education.
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Affiliation(s)
- Paolo Massirio
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
| | - Marcella Battaglini
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
| | - Irene Bonato
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
| | - Sara De Crescenzo
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
| | - Maria Grazia Calevo
- Epidemiology and Biostatistic Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Mariya Malova
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
| | - Samuele Caruggi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
| | - Deborah Preiti
- Psychology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Agata Zoia
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Psychology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Sara Uccella
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (D.T.); (M.S.); (A.R.)
| | - Mariasavina Severino
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (D.T.); (M.S.); (A.R.)
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (D.T.); (M.S.); (A.R.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
| | - Cristina Traggiai
- Neonatology Unit, International Evangelical Hospital, 16122 Genoa, Italy;
| | - Lino Nobili
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
- Paediatric Neurology and Muscle Disease Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
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Krkalić A. Tracheostomy in COVID-19 patients and its effect on laboratory parameters: a retrospective case series. Med Glas (Zenica) 2024; 21. [PMID: 37950654 DOI: 10.17392/1628-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/20/2023] [Accepted: 08/22/2023] [Indexed: 11/13/2023]
Abstract
Aim To evaluate characteristics of COVID-19 tracheostomy and its eff ect on laboratory parameters. Methods Demographic parameters, duration indicators, and laboratory parameters before and after tracheostomy were analysed in a series of 17 patients with COVID-19 patients. Results Of the 17 patients, four were males and 13 females with a mean age of 59 years. The average length of total hospitalization was 12 days, the length of stay in intensive care was 10 days, the length of endotracheal intubation was 9 days; tracheostomy was mostly performed on the seventh day. There was a signifi cant correlation between comorbidities and outcomes; however, laboratory parameters did not show statistical signifi cance. Conclusion Open surgical tracheostomy is recommended in all COVID-19 critically ill patients within 1 or 2 weeks after endotracheal intubation; it can be performed in terms of renal laboratory parameters, lactate and D-dimer. These patients had a lower possibility of weaning from mechanical ventilation.
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Affiliation(s)
- Amel Krkalić
- Department of Otorhinolaryngology and Maxillofacial Surgery, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
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Athar ZM, Arshad M, Shrivastava S. Exploring the Efficacy of Midodrine for Tapering Off Vasopressors. Cureus 2024; 16:e55192. [PMID: 38558716 PMCID: PMC10981505 DOI: 10.7759/cureus.55192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Sepsis and septic shock represent critical conditions, often necessitating vasopressor support in the intensive care unit (ICU). Midodrine, an oral vasopressor, has gathered attention as a potential adjunct to vasopressor therapy, aiming to facilitate weaning and improve clinical outcomes. However, the efficacy of midodrine remains questionable, with conflicting evidence from clinical trials and meta-analyses. This article provides a comprehensive review of the literature on midodrine's role in ICU settings by gathering evidence from multicenter trials, retrospective studies, and meta-analyses. While some studies suggest a limited benefit of midodrine in expediting vasopressor weaning and reducing ICU/hospital stays, others report potential advantages, particularly in reducing mortality rates among septic shock patients. Ongoing efforts aim to address knowledge gaps surrounding midodrine's efficacy and safety.
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Affiliation(s)
| | - Mahnoor Arshad
- Internal Medicine, BronxCare Health System, New York, USA
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30
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Rastogi S, Lala MK. Assessment of breast-feeding and weaning practices of under-fives and their associated co-morbidities in urban and rural areas of Ahmedabad City, Gujarat, India. J Family Med Prim Care 2024; 13:600-606. [PMID: 38605792 PMCID: PMC11006042 DOI: 10.4103/jfmpc.jfmpc_1203_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 04/13/2024] Open
Abstract
Introduction Shaping up the post-2015 development agenda is of crucial importance in the development process around the Globe as 20151 was the last year of milllenium development goals. It is the right time to asses our own progress vis-a-vis the Millennium development goals. Appropriate feeding and weaning practices are the key contributor for decreasing morbidities and mortalities in under-five children. As per national family health survey-5 (NFHS-5), only 55.8% of the Indian infants between 0 and 6 months were exclusively breastfed in Gujarat. Children age 6-8 months receiving solid or semi-solid food and breast milk were only 49.4% in Gujarat. Only 5.8% of breastfeeding infants aged 6-23 months receive an adequate diet in Gujarat. Hence the following study was done to know the practice of breastfeeding and weaning in mothers of urban and rural area of Ahmedabad city, Gujarat. Objective The primary objective of this study was to describe the breastfeeding and newborn care practices and the factors affecting the initiation and duration of breastfeeding in urban and rural areas of Ahmedabad city, Gujarat and the secondary objective was to describe the comorbidities associated with them. Methods Cross-sectional study was done in anganwadis of slums of urban and rural field practice area of B.J. Medical College, Ahmedabad. Results Half of the under-five children were provided jaggery as pre-lacteal feed both in urban (45%) and rural (53%) area. In urban area most common reason for providing pre lacteal feeds was due to family customs (55%) followed by their belief that it leads to help in removal of meconium from gut (22%) followed by as advised from their relatives (23%) as compared to in rural area where there was belief that it leads to help in removal of meconium from gut (52%) followed by family customs (31%) and advise from relatives (17%). There were 7.5% under-five children in urban area in whom breastfeeding was not initiated immediately compared to rural area in which there were 42% under-five children. Conclusion Frequent occurrence of acute illness among under-fives may have lead to undernutrition.
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Affiliation(s)
- Swarna Rastogi
- Department Community Medicine, Hind Institute of Medical Sciences Ataria, Sitapur, Uttar Pradesh, India
| | - M. K. Lala
- Department Community Medicine, B. J. Medical College, Asarwa, Ahmedabad, Gujarat, India
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Sørby J, Johnsen JF, Kischel SG, Ferneborg S. Effects of 2 gradual debonding strategies on machine milk yield, flow, and composition in a cow-driven cow-calf contact system. J Dairy Sci 2024; 107:944-955. [PMID: 37730177 DOI: 10.3168/jds.2022-23117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/31/2023] [Indexed: 09/22/2023]
Abstract
This controlled study compared the effects of 2 different gradual debonding strategies on machine milk yield, flow, and composition in a cow-driven cow-calf contact (CCC) system with automatic milking. Cows had 24 h/d access to their calves during the first weeks of lactation. In the long debonding (LDB) treatment (n = 16), a gradual reduction of cows' access to their calves was initiated 4 wk after calving over a total period of 28 d; first to 12 h/d (14 d), and then to 6 h/d (14 d). In the short debonding (SDB) treatment (n = 14), gradual reduction was initiated 6.5 wk after calving over a total period of 10 d; first to 12 h/d (5 d), and then to 6 h/d (5 d). From 6 h/d, access was finally reduced to 0 h/d for 7 d for both treatments. Machine milk yield, somatic cell count, and peak and average milk flow were automatically registered at milking. During the 9-wk study period, composite samples were analyzed for milk composition. Data were analyzed with linear mixed effect models. Results showed that machine milk yield during 24 h/d access varied between cows (range 1.2-49.9 kg/d, average ± standard deviation 13.2 ± 7.82 kg/d). The LDB cows had a higher daily machine milk yield than SDB cows at the end of and after access reduction was completed (+5.0 ± 1.63 and +5.1 ± 1.55 kg during the last 5 d of 6 h/d access, and 0 h/d access, respectively). Somatic cell count was on a healthy level, with no difference between treatments. Milk fat content increased with reduction in access, regardless of treatment. Short debonding cows tended to show higher milk protein content and lower milk lactose content than cows with a longer debonding. This study has shown that a longer debonding initiated earlier may give a higher milk yield in the short term. The variation in machine milk yield may indicate differences in milk ejection, suckling, and visiting patterns and preferences among cows.
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Affiliation(s)
- Johanne Sørby
- Department of Animal and Aquacultural Sciences, Faculty of Biosciences, Norwegian University of Life Sciences, Ås 1432, Norway.
| | - Julie F Johnsen
- Section of Terrestrial Animal Health and Welfare, Norwegian Veterinary Institute, Ås 1432, Norway
| | - Stine G Kischel
- Department of Research and Development, Farm Advisory Services, TINE SA, Ås 1432, Norway
| | - Sabine Ferneborg
- Department of Animal and Aquacultural Sciences, Faculty of Biosciences, Norwegian University of Life Sciences, Ås 1432, Norway
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Mortamet G, Milési C, Baudin F, Yalindag N, Kneyber M, Pons-Odena M. Weaning from noninvasive respiratory support in children in acute settings: Expert consensus statement using modified Delphi methodology. Pediatr Pulmonol 2024; 59:348-354. [PMID: 37942833 DOI: 10.1002/ppul.26753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To reach a consensus on the definition and modalities of weaning from noninvasive ventilation in acute settings. DESIGN A modified Delphi survey using closed and open-ended questions. SETTING Three rounds of consensus determination were sent via electronic mail survey to 33 experts. The survey questionnaire had four sections: definition of weaning, definition of weaning failure, criteria to initiate weaning, and modalities of weaning. Questions where agreement had been reached on round 1 were no longer part of the survey in rounds 2 and 3. SUBJECTS Twenty-five international experts from 10 countries. MEASUREMENT AND MAIN RESULTS Overall, this survey generated positive consensus from experts for 19/35 statements (9 with strong agreement and 10 with weak agreement) about weaning from noninvasive respiratory support. No negative consensus could be identified. CONCLUSION The clinical practice statements issued address important aspects of definition of weaning, definition of weaning failure, criteria to initiate weaning, and modalities of weaning in acute settings.
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Affiliation(s)
- Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Christophe Milési
- Pediatric Intensive Care Unit, Montpellier University Hospital, Montpellier, France
| | - Florent Baudin
- Pediatric Intensive Care Unit, Women Mother Children Hospital, Bron, France
| | - Nilufer Yalindag
- Pediatric Intensive Care Unit, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Martin Kneyber
- Department of Pediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Critical Care, Anaesthesiology, Peri-operative & Emergency Medicine (CAPE), University of Groningen, Groningen, The Netherlands
| | - Marti Pons-Odena
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Pediatric Intensive Care and Intermediate Care Department, Sant Joan de Déu University Hospital, Esplugues de Llobregat, Spain
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Österlund J, Granåsen G, Bodén S, Silfverdal SA, Domellöf M, Winberg A, West CE. Revised Swedish infant feeding guidelines are associated with earlier introduction of allergenic foods. J Allergy Clin Immunol 2024; 153:461-470. [PMID: 37813287 DOI: 10.1016/j.jaci.2023.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/07/2023] [Accepted: 08/23/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Randomized controlled trials have demonstrated that early introduction of allergenic foods, such as peanut and egg, can reduce food allergy in high-risk children. Many international guidelines recommend introduction of allergenic foods in the first year of life, and accordingly, the Swedish National Food agency released updated guidelines in June 2019. OBJECTIVE Our aim was to examine whether the age at introduction and consumption frequency of allergenic foods have changed since release of the revised national guidelines on the introduction of solid foods in Sweden. METHODS Children born between June 2016 and December 2018 (n = 1925) were compared with children born between June 2019 and April 2021 (n = 1761) by using data from the NorthPop Birth Cohort study. Data on food introduction, eczema, and food allergy were prospectively collected until age 18 months by using web-based questionnaires. IgE sensitization was assessed at 18 age months. RESULTS The proportion of participants who had been introduced to egg, legume, soy products, peanut, almond, and cashew nut during the first year of life increased after implementation of the revised national guidelines. The most significant changes were seen for legume (from 55.2% to 69.8% [adjusted odds ratio = 1.90 (95% CI = 1.62-2.24)]) and peanut (from 29.2% to 43.2% adjusted odds ratio = 1.87 (95% CI = 1.55-2.24)]); consumption frequency had also increased. No differences in the prevalence of eczema, food allergy, or sensitization to the foods of interest were found. CONCLUSION Since release of the revised guidelines, infants in the general population are introduced to and consume a variety of allergenic foods earlier and more frequently; however, early manifestations of allergic disease have remained unchanged.
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Affiliation(s)
- Jonas Österlund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
| | - Gabriel Granåsen
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stina Bodén
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | | | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Anna Winberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Christina E West
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Li J, Liu F, Mo K, Ni H, Yin Y. Effects of weaning on intestinal longitudinal muscle-myenteric plexus function in piglets. Sci China Life Sci 2024; 67:379-390. [PMID: 37824029 DOI: 10.1007/s11427-022-2391-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/18/2023] [Indexed: 10/13/2023]
Abstract
Weaning piglets usually suffer from severe diarrhea (commonly known as postweaning diarrhea, PWD) along with intestinal motility disorder. Intestinal peristalsis is mainly regulated by the longitudinal muscle-myenteric plexus (LM-MP). To understand the relationship between intestinal LM-MP function and the development of PWD, we compared the intestinal electrical activity, and the transcriptional profile of the LM-MP between 21-day-old piglets (just weaned, n=7) and 24-day-old piglets (suffered the most severe weaning stress, n=7). The results showed that 24-day-old piglets exhibited different degrees of diarrhea. A significant increase in the slow-wave frequency in the ileum and colon was observed in 24-day-old piglets, while c-kit expression in the intestinal LM-MPs was significantly decreased, indicating that PWD caused by elevated slow-wave frequency may be associated with loss of c-kit. The real-time quantitative PCR (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA) showed that intestinal LM-MPs in 24-day-old piglets may undergo inflammation and oxidative stress. Significant increases in 8-hydroxy-2'-deoxyguanosine and decreases in thioredoxin suggest that weaning may lead to DNA damage in the LM-MP of 24-day-old piglets. In addition, activating transcription factor 3 was significantly upregulated, indicating nerve damage in the LM-MP of 24-day-old piglets. The transcriptomic results showed that most of the differentially expressed genes in the ileal LM-MP after weaning were downregulated and closely related to the cell cycle process. Subsequent RT-qPCR analysis showed that the relative expression of p21 was upregulated, while the expression of cyclin A2, cyclin B1, and proliferating cell nuclear antigen was downregulated in the ileal and colonic LM-MP of 24-day-old piglets, suggesting that weaning may inhibit cell proliferation and cause G1/S cell cycle arrest in ileal and colonic LM-MP. In conclusion, weaning may lead to cell cycle arrest by causing DNA damage in the LM-MP, impairing intestinal motility regulation, and ultimately leading to diarrhea in piglets.
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Affiliation(s)
- Jing Li
- Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, Hunan Research Center of Livestock and Poultry Sciences, South Central Experimental Station of Animal Nutrition and Feed Science in the Ministry of Agriculture, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, 410125, China
| | - Fenfen Liu
- Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, Hunan Research Center of Livestock and Poultry Sciences, South Central Experimental Station of Animal Nutrition and Feed Science in the Ministry of Agriculture, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, 410125, China
- University of Chinese Academy of Sciences, Beijing, 100008, China
| | - Kaibin Mo
- Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, Hunan Research Center of Livestock and Poultry Sciences, South Central Experimental Station of Animal Nutrition and Feed Science in the Ministry of Agriculture, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, 410125, China
- Guangdong Key Laboratory for Veterinary Drug Development and Safety Evaluation, College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Hengjia Ni
- Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, Hunan Research Center of Livestock and Poultry Sciences, South Central Experimental Station of Animal Nutrition and Feed Science in the Ministry of Agriculture, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, 410125, China.
- University of Chinese Academy of Sciences, Beijing, 100008, China.
| | - Yulong Yin
- Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, Hunan Research Center of Livestock and Poultry Sciences, South Central Experimental Station of Animal Nutrition and Feed Science in the Ministry of Agriculture, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, 410125, China.
- University of Chinese Academy of Sciences, Beijing, 100008, China.
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Deshpande S, Gunderson M, Rajamani G, Park S, Diethelm M, Marquard J, Melton G, Rizvi R. Development and Usability Evaluation of an Opioid Management App. Stud Health Technol Inform 2024; 310:976-980. [PMID: 38269954 DOI: 10.3233/shti231110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
We describe the development and usability evaluation of a novel patient engagement tool (OPY) in its early stage from perspectives of both experts and end-users. The tool is aimed at engaging patients in positive behaviors surrounding the use, weaning, and disposal of opioid medications in the post-surgical setting. The messaging and design of the application were created through a behavioral economics lens. Expert-based heuristic analysis and user testing were conducted and demonstrated that while patients found the tool to be easy to use and subjectively somewhat useful, additional work to enhance the user interface and features is needed in close partnership with developers and stakeholders.
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Affiliation(s)
| | | | | | - Suhyun Park
- University of Minnesota, Minneapolis, MN, USA
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Sørby J, Johnsen JF, Kischel SG, Ferneborg S. Calf performance in a cow-driven cow-calf contact system; effect of two methods to gradually reduce cows' access to their calf. J Dairy Sci 2024:S0022-0302(24)00041-9. [PMID: 38278291 DOI: 10.3168/jds.2023-23615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/29/2023] [Indexed: 01/28/2024]
Abstract
Knowledge is lacking on separation strategies that can best prepare calves to final separation from the dam in cow-calf contact (CCC) systems. This controlled trial compared the effects of 2 different methods to gradually reduce cows' access to their calf termed "debonding" on calf growth in a cow-driven CCC system. Initially, cows (Norwegian Red breed) had 24 h/d computer-controlled access to their calves. In the long debonding (LDB) treatment (n = 16), a gradual reduction of cows' access to their calves was initiated 28 d after calving over a total duration of 28 d; first to 12 h/d (14 d), and then to 6 h/d (14 d). In the short debonding (SDB) treatment (n = 14), reduction was initiated 45 d after calving over a total duration of 10 d; first to 12 h/d (5 d), and then to 6 h/d (5 d). From 6 h/d, access was finally reduced to 0 h/d for 4 d for both treatments, resulting in a study period of 60 d in total. Calves had ad libitum access to concentrate, hay and water throughout the study. Independent of treatment, ad libitum access to whole-milk from an automatic feeder was granted once cow access was reduced. Cows and calves had the possibility for fence line contact at all times. The primary outcome variable calf weight gain was registered biweekly. Calf average daily gain (ADG) was analyzed with a linear mixed model. ADG was similar across treatments during 24 h/d access (1.04 ± 0.07 kg). Debonding treatment affected calf growth differently with each gradual reduction in cow access (12 h/d, 6 h/d and 0 h/d), however no main effect of treatment was detected. SDB calves had a pattern of increased ADG with the first reduction in access (+0.39 ± 0.18kg), followed by significant growth checks as access was reduced further to 6 h/d and 0 h/d (-0.41 ± 0.20 kg and -1.15 ± 0.31 kg, respectively). LDB calves only showed significant weight checks at the final reduction in access (0 h/d access), yet at a lower degree (-0.46 ± 0.21 kg) than SDB calves. As expected, ADG was negatively associated with health events but positively associated with intake of concentrate and supplemental milk. Collectively, the results from the present study might point toward a long adaptation to separation which is initiated at a younger age being more favorable for calf performance.
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Affiliation(s)
- Johanne Sørby
- Department of Animal and Aquacultural Sciences, Faculty of Biosciences, Norwegian University of Life Sciences, Ås, Norway.
| | - Julie F Johnsen
- Section of Terrestrial Animal Health and Welfare, Norwegian Veterinary Institute, Oslo, Norway
| | - Stine G Kischel
- Department of Research and Development, Farm Advisory Services, TINE SA, Ås, Norway
| | - Sabine Ferneborg
- Department of Animal and Aquacultural Sciences, Faculty of Biosciences, Norwegian University of Life Sciences, Ås, Norway
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37
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Lashkari S, Jensen SK, Foldager L, Larsen T, Vestergaard M. A high fat to vitamin E ratio in the feed protects and improves uptake of the natural form of vitamin E in post weaning calves. J Anim Physiol Anim Nutr (Berl) 2024. [PMID: 38264860 DOI: 10.1111/jpn.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/06/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
In postweaning calves, it is a challenge to maintain the plasma vitamin E level at or above the recommended level (3 µg/mL), which is linked to a good immune response. It has been unclear until now why the provision of solid feed with concentrations below 200 mg/kg feed of vitamin E is ineffective in maintaining the plasma vitamin E level of calves above the recommended plasma level postweaning. The present study was conducted to investigate if a high fat to vitamin E ratio in the concentrate could protect and improve the delivery of the natural form of vitamin E (RRR-α-tocopherol) to calves postweaning. Thirty calves were included in the experiment from 2 weeks preweaning until 2 weeks postweaning (Weeks -2, -1, 0 [weaning], 1, and 2 relative to weaning) and fed one of three concentrates in which lecithin mixture provided the fat supplement: control (77 mg/kg of vitamin E and 4.9% DM of crude fat; CONT), medium level of vitamin E supplemented (147 mg/kg of vitamin E and 7.7% DM of crude fat; MedVE) or high level of vitamin E supplemented (238 mg/kg of vitamin E and 12.4% DM of fat; HiVE). Thus, there was a comparable ratio of fat to vitamin E (520-630) in the three concentrates. During the 2 weeks postweaning, final body weight (92 ± 2 kg), average daily gain (917 ± 51 g/day) and concentrate intake (2.2 ± 0.09 kg/day; mean of treatment ± standard error) were unaffected by treatment and the interaction between treatment and week. There was an interaction between treatment and week for vitamin E intake pre- (p < 0.001) and postweaning (p < 0.001). There was an interaction between treatment and week (p < 0.001) for plasma vitamin E level postweaning, and it was 2.5, 3.1, and 3.8 µg/mL in CONT, MedVE, and HiVE, respectively, at Week 1 postweaning. In addition, plasma vitamin E levels at Week 2 postweaning were 2.6, 3.6 and 4.8 µg/mL in CONT, MidVE and HiVE respectively. The results show that 147 mg/kg of lecithin-protected vitamin E in the concentrate is needed to secure a plasma vitamin E level well above the recommended level. In addition, lecithin-protected vitamin E elevated the plasma level of triglycerides and nonesterified fatty acids.
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Affiliation(s)
- Saman Lashkari
- Department of Animal and Veterinary Sciences, Aarhus University, Tjele, Denmark
| | - Søren K Jensen
- Department of Animal and Veterinary Sciences, Aarhus University, Tjele, Denmark
| | - Leslie Foldager
- Department of Animal and Veterinary Sciences, Aarhus University, Tjele, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Torben Larsen
- Department of Animal and Veterinary Sciences, Aarhus University, Tjele, Denmark
| | - Mogens Vestergaard
- Department of Animal and Veterinary Sciences, Aarhus University, Tjele, Denmark
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Biagioli V, Volpedo G, Riva A, Mainardi P, Striano P. From Birth to Weaning: A Window of Opportunity for Microbiota. Nutrients 2024; 16:272. [PMID: 38257165 PMCID: PMC10819289 DOI: 10.3390/nu16020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: The first 1000 days of life constitute a critical window of opportunity for microbiota development. Nutrients play a crucial role in enriching and diversifying the microbiota, derived not only from solid food but also from maternal dietary patterns during gestation. (2) Methods: We conducted a comprehensive literature review using the PubMed database, covering eleven years (2013-2023). We included English-language reviews, original research papers, and meta-analyses, while excluding case reports and letters. (3) Results: Consensus in the literature emphasizes that our interaction with a multitude of microorganisms begins in the intrauterine environment and continues throughout our lives. The existing data suggest that early nutritional education programs, initiated during pregnancy and guiding infant diets during development, may influence the shaping of the gut microbiota, promoting long-term health. (4) Conclusions: Further research is necessary in the coming years to assess potential interventions and early nutritional models aimed at modulating the pediatric microbiota, especially in vulnerable populations such as premature newborns.
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Affiliation(s)
- Valentina Biagioli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (G.V.); (A.R.); (P.M.); (P.S.)
| | - Greta Volpedo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (G.V.); (A.R.); (P.M.); (P.S.)
| | - Antonella Riva
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (G.V.); (A.R.); (P.M.); (P.S.)
| | - Paolo Mainardi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (G.V.); (A.R.); (P.M.); (P.S.)
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (G.V.); (A.R.); (P.M.); (P.S.)
- IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
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Benli RK, Yurdalan U, Yılmaz B, Adıgüzel N. Effect of post-extubation inspiratory muscle training on diaphragmatic function in mechanically ventilated patients: A randomized controlled trial. ADV CLIN EXP MED 2024; 33:0-0. [PMID: 38230846 DOI: 10.17219/acem/174815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/22/2023] [Accepted: 11/03/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Diaphragmatic dysfunction is a common problem in patients who have been mechanically ventilated. OBJECTIVES The study aimed to evaluate the effectiveness of inspiratory muscle training (IMT) on diaphragm muscle thickness and function in mechanically ventilated patients. MATERIAL AND METHODS A single-blind trial was conducted. Twenty patients were randomly assigned to either the conventional physiotherapy (CP) group or to the IMT group for 5 days following extubation. The CP group received only CP, while the IMT group received CP in addition to IMT. Ten healthy controls (HCs) underwent IMT. Maximum inspiratory pressure (MIP) and physical function were recorded. Diaphragm excursion (DE), diaphragm thickness at the end of inspiration (Tdi), diaphragm thickness at the end of expiration (Tde), peak contraction velocity (PCV), and peak relaxation velocity (PRV) were evaluated with ultrasonography before and after the intervention. RESULTS The IMT group and HCs showed significant improvements in DE (p = 0.005; p = 0.005, respectively), PCV (p = 0.028; p = 0.015, respectively) and PRV (p = 0.029; p = 0.020, respectively) after 5 days of IMT. A significant increase in MIP was recorded in all groups after the intervention (CP: p = 0.044; IMT: p = 0.005; HC: p < 0.001). There was a significant improvement in the Medical Research Council (MRC) and the Physical Function in Intensive Care Test (PFIT) scores in both the CP and IMT groups (p < 0.001 and p < 0.001, respectively). CONCLUSIONS Inspiratory muscle training improves diaphragmatic functions, including MIP, diaphragm excursion, PCV, and PRV. We think that IMT applied after extubation may serve as a tool to prevent and facilitate the recovery of diaphragmatic function.
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Affiliation(s)
- Reyhan Kaygusuz Benli
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - Ufuk Yurdalan
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - Barış Yılmaz
- Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Respiratory Intensive Care Unit, Istanbul, Turkey
| | - Nalan Adıgüzel
- Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Respiratory Intensive Care Unit, Istanbul, Turkey
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Yang Q, Liu H, Jafari H, Liu B, Wang Z, Su J, Wang F, Yang G, Sun M, Cheng J, Dong B, Li M, Gen M, Yu J. Metabolic changes before and after weaning in Dezhou donkey foals in relation to gut microbiota. Front Microbiol 2024; 14:1306039. [PMID: 38282742 PMCID: PMC10812615 DOI: 10.3389/fmicb.2023.1306039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/22/2023] [Indexed: 01/30/2024] Open
Abstract
Weaning is undoubtedly one of the most crucial stages in the growth and development of all mammalian animals, including donkey foals. Weaning is a dynamic and coordinated process of the body, which is closely associated with the health, nutrition, and metabolism of the host. Many studies have shown that the intestinal microbiota and serum metabolites of mammals exhibit different changes during lactation, weaning, and postweaning. However, the alterations in serum metabolites in donkey foals before and postweaning and the correlation between serum metabolites and intestinal microbiota are largely unknown. This study is based on the fecal 16S rRNA and serum metabolomes of Dezhou donkey foals. In total, 10 samples (fecal and serum) were collected during the following three stages: before weaning (F.M.1), during weaning (F.M.3), and postweaning (F.M.6). To study the alterations in intestinal microflora, serum metabolites, and their correlation before and postweaning. We found that with the growth and weaning progress of donkey foals, the intestinal microbiota of donkey foals underwent obvious changes, and the diversity of fecal bacteria increased (Chao1 and Shannon indexes). The main intestinal microbial flora of donkey foals include Bacteroides and Firmicutes. We found many microbiota that are associated with immunity and digestion in the postweaning group, such as Verrucomicrobiales, Clostridia, Oscillospiraceae, Akkermansia, and Rikenellaceae, which can be considered microbial markers for the transition from liquid milk to solid pellet feed. Clostridia and Oscillospiraceae can produce organic acids, including butyric acid and acetic acid, which are crucial for regulating the intestinal microecological balance of donkeys. Furthermore, the metabolome showed that the serum metabolites enriched before and postweaning were mainly related to arachidonic acid metabolism and riboflavin metabolism. Riboflavin was associated with the development of the small intestine and affected the absorption of the small intestine. We also found that the changes in the gut microbiome of the foals were significantly correlated with changes in serum metabolites, including lysophosphatidylcholine (LPC; 12,0) and positively correlated with Lachnoclostridium and Roseburia. To summarize, this study provides theoretical data for the changes in the intestinal microbiome and serum metabolism during the entire weaning period of donkey foals.
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Affiliation(s)
- Qiwen Yang
- National Engineering Research Center for Gelatin-Based Traditional Chinese Medicine, Dong-E-E-Jiao Co. Ltd., Dong'e County, Shandong, China
- Key Laboratory of Animal Genetics, Breeding and Reproduction of Shaanxi Province, College of Animal Science and Technology, Northwest A&F University, Xianyang, Shaanxi, China
| | - Haibing Liu
- National Engineering Research Center for Gelatin-Based Traditional Chinese Medicine, Dong-E-E-Jiao Co. Ltd., Dong'e County, Shandong, China
| | - Halima Jafari
- Key Laboratory of Animal Genetics, Breeding and Reproduction of Shaanxi Province, College of Animal Science and Technology, Northwest A&F University, Xianyang, Shaanxi, China
| | - Bing Liu
- National Engineering Research Center for Gelatin-Based Traditional Chinese Medicine, Dong-E-E-Jiao Co. Ltd., Dong'e County, Shandong, China
| | - Zhaofei Wang
- Key Laboratory of Animal Genetics, Breeding and Reproduction of Shaanxi Province, College of Animal Science and Technology, Northwest A&F University, Xianyang, Shaanxi, China
| | - Jiangtian Su
- Key Laboratory of Animal Genetics, Breeding and Reproduction of Shaanxi Province, College of Animal Science and Technology, Northwest A&F University, Xianyang, Shaanxi, China
| | - Fuwen Wang
- Key Laboratory of Animal Genetics, Breeding and Reproduction of Shaanxi Province, College of Animal Science and Technology, Northwest A&F University, Xianyang, Shaanxi, China
| | - Ge Yang
- Key Laboratory of Animal Genetics, Breeding and Reproduction of Shaanxi Province, College of Animal Science and Technology, Northwest A&F University, Xianyang, Shaanxi, China
| | - Minhao Sun
- Key Laboratory of Animal Genetics, Breeding and Reproduction of Shaanxi Province, College of Animal Science and Technology, Northwest A&F University, Xianyang, Shaanxi, China
| | - Jie Cheng
- National Engineering Research Center for Gelatin-Based Traditional Chinese Medicine, Dong-E-E-Jiao Co. Ltd., Dong'e County, Shandong, China
| | - Boying Dong
- National Engineering Research Center for Gelatin-Based Traditional Chinese Medicine, Dong-E-E-Jiao Co. Ltd., Dong'e County, Shandong, China
| | - Min Li
- National Engineering Research Center for Gelatin-Based Traditional Chinese Medicine, Dong-E-E-Jiao Co. Ltd., Dong'e County, Shandong, China
| | - Mingjian Gen
- National Engineering Research Center for Gelatin-Based Traditional Chinese Medicine, Dong-E-E-Jiao Co. Ltd., Dong'e County, Shandong, China
| | - Jie Yu
- National Engineering Research Center for Gelatin-Based Traditional Chinese Medicine, Dong-E-E-Jiao Co. Ltd., Dong'e County, Shandong, China
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Vassilopoulou E, Feketea G, Pagkalos I, Rallis D, Milani GP, Agostoni C, Douladiris N, Lakoumentas J, Stefanaki E, Efthymiou Z, Tsabouri S. Complementary Feeding Practices: Recommendations of Pediatricians for Infants with and without Allergy Risk. Nutrients 2024; 16:239. [PMID: 38257132 PMCID: PMC10819658 DOI: 10.3390/nu16020239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/30/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
AIM To investigate the routine guidance provided by pediatricians concerning the timing of complementary feeding (CF) for both healthy infants and those at a heightened risk of allergies. METHODS A total of 233 pediatricians participated in an anonymous online survey that included questions about demographics and recommendations for CF. Specifically, they provided guidance on the types of foods, preparation methods, supplements, time intervals for introducing new foods to infants at low and high allergy risk, and delayed food introductions for high-risk cases. RESULTS The respondents advised introducing certain foods at specific ages: fruits, starchy non-gluten grains, vegetables, olive oil, and meat were appropriate at 6 months; gluten-rich grains at 7 months; yogurt, hard-boiled eggs, and legumes at 8 months; fish at 8.5 months; and nuts at 9 months. Pediatricians, especially those with less than 15 years of practice, often introduced egg, seafood, gluten-rich grains, legumes, and nuts earlier for high-risk infants. Parenthood and male gender were associated with the earlier introduction of eggs and grains. CONCLUSIONS Greek pediatricians follow a structured food introduction schedule for CF in infants. Interestingly, they tend to delay the introduction of common food allergens and recommend longer intervals between introducing new foods, particularly for high-risk infants. Key Notes: Despite recent evidence-based indications on healthy complementary feeding strategies for infants, discrepancies persist among pediatricians regarding food choices and the order and timing of food introduction, both for healthy infants and those at risk of allergy. Guidance on complementary feeding by pediatricians is influenced by their individual characteristics. Pediatricians tend to delay the introduction of common food allergens and recommend longer intervals between introducing new foods, particularly for high-risk infants.
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Affiliation(s)
- Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (E.V.); (I.P.); (J.L.); (Z.E.)
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.P.M.); (C.A.)
| | - Gavriela Feketea
- Department of Pediatrics, “Karamandaneio” Children’s Hospital of Patra, 26331 Patras, Greece
- Department of Pharmacology, “luliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Ioannis Pagkalos
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (E.V.); (I.P.); (J.L.); (Z.E.)
| | - Dimitrios Rallis
- School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (D.R.); (S.T.)
| | - Gregorio Paolo Milani
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.P.M.); (C.A.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20157 Milan, Italy
| | - Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.P.M.); (C.A.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20157 Milan, Italy
| | - Nikolaos Douladiris
- Allergy Unit, 2nd Pediatric Clinic, University of Athens, 11527 Athens, Greece;
| | - John Lakoumentas
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (E.V.); (I.P.); (J.L.); (Z.E.)
| | - Evangelia Stefanaki
- Department of Pediatrics, General Hospital of Heraklion, Venizeleio and Pananio, 71409 Heraklion, Greece;
| | - Zenon Efthymiou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (E.V.); (I.P.); (J.L.); (Z.E.)
| | - Sophia Tsabouri
- School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (D.R.); (S.T.)
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Shaikh H, Ionita R, Khan U, Park Y, Jubran A, Tobin MJ, Laghi F. Effect of Atypical-Sleep EEG Patterns on Weaning From Prolonged Mechanical Ventilation. Chest 2024:S0012-3692(24)00011-4. [PMID: 38211699 DOI: 10.1016/j.chest.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Approximately one-third of acute ICU patients display atypical sleep patterns that cannot be interpreted by using standard EEG criteria for sleep. Atypical sleep patterns have been associated with poor weaning outcomes in acute ICUs. RESEARCH QUESTION Do patients being weaned from prolonged mechanical ventilation experience atypical sleep EEG patterns, and are these patterns linked with weaning outcomes? STUDY DESIGN AND METHODS EEG power spectral analysis during wakefulness and overnight polysomnogram were performed on alert, nondelirious patients at a long-term acute care facility. RESULTS Forty-four patients had been ventilated for a median duration of 38 days at the time of the polysomnogram study. Eleven patients (25%) exhibited atypical sleep EEG. During wakefulness, relative EEG power spectral analysis revealed higher relative delta power in patients with atypical sleep than in patients with usual sleep (53% vs 41%; P < .001) and a higher slow-to-fast power ratio during wakefulness: 4.39 vs 2.17 (P < .001). Patients with atypical sleep displayed more subsyndromal delirium (36% vs 6%; P = .027) and less rapid eye movement sleep (4% vs 11% total sleep time; P < .02). Weaning failure was more common in the atypical sleep group than in the usual sleep group: 91% vs 45% (P = .013). INTERPRETATION This study provides the first evidence that patients in a long-term acute care facility being weaned from prolonged ventilation exhibit atypical sleep EEG patterns that are associated with weaning failure. Patients with atypical sleep EEG patterns had higher rates of subsyndromal delirium and slowing of the wakeful EEG, suggesting that these two findings represent a biological signal for brain dysfunction.
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Affiliation(s)
- Hameeda Shaikh
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL
| | - Ramona Ionita
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL
| | - Usman Khan
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL
| | - Youngsook Park
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL
| | - Amal Jubran
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL; RML Specialty Hospital, Hinsdale, IL
| | - Martin J Tobin
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL.
| | - Franco Laghi
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL; RML Specialty Hospital, Hinsdale, IL
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Su H, Jiang X, Liu H, Bai H, Bai X, Xu Y, Du Z. Comparison of Intestinal Microbiota of Blue Fox before and after Weaning. Animals (Basel) 2024; 14:210. [PMID: 38254379 PMCID: PMC10812593 DOI: 10.3390/ani14020210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/25/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Intestinal flora plays an important role in maintaining the internal stability and health of the intestine. Currently, intestinal microbes are considered an important "organ" but are mostly ignored by people. This study evaluated the flora structure of each intestinal segment of blue foxes pre-weaning and explored the differences between the fecal flora and intestinal flora structure of each segment after weaning. Samples of intestinal contents from three blue foxes at 45 days of age (before weaning) and intestinal contents and feces samples from at 80 days (after weaning) were collected for 16s rRNA flora analysis. The species and distribution characteristics of microorganisms in different intestinal segments of blue foxes before and after weaning were different. Except for the rectum, the dominant flora of each intestinal segment of blue fox changed significantly after experiencing weaning, and the fecal flora structure of young fox at the weaning stage did not represent the whole intestinal flora structure but was highly similar to that of the colon and rectum. To sum up, the intestinal flora of blue foxes changed systematically before and after weaning. When performing non-invasive experiments, the microflora structure of the colon and rectum of blue foxes can be predicted by collecting fecal samples.
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Affiliation(s)
| | | | | | | | | | - Yuan Xu
- College of Animal Sciences and Technology, Northeast Agricultural University, Harbin 150030, China; (H.S.); (X.J.); (H.L.); (H.B.); (X.B.)
| | - Zhiheng Du
- College of Animal Sciences and Technology, Northeast Agricultural University, Harbin 150030, China; (H.S.); (X.J.); (H.L.); (H.B.); (X.B.)
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Blavi L, Villagómez-Estrada S, Solà-Oriol D, Pérez JF. Exploring zinc deficiency using serum Zn levels: consequences and potential solutions in suckling pigs. J Anim Sci 2024; 102:skad396. [PMID: 38035764 PMCID: PMC10799317 DOI: 10.1093/jas/skad396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/29/2023] [Indexed: 12/02/2023] Open
Abstract
Three trials were undertaken to provide an answer to different questions: 1) Are suckling pigs able to maintain physiological serum Zn levels throughout lactation and do these levels vary between high and low body weight (BW) pigs?, 2) Are serum Zn levels in pigs soon after weaning a predisposing factor for diarrhea?, and 3) Is it possible to increase serum Zn levels at weaning by supplementing Zn during lactation. In trial 1, blood samples were taken from pigs during lactation. Eight pigs (one piglet per litter) had blood drawn on days 0 (farrowing), 7, 14, 21, and 28 (weaning), and 60 pigs (selected from the whole farrowing batch with 35 sows), categorized as either heavy (8.63 kg) or light (5.50 kg) had blood drawn on day 28. Serum Zn levels at birth were 1.2 mg/L and decreased (P < 0.01) to 0.67 mg/L on day 28. Heavier pigs showed greater (P < 0.01) serum Zn levels (0.98 mg/L) than light BW pigs (0.79 mg/L). In trial 2, blood samples were obtained from 240 pigs at weaning (26.2 ± 2.5 d) with an average initial BW of 6.94 ± 1.87 kg and were distributed into 24 pens (10 pigs/pen) by BW. Diarrhea incidence was recorded daily from days 0 to 35 post-weaning. From the 240 pigs, a group of 110 pigs with uniform BW (6.5 ± 1.9 kg) was selected and separated into two groups based on serum Zn levels at weaning with 55 pigs with low serum Zn (LZn: <0.71 mg/L) and 55 pigs with high serum Zn (HZn: >0.9 mg/L). Pigs with LZn were 2.49 times as likely to have diarrhea as pigs with HZn (P < 0.02). In trial 3, a total of 96 suckling pigs were allotted four treatments that consisted of the daily administration of 0, 6, 18, or 30 mg of Zn as Zn citrate in capsule form during the last 7 d of lactation. Pigs were individually weighed, and blood samples were obtained on days 14, 21 (weaning), and 7 after weaning. Serum Zn levels linearly increased by day as Zn citrate supplementation increased (interaction, P < 0.001). However, only light pigs supplemented with 18 and 30 mg/L of Zn experienced an increase in serum Zn levels during lactation. In conclusion, a decrease in serum Zn levels occurs during lactation and is more severe in low BW pigs. Low Zn status (< 0.7 mg/L) at weaning may be a predisposing factor for diarrhea. However, Zn supplementation during lactation can mitigate this decrease in light pigs.
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Affiliation(s)
- Laia Blavi
- Animal Nutrition and Welfare Service, Department of Animal and Food Sciences, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - Sandra Villagómez-Estrada
- Animal Nutrition and Welfare Service, Department of Animal and Food Sciences, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
- Faculty of Veterinary Medicine and Agronomy, Veterinary Medicine Department, Universidad UTE, Quito 17012764, Ecuador
| | - David Solà-Oriol
- Animal Nutrition and Welfare Service, Department of Animal and Food Sciences, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - José F Pérez
- Animal Nutrition and Welfare Service, Department of Animal and Food Sciences, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
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Bélanger-Naud S, Wolfe T, Zambelis A, Lévesque J, Julien C, Vasseur E. Is there a right time for dairy Alpine goat kid weaning: How does the weaning age of dairy Alpine goat kids affect their growth and behavior? J Anim Sci 2024; 102:skad413. [PMID: 38141243 PMCID: PMC10836510 DOI: 10.1093/jas/skad413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 12/20/2023] [Indexed: 12/25/2023] Open
Abstract
In dairy goat kids, weaning is often associated with poor growth leading to a decline in welfare and performance; however, little is known about optimal weaning practices. This study aimed to determine the optimal weaning age for dairy goat kids to maximize outcome measures of welfare related to growth, feed intake, and behavior. Thirty-six newborn female Alpine kids were blocked by weight and birth date, paired with a similar male companion and randomly allocated to one of the three weaning age treatments: 6 (6W), 8 (8W), and 10 wk (10W). Kids had ad libitum access to acidified milk replacer refilled twice daily, concentrates, hay, and water. Milk consumption was measured daily, and concentrate consumption, weekly. Ten behaviors were live observed on days -8, -4, 0, 6, and 12 relative to weaning (i.e., weaning day = 0). Kruskal-Wallis tests were used to assess differences from baseline between the 6W, 8W, and 10W treatments. Post hoc analysis using the Dwass, Steel, Critchlow-Fligner (DSCF) multiple comparison analysis was used to evaluate pairwise treatment differences based on two-sample Wilcoxon comparisons. Kids weaned at 10 wk had the greatest increase compared to baseline in concentrate consumption (P = 0.0160), and greatest decrease compared to baseline in vocalization (P = 0.0008) while both 8- and 10- wk kid's groups had the greatest increase compared to baseline in self-grooming time (P < 0.0001), and cross-sucking time (P = 0.0006). Kids weaned at 6 wk of age were found to have the smallest increase compared to baseline in concentrate consumption (P = 0.0160) and self-grooming time (P < 0.0001), and the greatest increase compared to baseline in allogrooming time (P = 0.0032) and in redirected behaviors aimed towards the environment (biting and licking time [P = 0.0173]; displacement at the nipple frequency [P = 0.0236]). No negative impact of weaning on growth of either group was identified. Overall, our results tend towards a higher degree of discomfort behaviors (allogrooming, biting/licking, displacement, and vocalizations) in kids weaned earlier compared to later weaning, while kids weaned later showed higher levels of positive behaviors (lying time and self-grooming).
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Affiliation(s)
- Stéphanie Bélanger-Naud
- Department of Animal Science, McGill University, Sainte-Anne-de-Bellevue, QC, Canada H9X 3V9
| | - Tania Wolfe
- Department of Animal Science, McGill University, Sainte-Anne-de-Bellevue, QC, Canada H9X 3V9
| | - Athena Zambelis
- Department of Animal Science, McGill University, Sainte-Anne-de-Bellevue, QC, Canada H9X 3V9
| | - Janie Lévesque
- Centre de recherche en sciences animales de Deschambault, Deschambault, QC, Canada G0A 1S0
| | - Carl Julien
- Centre de recherche en sciences animales de Deschambault, Deschambault, QC, Canada G0A 1S0
| | - Elsa Vasseur
- Department of Animal Science, McGill University, Sainte-Anne-de-Bellevue, QC, Canada H9X 3V9
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Wijesiriwardana UA, Pluske JR, Craig JR, Furness JB, Ringuet M, Fothergill LJ, Dunshea FR, Cottrell JJ. A comparative analysis of gastrointestinal tract barrier function and immune markers in gilt vs. sow progeny at birth and weaning. J Anim Sci 2024; 102:skae054. [PMID: 38447056 PMCID: PMC10977035 DOI: 10.1093/jas/skae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/04/2024] [Indexed: 03/08/2024] Open
Abstract
Progeny born to primiparous sows (gilt progeny; GP) have lower birth, weaning and slaughter weights than sow progeny (SP). GP also have reduced gastrointestinal tract (GIT) development, as evidenced by lower organ weights. Therefore, the aim of this experiment was to quantify changes in GIT barrier function that occur in birth and weaning, representing two major challenges to the young piglet. The effects of parity (GP vs. SP) in GIT barrier integrity function were quantified at four timepoints: birth (~0 h), 24 h after birth (24 h), 1-d preweaning (PrW), and 1-d postweaning (PoW) in commercially reared piglets. Due to inherent differences between newborn and weanling pigs, the results were analyzed in two cohorts, birth (0 vs. 24 h, n = 31) and weaning (PrW vs. PoW, n = 40). Samples of the stomach, jejunum, ileum, and colon were excised after euthanasia and barrier integrity was quantified by measuring transepithelial resistance (TER), macromolecular permeability, the abundance of inflammatory proteins (IL-8, IL-1β, and TNF-α) and tight junction proteins (claudin-2 and -3). Papp was characterized using a dual tracer approach comprising 4 KDa fluorescein isothiocyanate (FD4) and 150 kDa tetramethyl rhodamine isothiocyanate (T150)-labeled dextrans. Characteristic effects of the initiation of feeding and weaning were observed on the GIT with the initiation of feeding, such as increasing TER and reducing Papp at 24 h, consistent with mucosal growth (P = 0.058) This was accompanied by increased cytokine abundance as evidenced by elevations in TNF-α and IL-1β. However, GP had increased IL-8 abundance (P = 0.011 and 0.063 for jejunum and ileum respectively) at birth than 24 h overall. In the weaning cohort, jejunal and ileal permeability to FD4 was higher in GP (P = 0.05 and 0.022, respectively) while only higher ileal T150 was observed in GP (P = 0.032). Ileal claudin-2 abundance tended to be higher in SP overall (P = 0.063), but GP ileal claudin-2 expression was upregulated weaning while no change was observed in SP (P = 0.043). Finally, other than a higher jejunal TNF-α abundance observed in SP (P = 0.016), no other effect of parity was observed on inflammatory markers in the weaning cohort. The results from this study indicate that the GIT of GP have poorer adaptation to early life events, with the response to weaning, being more challenging which is likely to contribute to poorer postweaning growth.
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Affiliation(s)
- Udani A Wijesiriwardana
- School of Agriculture, Food and Ecosystem Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - John R Pluske
- School of Agriculture, Food and Ecosystem Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
- Australasian Pork Research Institute Ltd, Willaston, SA 5118, Australia
| | - Jessica R Craig
- Research and Innovation, Rivalea (Australia), Pty. Ltd, Corowa, NSW 2646, Australia
| | - John B Furness
- Florey Institute for Neuroscience and Mental Health, Parkville, VIC 3010, Australia
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Mitchell Ringuet
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Linda J Fothergill
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Frank R Dunshea
- School of Agriculture, Food and Ecosystem Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Jeremy J Cottrell
- School of Agriculture, Food and Ecosystem Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
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Assadoon MS, Kovacevic MP, Dube KM, Szumita PM, Lupi KE, DeGrado JR. Evaluation of Atypical Antipsychotics for the Facilitation of Weaning Sedation in Mechanically Ventilated Critically Ill Patients. J Intensive Care Med 2024; 39:52-58. [PMID: 37431208 DOI: 10.1177/08850666231188029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Sedatives and analgesics are commonly utilized as continuous infusions in the ICU but have complications, including an increase in mechanical ventilation days, ICU length of stay, and delirium. Atypical antipsychotics (AAPs) affect several receptors including muscarinic, histamine, and α-1 adrenergic receptors, which may allow them to act as adjunctive agents to facilitate weaning of continuous infusions. OBJECTIVE To determine if there is a decrease in sedatives/analgesics requirements with the use of quetiapine and olanzapine in mechanically ventilated critically ill patients. METHODS A single-center, retrospective study conducted at Brigham and Women's Hospital from 1/1/2018 to 12/31/2019. Patients were included if they were mechanically ventilated for at least 48 hours before and following AAP initiation, were receiving at least one sedative/analgesic by continuous infusion and received AAP for at least 48 hours. The major endpoint was the percentage of patients with ≥20% reduction in the cumulative dose (CD) of midazolam, propofol, or opioids using morphine mg equivalent (MME), 48 hours from AAP initiation. Minor endpoints included median changes in CD at 24 and 48 hours, and Richmond Agitation-Sedation Scale (RASS), and Critical Care Pain Observation Tool (CPOT) changes at 48 hours. RESULTS A total of 1177 encounters were screened and 107 were included. Within the 48 hours after AAP initiation, 77.6% had ≥20% reduction in the CD of a sedative/analgesic. There was a significant reduction in propofol, no change in MME, and significant increase in dexmedetomidine median CD at 48 hours from AAP start. No difference was found in pain scores, but patients had significantly lighter sedation scores in the 48 hours after AAP initiation. A multivariate analysis showed that earlier initiation of antipsychotics was associated with a higher likelihood of achieving a 20% reduction in a sedative/analgesic. CONCLUSION AAP use was associated with a significant reduction in sedatives/analgesics doses. Future studies are warranted to confirm the results.
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Affiliation(s)
- Maha S Assadoon
- Department of Pharmacy, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Mary P Kovacevic
- Department of Pharmacy, Brigham and Women's Hospital, Boston, USA
| | - Kevin M Dube
- Department of Pharmacy, Brigham and Women's Hospital, Boston, USA
| | - Paul M Szumita
- Department of Pharmacy, Brigham and Women's Hospital, Boston, USA
| | - Kenneth E Lupi
- Department of Pharmacy, Brigham and Women's Hospital, Boston, USA
| | - Jeremy R DeGrado
- Department of Pharmacy, Brigham and Women's Hospital, Boston, USA
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Duddeck KA, Petersen TE, Adkins HJ, Smith AH, Hernandez S, Wenner SJ, Yao D, Chen C, Li W, Fregulia P, Larsen A, Jang YD. Dose-Dependent Effects of Supplementing a Two-Strain Bacillus subtilis Probiotic on Growth Performance, Blood Parameters, Fecal Metabolites, and Microbiome in Nursery Pigs. Animals (Basel) 2023; 14:109. [PMID: 38200840 PMCID: PMC10777967 DOI: 10.3390/ani14010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
This experiment was conducted to evaluate the effects of dietary supplementation level of a two-strain Bacillus subtilis probiotic on growth performance, blood parameters, fecal metabolites, and microbiome in nursery pigs. A total of 54 weaned piglets were allotted to three treatments in three replicate pens with six pigs/pen for a 28 d feeding trial. The treatments were as follows: control: no probiotic supplementation; Pro1x: B. subtilis supplementation at 1.875 × 105 CFU/g diet; and Pro10x: B. subtilis supplementation at 1.875 × 106 CFU/g diet. Body weight at d 14 postweaning (p = 0.06) and average daily gain for d 0 to 14 postweaning (p < 0.05) were greater in the Pro1x treatment than in the other treatments. Blood glucose levels were greater in both probiotic treatments than in the control treatment at d 14 postweaning (p < 0.05). In the fecal short-chain fatty acid (SCFA) concentrations, the butyrate concentrations were greater in the Pro1x treatment than in the other treatments (p < 0.05), and the acetate, propionate, and total SCFA concentrations were greater in the Pro1x treatment than in the Pro10x treatment (p < 0.05). The beta diversity of fecal microbiome composition at d 14 postweaning based on Unweighted Unifrac analysis was dissimilar between the Pro1x and Pro10x treatments (p < 0.05). In conclusion, dietary B. subtilis supplementation of two strains selected to reduce effects of pathogenic Escherichia coli to nursery diets at 1.875 × 105 CFU/g diet improved the growth rate in the early postweaning period, increased fecal SCFA concentrations and altered the fecal microbial community composition. A higher dose of B. subtilis did not improve the performance parameters over those of the control piglets.
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Affiliation(s)
- Karyn A. Duddeck
- Department of Animal and Food Science, University of Wisconsin-River Falls, River Falls, WI 54022, USA
| | - Tiffany E. Petersen
- Department of Animal and Food Science, University of Wisconsin-River Falls, River Falls, WI 54022, USA
| | - Haley J. Adkins
- Department of Animal and Food Science, University of Wisconsin-River Falls, River Falls, WI 54022, USA
| | - Alexandra H. Smith
- The ScienceHearted Center, Arm & Hammer Animal and Food Production, Waukesha, WI 53186, USA
| | - Samantha Hernandez
- The ScienceHearted Center, Arm & Hammer Animal and Food Production, Waukesha, WI 53186, USA
| | - Seth J. Wenner
- The ScienceHearted Center, Arm & Hammer Animal and Food Production, Waukesha, WI 53186, USA
| | - Dan Yao
- Department of Animal Science, University of Minnesota, St. Paul, MN 55108, USA
| | - Chi Chen
- Department of Animal Science, University of Minnesota, St. Paul, MN 55108, USA
| | - Wenli Li
- United States Department of Agriculture-Agricultural Research Service, US Dairy Forage Research Center, Madison, WI 53706, USA
| | - Priscila Fregulia
- United States Department of Agriculture-Agricultural Research Service, US Dairy Forage Research Center, Madison, WI 53706, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
| | - Anna Larsen
- United States Department of Agriculture-Agricultural Research Service, US Dairy Forage Research Center, Madison, WI 53706, USA
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Young Dal Jang
- Department of Animal and Food Science, University of Wisconsin-River Falls, River Falls, WI 54022, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602, USA
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Krasivskyi I, Großmann C, Aswadi W, Ivanov B, Gerfer S, Gaisendrees C, Elderia A, Mihaylova M, Eghbalzadeh K, Deppe AC, Sabashnikov A, Rahmanian PB, Mader N, Wahlers T, Djordjevic I. Impact of thrombocytopenia on short-term outcomes in patients undergoing mobile extracorporeal membrane oxygenation support. Perfusion 2023:2676591231224635. [PMID: 38146253 DOI: 10.1177/02676591231224635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
INTRODUCTION The prolonged use of extracorporeal membrane oxygenation (ECMO) support is associated with increased consumption of platelets and hemolysis. The prognostic impact of thrombocytopenia prior to and during ECMO support on patient's short-, mid- and long-term outcomes has been critically evaluated and discussed over the last years. However, only few data have been published on thrombocytopenia caused by mobile ECMO support. The aim of this study was to evaluate the impact of thrombocytopenia on short-term outcomes and predictors of in-hospital mortality in patients supported by mobile ECMO for transportation and subsequent weaning in a tertiary centre. METHODS This retrospective single-centre study analyzed a total of 117 patients requiring mobile veno-arterial (va) ECMO support and subsequent transportation from referral hospitals to our department from January 2015 until December 2021. A total of 15 patients had to be excluded from the analysis for missing data regarding baseline platelet count. Patients were divided into two groups: thrombocytopenia group (<130 × 109/L, n = 44) and non-thrombocytopenia group (≥130 × 109/L, n = 58). The primary outcome was in-hospital mortality. Secondary outcomes were successful ECMO-weaning, and the incidence of associated complications (bleeding, acute hepatic failure, acute renal failure, dialysis, and septic shock). RESULTS The dialysis rate before ECMO initiation was significantly higher (p = .041) in the thrombocytopenia group compared to the non-thrombocytopenia group. The rates of bleeding complications (p = .032) and limb ischemia (p = .003) were significantly higher in patients with low platelet count. Moreover, complication rates of acute hepatic failure (p < .001), acute renal failure (p < .001) and dialysis (p = .033) were significantly higher in the thrombocytopenia group. Also, in-hospital mortality was significantly higher (p = .002) in patients with low platelet count before initiation of ECMO support. CONCLUSION Based on the results of the present study, patients with thrombocytopenia prior to mobile vaECMO support may be at significantly higher risk for associated complications and short-term mortality.
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Affiliation(s)
- Ihor Krasivskyi
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Clara Großmann
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Wasil Aswadi
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Borko Ivanov
- Department of Cardiothoracic Surgery, Helios Hospital Siegburg, Siegburg, Germany
| | - Stephen Gerfer
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Christopher Gaisendrees
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Ahmed Elderia
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Mariya Mihaylova
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Antje-Christin Deppe
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Parwis Baradaran Rahmanian
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
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50
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Treon E, Sidney T, Taiwo G, Idowu M, Leal Y, Ologunagba D, Ogunade IM. Effects of dietary supplementation of a blend of Saccharomyces cerevisiae, multiple live probiotic bacteria, and their fermentation products on performance, health, and rumen bacterial community of newly weaned beef steers during a 56-d receiving period. Transl Anim Sci 2023; 8:txad143. [PMID: 38221963 PMCID: PMC10785767 DOI: 10.1093/tas/txad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024] Open
Abstract
We examined the effects of a blend of Saccharomyces cerevisiae, multiple live probiotic bacteria, and their fermentation products on performance, health, and the ruminal bacterial community of newly weaned beef steers during a 56-d receiving period. Forty newly weaned Angus crossbred steers (221 ± 25.6 kg BW; 180 ± 17 d of age) were stratified by body weight (BW) into four pens (10 steers per pen) such that each pen had a similar average BW at the beginning of the experiment. The pens were randomly assigned to receive a corn silage basal diet (CON; n = 20) or the basal diet supplemented with 9 g/steer/d of PRO feed additive (PRO; n = 20). The PRO additive is a blend of S. cerevisiae and the fermentation products of Enterococcus faecium, Bacillus licheniformis, B. subtilis, Lactobacillus animalis, and Propionibacterium freudenreichii. The DMI and water consumed were monitored using the GrowSafe intake nodes and custom flow meters, respectively. BWs were recorded weekly to calculate average daily gain (ADG). Before morning feeding, 10 mL of blood was taken from each steer on days 0-7, and thereafter weekly for analyses of immune cells, plasma glucose, and NEFAs. On day 56, rumen fluid samples (200 mL each) were collected from all the steers for microbiome analysis. Over the 56-d receiving period, the supplemental PRO had no effects on DMI, water intake, or ADG. However, compared to CON, beef steers fed supplemental PRO tended to have greater ADG (P = 0.08) and BW (P = 0.07) during the first 14 d of the study. There was a treatment × day interaction (P ≤ 0.05) for WBC, neutrophils and monocytes over the 56 d such that beef steers fed supplemental PRO had lower blood concentrations on certain days during the first 7 d after weaning, indicating reduced inflammation or stress response. The results of the rumen microbiome analysis revealed that the relative abundance of complex fiber degrading or obligate proton-reducing bacterial genera such as Bacteroides, Ruminococcus gauvreauii group, Desulfovibrio, Syntrophococcus, and Acetitomaculum were greater (P ≤ 0.05) in beef steers fed supplemental PRO compared to CON. This study demonstrated that dietary supplementation of PRO improved the growth performance, reduced stress or inflammatory response during the initial days after weaning, and altered the ruminal bacterial community toward increased relative abundance of bacterial genera associated with improved rumen function.
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Affiliation(s)
- Emily Treon
- Division of Animal and Nutritional Science, West Virginia University, Morgantown, WV 26505, USA
| | - Taylor Sidney
- Division of Animal and Nutritional Science, West Virginia University, Morgantown, WV 26505, USA
| | - Godstime Taiwo
- Division of Animal and Nutritional Science, West Virginia University, Morgantown, WV 26505, USA
| | - Modoluwamu Idowu
- Division of Animal and Nutritional Science, West Virginia University, Morgantown, WV 26505, USA
| | - Yarahy Leal
- Division of Animal and Nutritional Science, West Virginia University, Morgantown, WV 26505, USA
| | - Deborah Ologunagba
- Division of Animal and Nutritional Science, West Virginia University, Morgantown, WV 26505, USA
| | - Ibukun M Ogunade
- Division of Animal and Nutritional Science, West Virginia University, Morgantown, WV 26505, USA
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