Qualidade da silagem de grãos de milho com adição de soja crua e parâmetros de digestibilidade parcial e total em bovinos / Quality of high moisture corn grain silage with addition of raw soybean grains and parameters of partial and total digestibility in cattle

Avaliou-se a qualidade da silagem de grãos úmidos de milho com adição de soja crua, por meio de medidas de digestibilidade parcial e total em bovinos. Foram utilizados três animais mestiços Nelore x Red Angus, implantados com cânulas ruminal e duodenal. O delineamento experimental foi o quadrado latino 3x3, com os seguintes tratamentos: SGM66= 60 por cento de volumoso, 26,6 por cento de silagem de grãos de milho e 13,4 por cento de farelo de soja e milho moído; SGM33= 60 por cento de volumoso, 13,4 por cento de silagem de grãos de milho e 26,6 por cento de farelo de soja e milho moído, e GMS= 60 por cento de volumoso e 40 por cento de farelo de soja e milho moído. A digestão e a digestibilidade da matéria seca não foram influenciadas pela inclusão de SGM na dieta. A dieta SGM66 aumentou a digestibilidade de matéria seca no intestino em relação à dieta GMS. Não houve efeito da inclusão da silagem de grãos na digestão e na digestibilidade das frações fibra em detergente ácido e fibra em detergente neutro da ração, bem como no fluxo ruminal e intestinal do amido. A SGM66 melhorou a digestibilidade total da proteína bruta, mas não mostrou efeito sobre a digestibilidade total da matéria seca, da fibra e do amido e sobre o ambiente ruminal no que se refere à acidez e à concentração de amônia.

The quality of high moisture corn grain silage with addition of raw soybean grains was evaluated by measures of partial and total digestibilities in cattle. Three crossbred Nelore x Red Angus steers averaging 305kg of live weigth and fitted with ruminal and duodenal cannulas were used. The experimental design was a 3x3 Latin square, and the steers received the following treatments: HMGS66 = 60 percent roughage, 26.6 percent high moisture grain silage, and 13.4 percent soybean meal and ground corn; HMGS33 = 60 percent roughage, 13.4 percent high moisture grain silage, and 26.6 percent soybean meal and ground corn; and GC = 60 percent roughage and 40 percent soybean meal and ground corn. The digestion and digestibility of dry matter was not influenced by the inclusion of HMGS in the diet. HMGS66 increased intestinal dry matter digestibility in relation to GC. The inclusion of high moisture corn grain silage did not affect acid detergent fiber and neutral detergent fiber digestions and digestibilities. The diet did not affect total intake of starch, as well ruminal and intestinal flow of starch. HMGS66 improved total digestibility of crude protein, but did not show effect on total digestibilities of dry matter, fiber, starch, and pH and ammonia concentration in the rumen.

Intracranial haemorrhage in patients on antithrombotics: clinical presentation and determinants of outcome in a prospective multicentric study in Italian emergency departments.

BACKGROUND: Intracranial haemorrhage (ICH) is the type of stroke associated with the highest death rate, and about 30% of ICH occurs in patients on antithrombotic treatment. This study relates clinical presentations and outcome of ICH patients on oral anticoagulant (OA) or antiplatelet (AP) therapy admitted to 33 Italian emergency departments (ED). METHODS: Consecutive patients were enrolled after cranial computed tomography (CT). Primary outcome was the Modified Rankin Scale (MRS) score at 3 months of follow-up. Common descriptive statistics were computed after stratification for traumatic or spontaneous ICH and identification of the anatomical location of bleeding. Multivariate logistic regression was used to assess predictors of death. RESULTS: We recruited 434 patients on AP therapy and 232 on OA. There were 432 spontaneous and 234 traumatic ICH patients. The proportions of AP and OA patients undergoing neurosurgery were 21.8 and 19.4%, respectively, while < 30% underwent procoagulant medical treatment. At the 3-month follow-up, the case fatality rate was 42.0%, while disability or death (MRS 3-6) was 68.1%. The odds ratio for death in OA versus AP patients was 2.63 (95% CI 1.73-4.00) in the whole population and 2.80 (95% CI 1.77-4.41) in intraparenchymal event patients. Glasgow Coma Scale, age, spontaneous event and anticoagulant use were found to be predictors of death both in traumatic and spontaneous events. CONCLUSION: This study confirms the high prevalence of death or disability in OA and AP patients with ICH. As far as the determinants of mortality and disability are concerned, the results of this study might be useful in the clinical management and allocation of resources in the ED setting. The observed low use of procoagulant therapy highlights the need for ED educational programmes to heighten the awareness of available and effective haemostatic treatments.

Non-invasive ventilation as a first-line treatment for acute respiratory failure: "real life" experience in the emergency department.

OBJECTIVE: To describe our experience with non-invasive ventilation (NIV) for patients with acute respiratory failure (ARF) in the emergency department (ED). METHODS: A prospective/retrospective, observational study on 190 patients with ARF (mean +/-SD age 72.2+/-12.9 years, mean APACHE II score 18.9+/-5.9), who received 200 NIV trials in an ED. We analysed the NIV register data (prospectively collected) and medical records (retrospective data abstraction) and evaluated clinical indications for NIV, patient outcomes, and predictive factors for success and death. NIV success was defined as tolerance of the procedure and no need for endotracheal intubation (ETI). RESULTS: Main indications to NIV were cardiogenic pulmonary oedema (CPE) (70 trials), acute exacerbation of COPD (39), both CPE and acute exacerbation of COPD (11), pneumonia (48), decompensation of obesity/hypoventilation (6), other conditions (26). The procedure was successful in 60.5% of trials. Global mortality was 34.5%, similar to the APACHE II predicted mortality of 32%. ETI rates were 6.5% and tracheostomy rates 1%. The improvement of pH within six hours after NIV initiation was predictive of survival in the hypercapnic group. CONCLUSIONS: Our results confirm the global efficacy of NIV in an ED setting, and show that, in spite of lower success rate in "real practice" in comparison with RCTs, an intermediate care unit can represent an appropriate and less expensive setting to perform this technique. The low rate of ETI seems to be because of the high number of patients for whom NIV was used as "ceiling" treatment.

Obese patients with obstructive sleep apnoea syndrome show a peculiar alteration of the corticotroph but not of the thyrotroph and lactotroph function.

OBJECTIVE: Obstructive sleep apnoea syndrome (OSAS) is strongly associated with obesity (OB) and is characterized by several changes in endocrine functions, e.g. GH/IGF-I axis, adrenal and thyroid activity. It is still unclear whether these alterations simply reflect overweight or include peculiar hypoxia-induced hormonal alterations. Hormonal evaluations have been generally performed in basal conditions but we have recently reported that OSAS is characterized by a more severe reduction of the GH releasable pool in comparison to simple obesity. We aimed to extend our evaluation of anterior pituitary function to corticotroph, thyrotroph and lactotroph secretion under dynamic testing in OSAS in comparison with simply obese and normal subjects. SUBJECTS AND METHODS: In 15 male patients with OSAS [age, mean +/- SEM 43.5 +/- 1.6 years; body mass index (BMI) 39.2 +/- 3.1 kg/m2; apnoea/hypopnoea index, (AHI) 53.4 +/- 8.7], 15 male patients with simple obesity (OB, age 39.7 +/- 1.2 years; BMI 41.2 +/- 2.0 kg/m2; AHI 3.1 +/- 1.2 events/h of sleep) and in 15 normal lean male subjects (NS, age 38.2 +/- 1.4 years; BMI 21.2 +/- 0.8 kg/m2; AHI 1.9 +/- 0.8 events/h of sleep) we evaluated: (a) the ACTH and cortisol responses to CRH [2 microg/kg intravenously (i.v.)] and basal 24 h UFC levels; (b) the TSH and PRL responses to TRH (5 microg/kg iv) as well as FT3 and FT4 levels. RESULTS: Twenty-four-hour UFC levels in OSAS and OB were similar and within the normal range. Basal ACTH and cortisol levels were similar in all groups. However, the ACTH response to CRH in OSAS (Deltapeak: 30.3 +/- 3.8 pmol/l; DeltaAUC: 682.8 +/- 128.4 pmol*h/l) was markedly higher (P < 0.001) than in OB (Deltapeak: 9.3 +/- 1.4 pmol/l; DeltaAUC 471.5 +/- 97.3 pmol*h/l), which, in turn, was higher (P < 0.05) than in NS (Deltapeak: 3.3 +/- 0.9 pmol/l; DeltaAUC 94.7 +/- 76.7 pmol*h/l). On the other hand, the cortisol response to CRH was not significantly different in the three groups. Basal FT3 and FT4 levels as well as the TSH response to TRH were similar in all groups. Similarly, both basal PRL levels and the PRL response to TRH were similar in the three groups. CONCLUSIONS: With respect to patients with simple abdominal obesity, obese patients with OSAS show a more remarkable enhancement of the ACTH response to CRH but a preserved TSH and PRL responsiveness to TRH. These findings indicate the existence of a peculiarly exaggerated ACTH hyper-responsiveness to CRH that would reflect hypoxia- and/or sleep-induced alterations of the neural control of corticotroph function; this further alteration is coupled to the previously described, peculiar reduction of somatotroph function.

Concomitant impairment of growth hormone secretion and peripheral sensitivity in obese patients with obstructive sleep apnea syndrome.

To clarify the impairment of the GH/IGF-I axis in obstructive sleep apnea syndrome (OSAS), in 13 adult male patients with OSAS (OSA) as well as 15 weight-matched patients with simple obesity (OB) and 10 normal lean male subjects (NS), we studied: 1) the GH response to GHRH (1 micro g/kg iv) plus arginine (30 g iv); and 2) the IGF-I and IGF binding protein-3 responses to a very low dose recombinant human (rh)GH treatment (5.0 microg/kg sc per day for 4 d). The GH response to arginine plus GHRH in OSA was lower than in OB (P < 0.05), which in turn was lower than in NS (P < 0.001). Basal IGF-I levels in OSA were lower than in OB (P < 0.05), which in turn were lower than in NS (P < 0.03). As opposed to OB and NS, in OSA a very low rhGH dose did not affect IGF-I. Adjusting for age and basal values, rhGH-induced IGF-I rise in OSA was lower than in OB (P < 0.01). IGF binding protein-3, glucose, and insulin levels in the three groups were not modified by rhGH. OSA show a more marked impairment of the maximal secretory capacity of somatotroph cells together with reduced IGF-I sensitivity to rhGH stimulation. These findings suggest that OSAS is connoted by a concomitant impairment of GH secretion and sensitivity.

Infection by Helicobacter pylori and acute myocardial infarction. Do cytotoxic strains make a difference?

The classical risk factors for acute myocardial infarction (AMI) fail to explain all the epidemiological variations of the disease. Among the risk factors recently reported, several infectious agents appear to increase the risk of AMI. Helicobacter pylori (H. pylori) infection, a bacterium involved in duodenal and gastric ulcer, gastric cancer and MALT-lymphoma, seems to be strongly associated with AMI. More virulent (anti-CagA positive) strains of the bacterium are almost exclusively the causative agents of such diseases. To determine the prevalence of H. pylori infection and of virulent strains, a case-control study was conducted in a group of male patients with AMI. A group of patients consecutively admitted to the Emergency Care Unit served as controls. We studied 223 consecutive male patients, mean age 60.2 (range 40-79) years, admitted for AMI to the Coronary Care Units at Hospitals in two towns of Northern Italy, 223 age matched male patients (mean age 61.8, range 40-79 years) admitted to the Emergency Care Unit, served as control. H. pylori seroprevalence was assessed by presence of antibodies (IgG) against H. pylori and anti-CagA in circulation. Among the patients we investigated the presence of hypertension, levels of cholesterol and glucose in serum, fibrinogen in plasma and smoking habits. H. pylori infection was present in 189/223 (84.7%) of the patients and in 138/223 (61.8%) of the control population (p < 0.0001 OR 3.42 [IC 95% 2.12-5.54]). The anti-CagA antibodies were detected in 33.8% of infected patients with AMI (64/189) versus 26.8% in the control subjects (37/138) (p:0.17, OR 1.40 [IC 95% 0.84-2.33]). Classical risk factors for AMI did not differ among patients with and without H. pylori infection. Patients admitted to the Coronary Care Unit for acute myocardial infarction had a notably higher prevalence of anti-H. pylori not restricted to virulent strains, when compared to a population of patients referred to the Emergency Care Unit. The classical risk factors for coronary disease were present in the patients with AMI irrespective of H. pylori status.

Accuracy and limitations of continuous oesophageal aortic blood flow measurement during general anaesthesia for children: comparison with transcutaneous echography-Doppler.

BACKGROUND: Because it is noninvasive and easy to use, oesophageal Doppler ultrasonography appears to be a worthwhile alternative for continuous assessment of cardiac output measurement during anaesthesia. A new oesophageal Doppler-echography device (Dynemo 3000, Sometec, Paris, France) can simultaneously determine aortic diameter and aortic blood flow at the same anatomical level (DEeso). The purpose of this study was to assess the accuracy and the potential limitations of this device during general anaesthesia among 20 children, using transcutaneous Doppler-echocardiography for comparison (DEtra). METHODS: The reproducibility of paired measurements of mean aortic blood flow velocity (MAFV), aortic diameter (ØAo) and aortic blood flow (ABF) was analysed with both methods. Second, haemodynamic values were measured simultaneously in a blinded manner by both methods before and after surgery. RESULTS: The percent change (%Delta) in MAFV and ABF was calculated with both methods for each child. The age and weight of children included in this study was 8.3 +/- 2.5 years and 27 +/- 8 kg, respectively. Intraoperator reproducibility of MAFVtra, ABFtra, MAFVeso and ABFeso, was 5.0 +/- 4.1%, 7.0 +/- 5.6%, 20.1 +/- 17.5% and 22.0 +/- 16.6%, respectively. ABFtra was significantly linked to ABFeso (R=0.55, P < 0.01). Bias +/- SD of ABF measurements between both methods was 2.2 +/- 1.1 l. min-1. %DeltaABFtra was significantly linked to %DeltaABFeso (R=0.62, P < 0.01). The bias +/- SD inherent to %DeltaABF measurements with both methods was -0.02 +/- 18%. CONCLUSION: These results suggest that this new oesophageal Doppler method is unsuitable to measure accurately absolute CO values and relative CO changes in children during anaesthesia.

Emergency medicine: the Italian experience.

The Italian health care system is largely socialized, with priorities and policies established both nationally and regionally. Currently emergency medicine in Italy is practiced mainly by traditional specialists, such as internists and surgeons, and the scope of emergency medicine practice is not as broad as that seen in the United States. However, dedicated training programs in emergency medicine have recently been developed, and it appears that in the future, specially trained emergency physicians will be increasingly available. Emergency medicine is currently viewed as a sub-specialty of internal medicine, and it is unclear whether emergency medicine will be recognized as an independent specialty.

Formation of emergency medicine in Italy.

In Italy departments of emergency medicine and emergency medical service systems (EMS) were first set up at the end of the 1970s. Since that time many dramatic and significant changes have taken place in the care of the critically ill patient. In Italy the interest in emergency problems and the need for emergency intervention have increased considerably. Nevertheless several problems still have to be solved in order to obtain a standardized organization of the emergency system in Italy and uniform training of emergency care providers.

Circadian blood pressure levels in normotensive normoalbuminuric type 1 diabetic patients.

Increase in blood pressure and its circadian alterations in Type 1 diabetes are usually associated with diabetic nephropathy. To evaluate if diabetes itself could be responsible for the observed increase in blood pressure levels, we studied a group of 17 normotensive, normoalbuminuric Type 1 diabetic patients with a disease duration more than 15 years, with no clinical evidence of autonomic neuropathy or ischaemic heart disease, and without any known determinant of hypertension, and a control group of 17 normal subjects, normotensive, each matched for sex, age, BMI, albumin excretion rate, and clinical blood pressure to a diabetic subject. In both groups an ambulatory blood pressure monitoring was performed through an oscillometric recorder. The mean systolic and diastolic ambulatory blood pressure values were significantly higher in diabetic patients (p < 0.001) in the 24-h analysis and during waking and sleeping periods. The night/day ratio of systolic and diastolic blood pressure were not significantly different in patients and controls, as well as heart rate values and heart rate variability. We conclude that mechanism(s) inherent to the diabetic condition other than diabetic nephropathy or autonomic neuropathy could be responsible for blood pressure evaluation in normotensive Type 1 diabetes with normoalbuminuria.

[Therapeutic possibilities in idiopathic headaches. Analysis of about 1000 cases]. / Possibilità terapeutiche per le cefalee idiopatiche. Analisi di circa 1000 casi

This work is an attempt to find an answer to the question: once arrived at the diagnostic identification of a certain type of idiopathic headache, which treatment should be followed? On the basis of recent researches and experience acquired during ten years' activity of our Headache Unit, a diagnostic identification can be made for migraine (in all its types and evolution stages), cluster headache, tension headache and pure psycogenic headache. Among the most widely used drugs, positive pharmacological results were obtained with: cyproheptadine, pizotifen, cinnarizine, lysergic acid derivatives, histamine, reserpine, clonidine and a barbituric acid derivative. The therapeutic cycles were standardized, for each drug, in the way of administration, dosage and total duration of the treatment. A comparison between the data obtained and the pre-therapeutic situation was made. When repeated, the most efficacious therapeutic cycle was evaluated. According to Pearson's dispersion index, each group of patients improved respresents 16.68% of the expected total results (frequency of attacks reduced to 50%, 25% and 0%): for cyproheptadine, pizotifen, methysergide, histamine, clonidine and allil-propyl-malonylurea, the "p" is less than 0.001; for cinnarizine, less than 0.02. This "a posteriori" analysis does not take into account the placebo control, the "anticipation effect", and the "carry over effect". It cannot therefore be a comparison of efficacy among the various drugs. An evaluation based on "among patients" and "inside patient" method by means of the cross over system, can instead give some useful suggestion about which treatment is to be recommended to patients suffering from recurrent headaches. With regard to migraine sufferers: cinnarizine, cyproheptadine, clonidine, histamine, pizotifen und reserpine. For cluster headaches: cinnarizine, cyproheptadine, clonidine, histamine and reserpine. For tension headaches: cyproheptadine. For pure psychogenic headache: allyl-propyl-malonylurea. For migraine attacks or parossystic crises in the course of ondulating or continuous headaches, positive therapeutic results, statistically significant, were obtained with an association of indomethacin, caffeine and prochlorperazine.

[Therapeutic possibilities in idiopathic headaches. Analysis of 1000 cases (author's transl)]. / Therapeutische Möglichkeiten bei idiopathischen Kopfschmerzen. Analyse von 1000 Fällen

According to Pearson's method (correlation coefficient) the group of improved patients is 16.88% of the expected total result (frequency of attacks regressed to 50%, 25% or 0%): for cyproheptadine, pizotifene, methysergide, methergoline, histamine, clonidine, allylpropylmalonyl urea 'p' is less than 0.001, for cinnarizine less than 0.02. For hemicrania we used cinnarizine, cyproheptadine, clonidine, histamine, pizotifene and reserpine; for cluster headache, cinnarizine, cyproheptadine, clonidine, histamine and reserpine; for tension headache, cyproheptadine; for psychogenic headache, allylpropylmalonylurea. In attacks of hemicrania or paroxysmal crises with undulant headache or persistent headache, positive statistically significant results were obtained with a combination of indomethacin, prochlorperazine and caffeine.