PhenoBR: a model to phenotype body condition dynamics in meat sheep

In situations of negative energy balance (NEB) due to feed scarcity or high physiological demands, body energy reserves (BRs), mainly stored in adipose tissues, become the main sources of energy for ruminants. The capacity to mobilise and restore such BRs in response to different challenges is of major concern in the current context of breeding for resilience. Body condition score (BCS) is a common, practical indicator of BR variations throughout successive productive cycles, and quantitative tools for characterising such dynamics at the individual level are still lacking. The main objective of this work was to characterise body condition dynamics in terms of BR mobilisation and accretion capacities of meat sheep during their productive lifespan through a modelling approach, using BCS measurements. The animal model used in this work was the reproductive meat ewe (n = 1 478) reared in extensive rangeland. Regular measurements of BCS for each productive cycle were used as the indicator of BR variations. A hybrid mathematical model and a web interface, called PhenoBR, were developed to characterise ewes' BCS variations through four synthetic and biologically meaningful parameters for each productive cycle i: BR accretion rate (k_bⁱ), BR mobilisation rate (k_pⁱ), plus the time of onset and the duration of the BR mobilisation, t_bⁱ and ΔTⁱ, respectively. The model PhenoBR converged for all the ewes included in the analysis. Estimation of the parameters indicated the inter-individual variability for BR accretion and mobilisation rates, and the length of the mobilisation period. The present study is a proof of concept that the combination of data-driven and concept-driven models is required for the estimation of biologically meaningful parameters that describe body reserve dynamics through consecutive productive cycles. Individual characterisation of animals by these parameters makes it possible to rank them for their efficiency in the use of body reserves when facing NEB challenges. Such parameters could contribute to better management and decision-making by farmers and advisors, e.g. by adapting feeding systems to the individual characteristics of BR dynamics, or by geneticists as criteria to develop future animal breeding programmes including BR dynamics for more robust and resilient animals.

Alternative hormone-free reproduction management of a dairy sheep flock disrupts the farm's annual feeding system calendar and its associated strategies

Hormone-free (HF) reproduction in dairy sheep is a way to meet current societal demands, but it requires being prepared for collateral impacts on related system components. The efficiency of HF practices (e.g., using the male effect for estrus induction and synchronization) is uncertain compared with hormonal treatment (HT). For example, these practices can lead to higher variability in the flock physiological stage patterns throughout the year, which has direct consequences for feeding regimens. The objective of this work was to simulate the impacts of HF reproduction management, including artificial insemination (AI), on the temporal distribution of productive performance and nutritional requirements of a conventional dairy sheep flock. Using the REPROsheep2.0 model, 6 scenarios were compared over one typical production season for the same flock (n = 597 Lacaune ewes) intensively reared in the Roquefort region of France. These scenarios depicted reproduction with HT and AI in mid-May (Early); HT and AI in July (Summer Late); HT and AI in November (Autumn Late); and their HF versions (HF-Early; HF-Summer Late, and HF-Autumn Late, respectively). In all HF scenarios, a reduction in the number of ewes lambing and consequently in the annual milk production of the farm was observed (-1 to -7%). This affected annual performance with a subsequent decrease of total annual nutritional requirements (-2 to -6%). The HF scenarios resulted in a staggering of lambing events with a 7- to 14-d shift in the appearance of milk production peaks and related nutritional requirements compared with the HT scenarios. Transitioning from conventional to HF reproduction management, while preserving AI, would increase farm workload, lengthen milking period operations, and necessitate a readjustment of feeding management strategies with regard to available feed resources. Depending on the production season, the observed delay in the distribution of nutritional requirements could be either an attractive or an unfavorable outcome for farmers. The delay may be concordant, for example, with the recently observed impacts of climate change on seasonal forage availability in Mediterranean regions (less spring herbage production and warmer temperatures) that are affecting farmers' decision-making about the most efficient use of forage and feed resources.

BTLA dysregulation correlates with poor outcome and diminished T cell-mediated antitumor responses in chronic lymphocytic leukemia

Patients with chronic lymphocytic leukemia (CLL) progressively develop marked immunosuppression, dampening innate and adaptive-driven antitumor responses. However, the underlying mechanisms promoting immune exhaustion are largely unknown. Herein, we provide new insights into the role of BTLA/HVEM axis promoting defects in T cell-mediated responses against leukemic cells. Increased expression of BTLA, an inhibitory immune checkpoint, was detected on the surface of CD4 + and CD8 + T lymphocytes in patients with CLL. Moreover, high levels of BTLA on CD4 + T cells correlated with diminished time to treatment. Signaling through BTLA activation led to decreased IL-2 and IFN-γ production ex vivo, whereas BTLA/HVEM binding disruption enhanced IFN-γ + CD8 + T lymphocytes. Accordingly, BTLA blockade in combination with bispecific anti-CD3/anti-CD19 antibody promoted CD8 + T cell-mediated anti-leukemic responses. Finally, treatment with an anti-BLTA blocking monoclonal antibody alone or in combination with ibrutinib-induced leukemic cell depletion in vitro. Altogether, our data reveal that BTLA dysregulation has a prognostic role and is limiting T cell-driven antitumor responses, thus providing new insights about immune exhaustion in patients with CLL.

[Recommendations for the use of neurophysiological techniques in the diagnosis of brain death from the Clinical Neurophysiology Society of the Communities of Valencia and Murcia]

In Spain organ transplantation constitutes one of the greatest challenges and teamwork of hospital centres. It is estimated that in the year 2020 Spain contributed 19% of all donors to the European Union. The confirmatory support diagnosis recommends by law some complementary techniques in certain cases, including neurophysiological techniques, especially the use of electroencephalogram and evoked potentials. These cases require the clinical neurophysiologist to make the right clinical and technical decisions for the correct performance and interpretation of the same. To date, there is no national consensus on the performance of these techniques. Updated bibliographic review on neurophysiological techniques (electroencephalogram and evoked potentials). Analysis by Delphi method and expert judgment of the working group of the Clinical Neurophysiology Society of the Communities of Valencia and Murcia. Neurophysiological techniques can be a support in the diagnosis of encephalic death, both confirmatory and to shorten observation times. In order to perform them, minimum technical standards are required to allow optimal performance of the studies, especially taking into account medication, hemodynamic situation, absence of hypothermia, and age group. We present the first guide in Spanish elaborated by the Society of Neurophysiology of the Communities of Valencia and Murcia for the performance in our hospitals of neurophysiological techniques in the diagnosis of brain death.

High body condition score combined with a reduced lambing to ram introduction interval improves the short-term ovarian response of milking Lacaune ewes to the male effect

The male effect is an effective natural technique to induce off-season ovulation and ultimately mating or artificial insemination in small ruminants. It constitutes an alternative to hormonal treatments in conventional breeding systems and, to shift and organise the yearly production cycle, is currently the only solution complying with European organic standards. However, its associated performances are still heterogeneous, both in terms of the global response and the extent of reproductive synchronisation of the females, due to complex interactions with environmental factors that limit its use on commercial farms. This study was carried out on a French organic farm under commercial conditions to investigate, in the field and across five consecutive years, the main parameters affecting the early ovarian response to a ram effect on Lacaune dairy ewes. While the within-year binary logistic regressions yielded contrasting results, the cross-year mixed-effect binary logistic regression models clearly showed that parameters associated with the nutritional state of the animals have a profound influence on the ovarian response of the ewes. Indeed, the probabilities of a spontaneous resumption of ovarian activity before the ram effect and of an early ovarian response to the ram effect were positively associated with the body condition score, total milk production and the age of the animals, while being negatively associated with the milk production level at the 3rd milk recording. The probabilities of a spontaneous resumption of ovarian activity before the ram effect were positively associated with the interval between lambing and the introduction of the rams. Altogether, these results indicate that the ovarian performances in response to a male effect follow a bell-curve pattern with optimal performances depending upon a complex combination between photoperiodic and nutritional cues. Regarding these latter, this study highlights the major contribution of body reserves and energy balance dynamics.

Impact of the use of pressurized liquids on the extraction and functionality of proteins and bioactives from brewer's spent grain

A green methodology based on pressurized liquids (PLE) to extract proteins and obtain highly active extracts from brewer's spent grain (BSG) is proposed. Box-Behnken experimental design was employed to study the effect of extraction parameters on the protein content (PC), the total phenolic content (TPC), and the antioxidant activity of extracts. Results were compared with those obtained by conventional alkaline extraction assisted with ultrasounds (UAE). The selection of PLE conditions enabled to tailor the PC and TPC of extracts. PLE extracted 36 % more proteins than UAE. PLE extracts showed higher antioxidant, cholesterol esterase inhibition, and ACE inhibitory activities than UAE extract. HPLC-MS/MS enabled to observe that the extraction technique and experimental conditions significantly affected to the kind and amount of extracted proteins, and released peptides, and phenolic compounds. A higher ratio of hydrophobic peptides was observed in PLE extracts, which justified their higher bioactivity.

Measuring liveweight changes in lactating dairy ewes with an automated walk-over-weighing system

Monitoring liveweight (LW) is an important part of sound management practices at the individual and flock level (e.g., controlling for nutritional status based on body condition, reproduction, and health-related issues), but it is time consuming and stressful. To our knowledge, no literature has reported on the evaluation of automated weighing systems in dairy sheep as an alternative to conventional static scales. The objective of this research was to evaluate the practical feasibility of using an automated walk-over-weighing (WoW) prototype to measure daily LW changes in dairy ewes without human intervention. We used adult Lacaune dairy ewes in 2 complementary trials conducted indoors. Trial 1 aimed at evaluating the repeatability, precision, and accuracy of LW measures recorded using WoW scales compared with a static scale (the gold standard). Forty-two adult ewes (LW ± standard deviation = 71.3 ± 10.4 kg) were randomly drafted from the main flock and used in a 1-day session. The trial included 3 passages. In each passage, ewes were weighed first on a static scale; once a static position was achieved and LW recorded, they continued the circuit and immediately traversed the WoW scale for an automated LW record. Trial 2 aimed to demonstrate the feasibility of using the WoW device under real-world conditions in a dairy sheep-farming system. The WoW scale was installed in the exit race of the milking parlor and evaluated over 7 wk with adult ewes in mid lactation (n = 93; LW 78.5 ± 8.1 kg). Once the ewes were acclimated to the WoW system, 1 group of ewes (n = 48) continued to receive the same feeding regimen (controls), and the other group (n = 45) underwent a nutritional challenge [challenged; 2 wk of undernutrition and then back to control regimen (refeeding) for 1 wk]. We evaluated the ability of the WoW to detect small changes in LW. We collected LW data (2 weighings per ewe per day) from the WoW after each of the 2 milking sessions (morning and evening). We also obtained LW values by weighing the ewes using a static scale once a week. The automated WoW system showed substantial agreement with the gold standard when assessed using Lin's concordance correlation coefficient and Bland and Altman's method, largely due to high repeatability. The WoW system was adequate for detecting small daily variations in LW during undernutrition and refeeding periods. Misbehaviors resulted in spurious WoW values in trial 2, requiring us to use filtration methods to exclude outlier weights and allow meaningful assessment of small LW changes. The WoW system evaluated here is an alternative to the static scales conventionally used on dairy sheep farms. If sound filtration of raw data is applied, WoW could contribute to the close (daily) monitoring of individual LW without operator intervention (i.e., voluntary weighing) and taking animal welfare into account (i.e., no stress related to the weighing session on static scales).

R-COMP versus R-CHOP as first-line therapy for diffuse large B-cell lymphoma in patients ≥60 years: Results of a randomized phase 2 study from the Spanish GELTAMO group

The use of non-pegylated liposomal doxorubicin (Myocet^® ) in diffuse large B-cell lymphoma (DLBCL) has been investigated in retrospective and single-arm prospective studies. This was a prospective phase 2 trial of DLBCL patients ≥60 years old with left ventricular ejection fraction (LVEF) ≥55% randomized to standard R-CHOP or investigational R-COMP (with Myocet^® instead of conventional doxorubicin). The primary end point was to evaluate the differences in subclinical cardiotoxicity, defined as decrease in LVEF to <55% at the end of treatment. Secondary objectives were efficacy, safety, and variations of troponin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and LVEF along follow-up. Ninety patients were included, 45 in each group. No differences were observed in the percentage of patients with LVEF <55% at end of treatment (11% in R-CHOP arm vs. 7% in R-COMP arm, p = 0.697) or at 4 months (10% vs. 6%, respectively, p = 0.667) and 12 months (8% vs. 7%, respectively, p = 1). However, a higher percentage of R-CHOP compared with R-COMP patients showed increased troponin levels in cycle 6 (100% vs. 63%, p = 0.001) and at 1 month after treatment (88% vs. 56%, respectively, p = 0.015). Cardiovascular adverse events were seen in five R-CHOP patients (nine episodes, four grade ≥3) and in four R-COMP patients (five episodes, all grade 1-2). No significant differences in efficacy were observed. In conclusion, R-COMP is a feasible immunochemotherapy schedule for DLBCL patients ≥60 years, with similar efficacy to R-CHOP. However, the use of non-pegylated doxorubicin instead of conventional doxorubicin was not associated with less early cardiotoxicity, although some reduced cardiac safety signals were observed. Trial registration: ClinicalTrials.gov Identifier: NCT02012088.

The Mithralog EC-7072 Induces Chronic Lymphocytic Leukemia Cell Death by Targeting Tonic B-Cell Receptor Signaling

B-cell receptor (BCR)-dependent signaling is central for leukemia B-cell homeostasis, as underscored by the promising clinical results obtained in patients with chronic lymphocytic leukemia (CLL) treated with novel agents targeting components of this pathway. Herein, we demonstrate that the mithralog EC-7072 displays high ex vivo cytotoxic activity against leukemia cells from CLL patients independently from high-risk prognostic markers and IGHV mutational status. EC-7072 was significantly less toxic against T cells and NK cells and did not alter the production of the immune effector molecules IFN-γ and perforin. EC-7072 directly triggered caspase-3-dependent CLL cell apoptosis, which was not abrogated by microenvironment-derived factors that sustain leukemia cell survival. RNA-sequencing analyses revealed a dramatic EC-7072-driven reprograming of the transcriptome of CLL cells, including a wide downregulation of multiple components and targets of the BCR signaling pathway. Accordingly, we found decreased levels of phosphorylated signaling nodes downstream of the BCR. Crosslinking-mediated BCR activation antagonized CLL cell death triggered by EC-7072, increased the phosphorylation levels of the abovementioned signaling nodes and upregulated BCL2 expression, suggesting that the mithralog disrupts CLL cell viability by targeting the BCR signaling axis at multiple levels. EC-7072 exerted similar or higher antileukemic activity than that of several available CLL therapies and displayed additive or synergistic interaction with these drugs in killing CLL cells. Overall, our findings provide rationale for future investigation to test whether EC-7072 may be a potential therapeutic option for patients with CLL and other B-cell malignancies.

Apricot and other seed stones: amygdalin content and the potential to obtain antioxidant, angiotensin I converting enzyme inhibitor and hypocholesterolemic peptides

Stones from olives and Prunus genus fruits are cheap and sustainable sources of proteins and could be potential sources of bioactive peptides. The main limitation to the use of these seeds is the presence of amygdalin. This work proposes to determine amygdalin in olive and Prunus seeds and in protein isolates obtained from them. Moreover, antioxidant, angiotensin I converting enzyme (ACE) inhibitor, and hypocholesterolemic properties will be evaluated in hydrolysates obtained from these seeds. Despite some seeds contained amygdalin, all protein isolates were free of this substance. Two different procedures to obtain bioactive peptides from protein isolates were examined: gastrointestinal digestion and processing with Alcalase, Flavourzyme or Thermolysin. Higher antioxidant, ACE inhibitor and hypocholesterolemic activities were observed when proteins were processed with Alcalase, Flavourzyme or Thermolysin. The highest antioxidant and ACE inhibitor capacities were observed for the Prunus genus seed hydrolysates while the highest capacity to reduce micellar cholesterol solubility was observed for the apricot and olive seed hydrolysates.

Refractoriness to immunochemotherapy in follicular lymphoma: Predictive factors and outcome

Follicular lymphoma is characterized by a good response to immunochemotherapy (ICT). However, a small percentage of patients responds poorly to treatment and seems to have a worse outcome. This study attempted to identify the predictive factors and outcome of refractoriness to first-line ICT. All patients diagnosed with stage II to IV follicular lymphoma between 2002 and 2014 and treated with first-line ICT in 4 Spanish institutions were analyzed. Those with no response or progression or relapse within 6 months of first-line response assessment were considered ICT refractory. Three hundred forty-three patients were included (median age 58 years, 48% male), of whom 53 (15%) were ICT refractory. On multivariate analysis, high-risk follicular lymphoma international prognostic index (FLIPI) score, B symptoms, and elevated β2-microglobulin were correlated with refractoriness, and refractoriness, high-risk FLIPI score, and β2-microglobulin were correlated with overall survival (OS). Compared with ICT-sensitive, ICT-refractory patients had a higher incidence of histological transformation (5-year cumulative incidence 25% [14%-39%] vs. 6% [3%-10%], P < .001), a higher rate of refractoriness to second-line therapy (16/33 [48%] vs. 13/57 [23%], P = .01), and a lower OS (5-year OS probability 38% [95% CI 23%-53%] vs. 87% [82%-92%%], P < .001). In conclusion, refractoriness to ICT was seen in 15% of patients and was predicted by high-FLIPI scores, B symptoms, and elevated serum β2-micrglobulin. Immunochemotherapy-refractory patients had a worse prognosis than ICT-sensitive patients, and current treatment options for this subgroup are not satisfactory.

The effects of parity, litter size, physiological state, and milking frequency on the metabolic profile of Lacaune dairy ewes

Effects of parity (primiparous, PRIM vs multiparous, MULT) and litter size (singletons, SING vs twins, TWIN) on metabolic profiles from 1 wk before lambing to the end of lactation were studied in 48 Lacaune dairy ewes reared in confinement during most of the year and grazed on improved pastures at the end of lactation (summer). Another group of 48 ewes was incorporated during the milking period (ie, from 1 wk after weaning), to measure the effects of milking frequency (1 vs 2 milkings per day) on intake, milk production and composition, and body energy usage. Thus, in a 2 × 2 × 2 factorial design, ewes (n = 96) were allocated to homogeneous groups according to body weight (BW) and body condition score (BCS) and were monitored from late pregnancy to late lactation as a function of parity (PRIM, n = 48; MULT, n = 48), litter size (LSi) (SING, n = 40; TWIN, n = 56) and daily milking frequency (FREQ; milked once, ONE; n = 48; or twice, TWO; n = 48). Individual BW, BCS, plasma metabolites, and metabolic hormones were measured regularly (ie, 9 consecutive sampling dates). The BW was higher in MULT but no differences because of LSi or FREQ were detected at the intra-parity group level. The BCS was higher in MULT and in ewes with SING throughout the experiment. The latter was related to the demands for body reserves mobilization, as expressed by higher nonesterified fatty acids and β-hydroxybutyrate concentrations in ewes with TWIN from late pregnancy to weaning (35 d postpartum) in both PRIM and MULT ewes. This was consistent with higher insulin in MULT and higher triiodothyronine, leptin and insulin-like growth factor 1 in ewes with SING during this period. Differences in energy balance because of FREQ were evident after interpretation of plasma nonesterified fatty acids, glucose, insulin, and leptin concentration during the milking period. At similar feed intakes, ewes in ONE were in positive balance with regard to TWO. Overall, clear effects of parity, LSi, physiological states, and FREQ on metabolic profiles were found because of differences in nutrient partitioning when combining these experimental factors. Without considering FREQ, changes in metabolic measures in milking period were marginal compared with the periparturient adjustments performed until weaning to compensate energy deficiencies.

Circannual body reserve dynamics and metabolic profile changes in Romane ewes grazing on rangelands

Throughout an entire year, 41 Romane ewes reared in an extensive rangeland were used to investigate temporal changes in body reserves (BRs) and profiles of related metabolites and metabolic hormones. Ewes were allocated to homogeneous groups according to BW and BCS and were distributed by parity (primiparous [PRIM], n = 21; multiparous [MULT], n = 20) and litter size (LSi; lambing singletons [SING], n = 21 or TWINS, n = 20). The feeding system was based on rotational grazing of rangeland paddocks and progressive supplementation with hay, silage, and barley at late pregnancy during the winter. Individual BW, BCS, plasma NEFA, β-hydroxybutyrate (β-OHB), glucose, insulin, leptin, and triiodothyronine (T3) were monitored at -56, -12, 8, 49, 76, 107, 156, 195, 216, 246, and 301 d relative to lambing. The BR mobilization was observed from late pregnancy to the end of suckling and varied as a function of the ewe energy balance but also because of transitions from fertilized to native rangeland paddocks and by supplementation. Contrarily, BR accretion occurred from weaning, during the dry-off, and until the start of the next pregnancy. Lipolysis was well reflected by NEFA, β-OHB, and T3 kinetics. Mean BW (but not mean BCS) was affected by parity (MULT > PRIM), whereas both BW and BCS were influenced by LSi (SING > TWINS) but only for MULT. The most drastic BW loss was observed during the mid-suckling period (49 d in milk [DIM]) in all ewes. The lack of effects of LSi in PRIM but not in MULT was also evident in the majority of blood plasma kinetics, which were affected (P < 0.0001) by physiological stage in all ewes. A tendency to ketosis (β-OHB) was found in ewes nursing TWINS around lambing, irrespective of parity. Glucose concentrations were greater during suckling and dry-off, and a peak (0.96 ± 0.05 g/L) was attained at 156 DIM in MULT nursing TWINS. The highest plasma leptin concentration was observed during the start and the middle of the next pregnancy in MULT (107-216 DIM; 9.6 ± 0.44 ng/mL). In all ewes the physiological stage affected T3, which was affected by LSi just in MULT (from late pregnancy, MULT by SING > MULT by TWINS; 99.91 vs 85.52 ng/dL) and during suckling (111.7 ± 4.18 ng/dL). Lamb BW was affected at birth and weaning by parity (MULT > PRIM) and LSi (SING > TWINS). Overall, temporal changes in BR were directly affected by the transition of physiological states and feeding levels, whereas individual responses were predetermined by parity. In MULT, the reactivity and magnitude of response was influenced by LSi. The whole set of parameters allowed us to detect sensitive and critical periods throughout the entire annual cycle. We thus identified opportunities for improved nutritional management, for example, during physiological states usually underestimated such as early and mid-pregnancy. This work indicates the applicability of long-term studies about BR dynamics in ruminants as a potential component contributing to farm economic resilience.

Effects of single or trickle Haemonchus contortus experimental infection on digestibility and host responses of naïve Creole kids reared indoor

The objective of this study was to compare the effects of the type of Haemonchus contortus experimental infection (trickle infection, TI versus single infection, SI) on feed intake, nutrients digestibility, parasitological and haematological measures, and plasma leptin in Creole kids. The animals were infected over 2 periods (challenge 1 and challenge 2) of 6 weeks each, corresponding respectively to the primary and the secondary infection. Periods prior infection (1 week each) were considered as controls. The primary infection was realized with 35 Creole kids (18.40±3.76 kg BW) housed in individual boxes and fed a hay-based diet. The secondary infection continued with 29 kids (21.90±3.40 kg BW) from the initial 35. A total of 6 kids and 8 kids were slaughtered for measuring nematode burden at the end of the primary and the secondary infection, respectively. Measurements of nutrients digestibility were made at 0, 3 and 5 weeks post-infection for both challenges. Faecal egg count (FEC), blood eosinophilia and packed cell volume (PCV) were monitored weekly. Feed intake (dry matter intake, DMI) and nutrients digestibility were negatively affected by H. contortus infection only during the primary infection. Plasma leptin changed significantly over time (P=0.0002) but was not affected by the infection type. Effect of infection type was observed only on crude protein digestibility during the primary infection, which was lower in the TI group (P<0.01). The overall level of blood eosinophilia was significantly higher in the TI group (P<0.0001) during both challenges. The overall FEC mean was significantly higher in the SI compared with the TI groups, during both challenges (P<0.02). These results were related to the mean female length significantly higher in the SI group compared with the TI group during challenge 1 (P=0.004), and the number of adult nematode significantly lower in the TI group compared with the SI group during the challenge 2 (P=0.05). The results showed that the response of Creole kids to H. contortus experimental infection was in part dependent on the type of experimental infection. Our data suggest that plasma leptin would not be involved in the response of Creole kids against H. contortus infection, as no relationship between its plasma level and the transient reduction in voluntary feed intake observed in both groups during the primary infection was observed.

Substitution of corn and soybean with green banana fruits and Gliricidia sepium forage in sheep fed hay-based diets: effects on intake, digestion and growth

This study aimed to evaluate the substitution of imported corn and soybean by local feed resources from tropical production settings such as entire green banana and Gliricidia sepium forage as energy and protein sources, respectively, in sheep diets. Two experiments were conducted: first, a 'growth trial' and second, an in vivo digestion study. In the 'growth trial', 40 Martinik lambs [body weight (BW): 29.4 +/- 3.6 kg; 6 months old) were used and distributed into four groups of 10 lambs each according to treatment: HBGl (banana + gliricidia at low level; 1500 g/day; 119 g/kg BW(0.75)), HBGh (banana + gliricidia at high level; 3000 g/day; 238 g/kg BW(0.75)), HBS (banana + soybean cake) and Control (corn + soybean cake). In digestion trial, four Martinik rams (BW: 57.2 +/- 3.45 kg) fitted with ruminal and duodenal cannulae were used; treatments (HBG, HBS and Control) were similar but adjusted to metabolic body weight (MW) and just one level of gliricidia was used. Intake, average daily gain (ADG), feed intake to gain index (F:G), apparent total and ruminal digestibilities as well as nitrogen balance, microbial efficiency and volatile fatty acid (VFA) profile were monitored. Lambs fed HBGh had greater dry matter (DM) intake based on MW and ADG (173 g/day vs. 141 g/day; p < 0.001), whereas HBGl lambs showed the lowest ADG (71.5 g/day) and the worst F:G (14.4; p < 0.001). The DM, organic matter (OM), neutral detergent fibre and acid detergent fibre digestibilities were not influenced by treatment, whereas crude protein digestibility was higher (p = 0.024) in diets offered banana or corn + soybean cake (687 g/kg DM and 658 g/kg DM, respectively). Ruminal DM and OM digestibilities did not differ among treatments. Total or individual VFA concentrations were also not influenced by the diet. Higher (p = 0.006) ruminal fluid pH values were recorded for diets combining banana and gliricidia (6.54) or banana and soybean (6.39) until 3 h after a meal. As all animals on gliricidia- and banana-supplemented diets gained weight and maintained a positive N balance, it is concluded that green banana and gliricidia forage may be a viable alternative to replace conventional energy and protein supplements in sheep diets.

[Functional recovery in hemifacial transplants in rats]

INTRODUCTION

There are a number of different options open to the surgeon for the reconstruction of the face and scalp, but when tissue loss is very extensive, good aesthetic and functional recovery is not possible. Not only must the damaged tissues be replaced, but motor and sensorial functioning also has to be restored.

AIM

To evaluate the functional recovery of hemifacial allografts in rats.

MATERIALS AND METHODS

Twenty-one hemifacial flaps were transplanted from Long-Evans rats to Wistar-Lewis rats, under immunosuppression monotherapy with tacrolimus. Prior to the operation, anatomical and allograft viability studies were conducted. Two groups of transplanted rats were formed: with or without nerve repair. In the nerve repair group, end-to-end suture was employed to repair the infraorbital branch of the trigeminal nerve and the buccolabial, upper mandibular marginal and zygomatico-orbital branches of the facial nerve. Sensory recovery was evaluated by filming traction of the whiskers, whereas motor recovery was assessed by blind tests using electromyography studies of the mystacial muscles and electroneurography of the facial nerve. At eight weeks, the animals were sacrificed and biopsy samples were taken from the mystacial region.

RESULTS

The facial flap was successfully lifted in 10 cases. In the nerve repair group both clinical and electrophysiological recovery were observed at six weeks, whereas biopsy samples taken in the eighth week showed recovery of the nerve fascicles.

CONCLUSIONS

The hemifacial flap can be transplanted. By repairing the nerves of the allograft, it is possible to achieve its functional recovery, as can be confirmed clinically, electrophysiologically and histopathologically. To date, this is the first evidence of functional recovery following a hemifacial transplant in rats.

[The use of evoked potentials in the follow-up and prognosis of patients in coma following severe traumatic brain injury]

INTRODUCTION

When dealing with patients in coma, it can be very useful to have early access to objective tests that provide information about their clinical status and can help to establish a prognosis for survival and functional recovery. The value of evoked potentials (EP) in such cases is already well known, although only techniques that assess the neurological status have been used.

AIM

To determine the usefulness of different types of evoked potentials as a means of reaching a short and medium term prognosis for survival and functional recovery in patients in coma as a result of traumatic brain injury (TBI).

PATIENTS AND METHODS

Our study involved patients with an admission Glasgow coma score of 8 or below due to severe TBI. During the first 24 hours the following tests were carried out on patients: somatosensory EP (SSEP), brainstem auditory EP, visual EP (VEP) obtained using stimulation goggles and mismatch negativity, as well as an imaging test (computerised axial tomography). The tests were repeated at one week and one month, and each patient was evaluated by means of the Glasgow scale and the Karnofsky scale.

RESULTS

We studied 22 patients (mean age: 39.95 years; interval: 15-84 years), 20 of them were males. The highest number of deaths occurred during the first week. There was a strong correlation between survival and the results from the SSEP and VEP.

CONCLUSIONS

SSEP and VEP performed on admission were a valuable aid for reaching a short and medium term prognosis for survival of patients in coma due to TBI, although they were not effective in evaluating a prognosis for functional recovery.

Surgery in haemophilic patients with inhibitor: 20 years of experience

Surgery in haemophilic patients with inhibitor against factor (F)VIII or FIX is high risk. Surgery may be performed with the administration of sufficiently high dose of FVIII in patients with low-response inhibitor or who, despite having a high response, present a low inhibitor titre at the time of surgery. The use of high doses of FX is more complicated in patients with a low-titre FIX inhibitor, as there is a high risk of anaphylactic reactions. In the case of patients with high-titre inhibitors, several treatments have been proposed, such as porcine FVIII, recombinant FVIIa (rFVIIa), and activated prothrombin complex concentrate (APCC). We present our 20 years' experience in the treatment and subsequent management of haemophilic patients with inhibitor in surgery and evaluate the results obtained with the products available for haemostatic control in 64 surgical procedures. The efficacy we obtained with FVIII is good in 100% of the cases described; we had no haemorrhagic complication (HC) in the 18 procedures in which it was used (three major and 15 minor surgery). With APCC we obtained excellent results with only one HC in a synoviorthesis in the form of bleeding and haematomas out of 32 procedures. Good results were obtained with rFVIIa with few haemorrhagic episodes. Thus, in major surgery there was one HC out of three cases. In minor surgery, greater efficacy was observed using extremely large doses of rFVIIa (> or =120 mg kg(-1) 2 h(-1)) because of the shorter half-life of this factor in this type of patients.