Does personality dysfunction add incremental utility over general psychopathology when modeling previous suicide attempts in adolescent patients?

BACKGROUND: Identifying patients at risk for a suicide attempt (SA) is critical in adolescents with mental disorders. The current study aimed to 1) examine whether personality dysfunction (PD) is associated with previous SA, 2) explore the incremental utility of PD over psychiatric disorders in modeling previous SA. METHODS: The sample comprised of n = 498 adolescent patients (mean age = 15.41 years, 79.12 % females, inpatient 48.8 %, outpatient 51.2 %). SA in the past year, PD according to the alternative DSM-5 model for personality disorders, and psychiatric diagnoses were assessed using semi-structured interviews. Logistic regression and principal component analysis examining the associations and specific patterns of PD and SA in the past year were conducted. Hierarchical (stepwise) logistic regression was applied to investigate the incremental utility of PD over that of psychiatric diagnoses to identify individuals with SA in the past year. RESULTS: Including all facets of PD revealed a significant model with SA in the past year as outcome (χ2(12) = 106.65, McFaddens Pseudo-R2 = 0.17, p < 0.01). Adding PD to the model explained a significant amount of variance in past SA over that of psychiatric diagnoses (Pseudo-R2 = 0.18, Wald χ2 = 43.05, p < 0.01). LIMITATIONS: As we only studied past SA and due to the cross-sectional design, no conclusion regarding the prediction of future SA can be drawn. DISCUSSION: PD should routinely be assessed in adolescent patients since individuals with PD are more likely to have attempted suicide even when controlling for comorbid psychiatric disorders. PD may represent an important target for intervention in those with suicidal thoughts and behaviors.

Three-dimensional imaging to estimate in vivo body and carcass chemical composition of growing beef-on-dairy crossbred bulls.

The dynamics of cattle body chemical composition during growth and fattening periods determine animal performance and beef carcass quality. The aim of this study was to estimate the empty body (EB) and carcass chemical composition of growing beef-on-dairy crossbred bulls (Brown Swiss breed as dam with Angus, Limousin or Simmental as sire) using three-dimensional (3D) imaging. The 3D images of the cattle's external body shape were recorded in vivo on 48 bulls along growth trajectory (75-520 kg BW and 34-306 kg hot carcass weight [HCW]; set 1) and on 70 bulls at target market slaughter weight, including 18 animals from set 1 (average 517 ± 10 kg BW and 289 ± 10 kg HCW; set 2). The linear, circumference, curve, surface and volume measurements on the 3D body shape were determined. Those predictive variables were used in partial least square regressions, together with the effect of the sire breed whenever significant (P < 0.05), with leave-one-out cross-validation to estimate water, lipid, protein, mineral and energy mass or proportions in the EB and carcass. Mass and proportions were determined directly from postmortem grinding and chemical analyses (set 1) or indirectly using the 11th rib dissection method (set 2). In set 1, bulls' BW and HCW were estimated via 3D imaging, with root mean square error of prediction (RMSEP) of 12 kg and 6 kg, respectively. The EB and carcass chemical component proportions were estimated with RMSEP from 0.2% for EB minerals (observed mean 3.7 ± 0.2%) to 1.8% for EB lipid (11.6 ± 4.2%), close to the RMSEP found for the carcass. In set 2, the RMSEP for estimation via 3D imaging was 9 kg for BW and 6 kg for HCW. The EB energy and protein proportions were estimated, with RMSEP of 0.5 MJ/kg fresh matter (10.1 ± 0.8 MJ/DM) and 0.2% (18.7 ± 0.7%), respectively. Overall, the estimations of chemical component proportions from 3D imaging were slightly less precise for both sets than the mass estimations. The morphological traits from the 3D images appeared to be precise estimators of BW, HCW as well as EB and carcass chemical component masses and proportions.

An ecological momentary assessment study of age effects on perceptive and non-perceptive clinical high-risk symptoms of psychosis.

Among individuals with clinical high risk for psychosis (CHR), perceptive symptoms are more frequent but have less clinical significance in children/adolescents compared to adults. However, findings are based on clinical interviews relying on patient's recall capacity. Ecological momentary assessment (EMA) can be used to explore experiences in real-time in the subject's daily life. The aim of this study was to assess frequency and stability of (perceptive and non-perceptive) CHR symptoms and to explore potential age effects. EMA was used in a sample of an early detection for psychosis service in Bern, Switzerland (N = 66; 11-36 years). CHR symptoms were recorded in random time intervals for seven days: eight assessments per day per subject, minimum time between prompts set at 25 min. CHR symptoms were additionally assessed with semi-structured interviews including the 'Structured Interview for Psychosis-Risk Syndromes' and the 'Schizophrenia Proneness Instruments'. Mixed-effects linear regression analysis on the frequency of CHR symptoms revealed a significant effect of age group, and the interaction CHR symptoms x age group for both perceptive and non-perceptive symptoms. Further, regarding stability of CHR symptoms, there was a significant effect of the interaction CHR symptoms x age group for perceptive symptoms only. Based on EMA, perceptive CHR symptoms were more frequently reported but less stable in children/adolescents compared with adults. Together with previous findings, our finding of higher instability/variability of perceptive symptoms in younger persons might suggest that with advancing age and more stability of CHR symptoms, clinical relevance (reduced psychosocial functioning) may increase.

Diet-dependent function of the extracellular matrix proteoglycan Lumican in obesity and glucose homeostasis.

OBJECTIVE: Extracellular matrix remodeling is required for adipose expansion under increased caloric intake. In turn, inhibited expandability due to aberrant collagen deposition promotes insulin resistance and progression towards the metabolic syndrome. An emerging role for the small leucine-rich proteoglycan Lumican in metabolically driven nonalcoholic fatty liver disease sparks an interest in further understanding its role in diet-induced obesity and metabolic complications. METHODS: Whole body ablation of Lumican (Lum-/-) gene and adeno-associated virus-mediated over-expression were used in combination with control or high fat diet to assess energy balance, glucose homeostasis as well as adipose tissue health and remodeling. RESULTS: Lumican was found to be particularly enriched in the stromal cells isolated from murine gonadal white adipose tissue. Likewise murine and human visceral fat showed a robust increase in Lumican as compared to fat from the subcutaneous depot. Lumican null female mice exhibited moderately increased fat mass, decreased insulin sensitivity and increased liver triglycerides in a diet-dependent manner. These changes coincided with inflammation in adipose tissue and no overt effects in adipose expandability, i.e. adipocyte formation and hypertrophy. Lumican over-expression in visceral fat and liver resulted in improved insulin sensitivity and glucose clearance. CONCLUSIONS: These data indicate that Lumican may represent a functional link between the extracellular matrix, glucose homeostasis, and features of the metabolic syndrome.

[Extra-articular impingement of the hip : Treatment of snapping hip by lengthening of the iliotibial band]. / Extraartikuläres Weichteilimpingement am Hüftgelenk : Verlängerungsplastik des Tractus iliotibialis zur Behandlung des Traktusschnappens.

OBJECTIVE: Snapping of the iliotibial band over the greater trochanter should be eliminated by reducing tension via lengthening, release, and incision of the iliotibial band. INDICATIONS: Positive clinical examination and painful snapping of the iliotibial band over the greater trochanter, despite extensive conservative treatments, for over 6 months. CONTRAINDICATIONS: Weakness of the abductor muscles with positive Trendelenburg sign. SURGICAL TECHNIQUE: Direct approach to the iliotibial tract. The snapping of the tract over the greater trochanter can be provoked and observed in situ via internal rotation and adduction of the hip. Lengthening of the iliotibial band is performed with a tongue-shape flap technique ("Griffelschachtelplastik") directly over the greater trochanter. This leads to simultaneous release and incision over the greater trochanter. Hereafter, no snapping of the tract should be observed upon motion analysis. POSTOPERATIVE MANAGEMENT: Pain-adapted mobilization with full weightbearing, no active abduction against resistance, and no adduction over and exceeding the 0­degree level for 6 weeks. RESULTS: The snapping of the iliotibial band could be eliminated in all cases. Apart from 2 patients with previous surgery who still complain of unimproved pain, improvement of symptoms with consequent subjective satisfaction with the outcome of surgery was reported in all cases.

Mixture EMOS model for calibrating ensemble forecasts of wind speed.

Ensemble model output statistics (EMOS) is a statistical tool for post-processing forecast ensembles of weather variables obtained from multiple runs of numerical weather prediction models in order to produce calibrated predictive probability density functions. The EMOS predictive probability density function is given by a parametric distribution with parameters depending on the ensemble forecasts. We propose an EMOS model for calibrating wind speed forecasts based on weighted mixtures of truncated normal (TN) and log-normal (LN) distributions where model parameters and component weights are estimated by optimizing the values of proper scoring rules over a rolling training period. The new model is tested on wind speed forecasts of the 50 member European Centre for Medium-range Weather Forecasts ensemble, the 11 member Aire Limitée Adaptation dynamique Développement International-Hungary Ensemble Prediction System ensemble of the Hungarian Meteorological Service, and the eight-member University of Washington mesoscale ensemble, and its predictive performance is compared with that of various benchmark EMOS models based on single parametric families and combinations thereof. The results indicate improved calibration of probabilistic and accuracy of point forecasts in comparison with the raw ensemble and climatological forecasts. The mixture EMOS model significantly outperforms the TN and LN EMOS methods; moreover, it provides better calibrated forecasts than the TN-LN combination model and offers an increased flexibility while avoiding covariate selection problems.

[Arthroscopic subacromial decompression]. / Arthroskopische subakromiale Dekompression.

OBJECTIVE: Coracoacromial ligament release to widen the subacromial space, resection of the anterior undersurface of the acromion and, if needed, caudal exophytes at the acromioclavicular joint. INDICATIONS: All types of outlet impingement after 3 months of conservative treatment. CONTRAINDICATIONS: Impingement syndrome with instability/muscular imbalance, massive rotator cuff tear, unstable os acromionale, posterior-superior impingement, joint infection, freezing phase of a secondary frozen shoulder. SURGICAL TECHNIQUE: Lateral decubitus position with traction device for the arm. Diagnostic arthroscopy of the glenohumeral joint via standard portals. With arthroscope moved to the subacromial space, bursectomy, electrosurgical release of coracoacromial ligament, resection of acromial hook through standard posterior portal. POSTOPERATIVE MANAGEMENT: Physiotherapy or self-exercises on postoperative day 1, pain-adapted analgesia to avoid shoulder stiffness. RESULTS: Several studies present positive long-term results compared to conservative treatment (and open acromioplasty) for partial rotator cuff tears and for elderly patients. With a 20-year follow-up, successful results have been achieved for all patients with isolated impingement syndrome.

The scent of stress: environmental challenge in the peripartum environment of mice affects emotional behaviours of the adult offspring in a sex-specific manner.

Early adverse experiences are known to influence the risk of developing psychiatric disorders later. To shed further light on the development of laboratory mice, we systematically examined the influence of a prenatal or postnatal olfactory stressor, namely unfamiliar male mouse faeces, presented to pregnant or nursing mouse dams. Maternal and offspring behaviours were then examined. Maternal behaviours relative to controls revealed changes in nest building by the pregnant dams exposed to the unfamiliar faeces. There were no differences among groups on pup retrieval or exploration by the dams. Behavioural phenotyping of male and female offspring as adults included measures of exploration, anxiety, social and depressive-like behaviours. Additionally, serum corticosterone was assessed as a marker of physiological stress response. Group differences were dependent on the sex of the adult offspring. Males raised by dams that were stressed during pregnancy presented elevated emotionality as indicated by increased numbers of faecal boluses in the open field paradigm. Consistent with the effects of prenatal stress on the males only the prenatally stressed females had higher body weights than their respective controls. Indeed, males in both experimental groups had higher circulating corticosterone levels. By contrast, female offspring of dams exposed to the olfactory stressor after parturition were more anxious in the O-maze as indicated by increased latencies in entering the exposed areas of the maze. These findings emphasize the necessity for researchers to consider the pre- and postnatal environments, even of mice with almost identical genetic backgrounds, in designing experiments and interpreting their data.

In vivo prediction of goat kids body composition from the deuterium oxide dilution space determined by isotope-ratio mass spectrometry.

Deuterium oxide dilution space (DOS) determination is one of the most accurate methods for in vivo estimation of ruminant body composition. However, the time-consuming vacuum sublimation of blood preceding infrared spectroscopy analysis, which is traditionally used to determine deuterium oxide (DO) concentration, limits its current use. The use of isotope-ratio mass spectrometry (IRMS) to determine the deuterium enrichment and thus quantify DO in plasma could counteract this limitation by reducing the sample preparation for plasma deproteinisation through centrifugal filters. The aim of this study was to validate the DOS technique using IRMS in growing goat kids to establish in vivo prediction equations of body composition. Seventeen weaned male Alpine goat kids (8.6 wk old) received a hay-based diet supplemented with 2 types of concentrates providing medium ( = 9) or high ( = 8) energy levels. Kids were slaughtered at 14.0 ( = 1, medium-energy diet), 17.2 ( = 4, medium-energy diet, and = 4, high-energy diet), or 21.2 wk of age ( = 4, medium-energy diet, and = 4, high-energy diet). Two days before slaughter, DOS was determined after an intravenous injection of 0.2 g DO/kg body mass (BM) and the resulting study of DO dilution kinetics from 4 plasma samples (+5, +7, +29, and +31 h after injection). The deuterium enrichment was analyzed by IRMS. After slaughter, the gut contents were discarded, the empty body (EB) was minced, and EB water, lipid, protein, ash, and energy contents were measured by chemical analyses. Prediction equations for body components measured postmortem were computed from in vivo BM and DOS. The lack of postmortem variation of fat-free EB composition was confirmed (mean of 75.3% [SD 0.6] of water), and the proportion of lipids in the EB tended ( = 0.06) to be greater for the high-energy diet (13.1%) than for the medium-energy diet (11.1%). There was a close negative relationship (residual CV [rCV] = 3.9%, = 0.957) between EB water and lipid content, whereas DOS was closely related to total body water (rCV = 2.9%, = 0.944) but DOS overestimated it by 5.8%. Adding DOS to BM improved the in vivo predictions of EB lipid and energy content (rCV = 13.1% and rCV = 7.9%, respectively) but not those of protein or ash. Accuracy of the obtained prediction equations was similar to those reported in studies determining DOS by infrared spectroscopy. Therefore, the use of IRMS to quantify DOS provides a highly accurate measure of the in vivo body composition in goat kids.

[Arthroscopic release for shoulder stiffness]. / Arthroskopische Arthrolyse bei Schultersteife.

OBJECTIVE: Arthroscopic capsular release for refractory shoulder stiffness to recreate active and passive shoulder joint mobility. INDICATIONS: Adhesive capsulitis of the shoulder (primary and secondary frozen shoulder) after receiving at least 3 months of conservative treatment. CONTRAINDICATIONS: Boney-related stiffening of the shoulder joint, joint infection, freezing phase of the primary frozen shoulder and shoulder stiffness after reconstructive surgery. SURGICAL TECHNIQUE: Opening of the lower shoulder joint capsule over a gentle unidirectional manipulation under general anesthesia. A diagnostic arthroscopy in lateral position with extension of the arm is then performed. The release is completed with incision of the ventral and the dorsal part of the capsule under arthroscopic control. POSTOPERATIVE MANAGEMENT: While still in the operation room, the anesthetist places an interscalene brachial plexus catheter, thus, delivering the best possible analgesia. This enables full range of active and passive movement of the shoulder joint for at least 3 days. Outpatient continuation of physiotherapy with anti-inflammatory and analgesic medication. RESULTS: The literature shows good functional results with age- and gender-related Constant scores greater than 75 %. Our retrospective inquiry of 37 cases with a mean follow-up of 40 months confirms this outcome. The disease duration was shortened by arthroscopic release. Ability to work was achieved after a mean of 1.9 months; treatment ended 3.6 months after operation. In 10 cases with secondary shoulder stiffness, residual symptoms remained.

Rapeseed or linseed in dairy cow diets over 2 consecutive lactations: effects on adipose fatty acid profile and carry-over effects on milk fat composition in subsequent early lactation.

During early lactation, milk fatty acid (FA) composition is influenced by diet, animal genetics, and the high availability of preformed FA from body-fat mobilization. Long-term prepartum dietary oilseed supplementation could, therefore, modify milk FA composition postpartum in the subsequent lactation through changes in adipose tissue (AT) FA profile. To test this hypothesis, measurements were made in 19 Holstein cows fed grass-based diets containing no additional lipid (control, CTL; n=4) or supplemented with extruded linseeds (EL; n=4), cold-pressed fat-rich rapeseed meal (FRM; n=6), or whole unprocessed rapeseeds (WR; n=5) over 2 consecutive lactations (yr 1 and 2) and 2 dry periods. Oilseed supplements were withdrawn from the diets 23 d before the calving of yr 3, following the end of the previous experimental periods in yr 1 to 2. Thereafter, all cows received a total mixed ration composed of grass silage, grass hay, and concentrates (forage:concentrate ratio of 70:30 on a dry-matter basis). Cows previously fed EL and WR had a lower milk fat content (6.32% for CTL and FRM vs. 5.46% for EL and WR) and yield (1.90kg/d for CTL and FRM vs. 1.61kg/d for EL and WR) during the first week of lactation. Treatment effects on milk fat content and yield did not persist into lactation wk 3 and 7. Whatever the week, EL and WR increased concentration of FA in milk synthesized de novo (i.e., carbon number ≤15; 17.1g/100g of FA for CTL and FRM vs. 22.2g/100g of FA for EL and WR) and decreased concentration and secretion of preformed FA (i.e., carbon number ≥17; 56.1g/100g of FA for CTL and FRM vs. 49.9g/100g of FA for EL and WR). Alterations in milk FA composition may be explained by the lower availability of mobilized FA for uptake by the mammary gland, as indicated by the lower plasma nonesterified FA concentrations for EL and WR compared with CTL and FRM. Prepartum EL feeding increased AT and milk concentration of 18:3n-3 (0.96 vs. 0.79g/100g of milk FA for EL and the other groups, respectively) and intermediates of ruminal 18:3n-3 biohydrogenation. In contrast, FRM increased AT and milk concentration of ruminal cis-9 18:1 biohydrogenation intermediates. However, EL and FRM supplements resulted in a similar profile of 18-carbon FA isomers in AT (yr 2) and milk (yr 3, 4-10 wk after removing oilseeds from the diet). In conclusion, results confirm that long-term feeding of oilseed supplements alter AT FA composition and may influence milk FA composition during periods of extensive body-fat mobilization such as early lactation.

[Arthroscopic synovectomy of the hip joint]. / Arthroskopische Synovektomie des Hüftgelenks.

OBJECTIVE: The aim of the treatment is reduction of hip pain through arthroscopic synovectomy of the hip joint, reduction in activity of the synovial disease and removal of loose bodies in chondromatosis. INDICATIONS: Synovialitis of the hip due to synovial disease, such as pigmented villonodular synovitis (PVNS) and chondromatosis, synovialitis of the hip due to a further diseases of the hip. The disease must be treatable by arthroscopy (e.g. femoroacetabular impingement and lesion of the acetabular labrum). CONTRAINDICATIONS: Suspicion of malignant synovial disease, extensive synovitis, especially in those areas of the hip which are difficult to reach or inaccessible to arthroscopy, primary disease not sufficiently treatable by arthroscopy, e.g. coxarthrosis. SURGICAL TECHNIQUE: Arthroscopy of the central compartment of the hip is carried out by lateral, anterolateral (alternatively inferior anterolateral) and posterolateral portals, using all portals both for the camera and for instruments. In the central compartment synovectomy of the acetabular fossa is performed. A shaver and/or a high frequency diathermy applicator (HF applicator) are employed for removal of the synovial membrane. For arthroscopy of the peripheral compartment lateral, anterolateral (alternatively inferior anterolateral) and superior anterolateral portals are established and all portals are used both for the camera and instruments. In the peripheral compartment, the synovial membrane of the anterior, anteromedial, anterolateral and as far as possible posterolateral areas of the hip is removed. The dorsolateral synovial plica needs to be spared. POSTOPERATIVE MANAGEMENT: Non-steroidal anti-inflammatory drugs (NSAIDs) are administered as prophylaxis of heterotopic ossification for 10 days. Contraindications for NSAIDs need to be considered. Thrombosis prophylaxis with low molecular weight heparin over 5 days. Mobilization with full weight bearing. Intensive physiotherapeutic exercises for at least 6 and possibly up to 12 postoperative weeks. Radiosynoviorthesis 6-8 weeks after surgery depending of the histopathological results. RESULTS: From June 2007 to December 2013 a total of 20 patients with specific synovial diseases were treated with hip arthroscopy of which 18 had chondromatosis and 2 had PVNS. A telephone interview was carried out after an average of 40.2 months (range 8-92 months) and revealed a recurrence rate of the synovial disease of 20 %. In two cases (10 %) a second arthroscopy was necessary due to recurrent symptoms but without return of the synovial disease.

[Arthroscopic arthrolysis of the hip]. / Arthroskopische Arthrolyse des Hüftgelenks.

OBJECTIVE: Increase of range of motion and pain reduction for pain limited movement of the hip joint by arthroscopic arthrolysis of the peripheral compartment. INDICATIONS: Painful primary or secondary restriction of movement of the hip joint with adhesive capsulitis and after previous surgery or additional arthroscopically treatable intra-articular changes. CONTRAINDICATIONS: Extensive periarticular ossification, severe arthrofibrosis and advanced arthritis of the hip. SURGICAL TECHNIQUE: Arthroscopy of the peripheral compartment of the hip, initially using a lateral portal for the arthroscope and an anterolateral portal for instruments. After expansion of the portal entry site with a shaver and/or HF applicator and removal of scar tissue between the capsule and femoral neck, the capsule is reduced from anterolateral to anteromedial. After exchange of arthroscope and working portal, the lateral and dorsolateral arthrolysis is done. POSTOPERATIVE MANAGEMENT: Administration of nonsteroidal anti-inflammatory drugs for prophylaxis of heterotopic ossifications. Thrombosis prophylaxis with heparin. Mobilization with full weight bearing. Intensive physiotherapeutic exercises for at least for 6 weeks and if needed for 12 postoperative weeks. RESULTS: After arthroscopic (n=38) or open (n=11) hip surgeries, 49 revision hip arthroscopies were performed from January 2009 to August 2013. Arthrolysis in the described technique was performed if adhesions were present. In 19 of these cases, a limitation of at least 30 % for one direction of movement was present pre-operatively. The following average values were obtained for the range of motion (preoperative/postoperative/increase): flexion 94°/128°/34 °, abduction 18°/40°/22°, internal rotation of 8°/20°/12°, external rotation 18°/38°/20°.

Rapeseed or linseed in grass-based diets: effects on conjugated linoleic and conjugated linolenic acid isomers in milk fat from Holstein cows over 2 consecutive lactations.

Changes in the distribution of conjugated linoleic (CLA) and conjugated linolenic (CLnA) acid isomers in milk from Holstein cows in response to 4 different oilseed supplements rich in either cis-9 18:1 or 18:3n-3 were determined over 2 consecutive lactations in 58 and 35 cows during the first and second years, respectively. For the first 5 wk of the first lactation, all cows were fed the same diet. Thereafter, cows received 1 of 5 treatments for 2 consecutive lactations, including the prepartum period. Treatments comprised the basal diet with no additional lipid, or supplements of extruded linseeds (EL), extruded rapeseeds (ER), cold-pressed fat-rich rapeseed meal, or whole unprocessed rapeseeds to provide 2.5 to 3.0% of additional oil in diet dry matter. During indoor periods, cows were housed and received a mixture (3:1, wt/wt) of grass silage and hay, whereas cows were at pasture during outdoor periods. Over the entire study, EL resulted in the enrichment of ∆11,13 CLA, ∆12,14 CLA, trans-9,trans-11 CLA, trans-13,trans-15 CLA, ∆9,11,15 CLnA, and cis-9,trans-11,trans-13 CLnA (identified for the first time in bovine milk fat) in milk fat, whereas ER and cold-pressed fat-rich rapeseed meal in particular, increased milk fat trans-7,cis-9 CLA concentration. With the exception of the first indoor period, whole unprocessed rapeseeds decreased cis-9,trans-11 CLA, trans-9,cis-11 CLA, and trans-10,trans-12 CLA abundance. During the second indoor period, EL increased milk trans-9,cis-11 CLA and trans-10,cis-12 CLA concentrations, but the increases in cis-9,trans-11 CLA, cis-12,trans-14 CLA, trans-11,cis-13 CLA, and cis-9,trans-11,cis-15 CLnA concentrations to EL and ER were lower for the second than first indoor period. In contrast to the indoor periods, EL and ER decreased milk cis-9,trans-11 CLA, trans-9,cis-11 CLA, and trans-10,cis-12 CLA concentrations at pasture. The extent of changes in the relative distribution and abundance of CLA and CLnA isomers in milk fat were related to the nature (rapeseed or linseed) and form of oilseed (extruded, cold-pressed fat-rich meal or whole unprocessed) supplement and their interactions with the composition of the basal diet (conserved grass or pasture and dietary starch content). Furthermore, milk fat CLA and CLnA responses to treatments were repeatable between both outdoor periods. Variations in milk fat content and yield measured during the entire study were significantly and inversely associated with milk trans-10 18:1, trans-10,cis-12 CLA, and in particular, trans-9,cis-11 CLA concentrations.

Rapeseed or linseed supplements in grass-based diets: effects on milk fatty acid composition of Holstein cows over two consecutive lactations.

Persistency of changes in milk fatty acid (FA) composition to 4 different oilseed supplements rich in cis-9 18:1 or 18:3n-3 was determined over 2 consecutive lactations in 58 and 35 Holstein cows during the first and second years, respectively. During the initial 5 wk of the study, all experimental cows were fed the same diet. Thereafter, cows received 1 of 5 treatments for 2 consecutive lactations, including the prepartum period. Treatments comprised the basal diet with no additional lipid, or supplements of extruded linseeds (EL), extruded rapeseeds (ER), cold-pressed fat-rich rapeseed meal (FRM), or whole unprocessed rapeseeds (WR). Oilseeds were offered to provide between 2.5 to 3.0% of additional oil in diet dry matter. During indoor periods, cows received a mixture (3:1, wt/wt) of grass silage and grass hay, whereas cows were at pasture during outdoor periods. Over the entire study, oilseed supplements decreased the concentration of milk FA synthesized de novo and increased 18:0 and cis-9 18:1 content, with a ranking of treatment responses (highest to lowest) of FRM, EL, ER, and WR. Irrespective of period, both EL and FRM increased total milk trans FA content, whereas WR resulted in lower concentrations in milk from grazing cows. Relative to rapeseed, EL resulted in higher increases in milk cis-12,cis-15,trans-12 to -16 18:1, nonconjugated trans 18:2 (especially ∆11,15), and 18:3n-3. In contrast, rapeseed supplements resulted in a greater enrichment of cis-11 18:1, trans-4 to -9 18:1, and cis 20:1 than EL. Changes in milk FA composition to oilseeds were of greater magnitude during indoor than outdoor periods, where oilseed supplements often decreased cis-9,trans-11 conjugated linoleic acid content. During the second indoor period, both EL and ER resulted in higher total trans FA content, trans-10 18:1 in particular, than during the first indoor period, consistent with an interaction between dietary starch content and oilseed supplement. Overall, the extent of changes in milk FA composition were related to the nature (rapeseed or linseed) and form of oilseed (extruded, cold-pressed fat-rich meal or whole unprocessed), and their interactions with the composition of the basal diet (grass silage and hay or pasture; or dietary starch content). Milk FA responses were stable within each period and repeatable over both outdoor feeding periods, with extent of changes being comparable to reports from relatively short-term (1- to 3-mo) studies.

Rapeseed or linseed supplements in grass-based diets: effects on dairy performance of Holstein cows over 2 consecutive lactations.

The aim of this study was to evaluate the effects of long-term supplementation with different oilseeds rich in 18:1 cis-9 or 18:3n-3 fatty acids on dairy cow performance over 2 consecutive lactations. This trial involved 58 Holstein cows during the first year and 35 during the second year. During the first 5 wk of the first year, all of the cows were fed the same diet; after a 4-wk transition period, the cows received 1 of 5 treatments for 2 consecutive lactations, including the dry period. Their basal diet was supplemented or not with extruded linseeds or with different forms of rapeseeds: extruded seeds, cold-pressed fat-rich meal, or whole unprocessed seeds. Oilseed amount was calculated to provide 2.5 to 3.0% additional oil in ration dry matter. Cows were fed a grass-based diet (75% grass silage and 25% hay) during indoor periods and grazed during outdoor periods. For the first year of experimentation, oilseed supplementation had no effect on milk, fat, protein, and lactose yields, body weight, or body condition score compared with the control treatment (no oilseed supplementation). During the indoor period, extruded linseed tended to decrease dry matter intake (-1.5 kg/d), whereas all of the oilseed treatments decreased milk protein content without changing protein yield. Cold-pressed fat-rich rapeseed meal decreased milk protein content independently of the period (-0.29 and -0.19 g/100 g for indoor and outdoor periods, respectively), and whole unprocessed rapeseed increased milk fat content during the outdoor period (+0.53 g/100 g compared with the control treatment). During the second year of experimentation, the effects of oilseed supplementation during the outdoor period were similar to those observed during the first outdoor period, but the effects of oilseed supplementation differed between the 2 indoor periods. This was likely due to changes in forage quality and composition and percentage in the ration of the concentrate mixtures. Thus, the effects of oilseed supplementation depended on oilseed nature (rapeseed or linseed) and form (extruded seeds, cold-pressed fat-rich meal, or whole unprocessed seeds) in interaction with the type of basal diet (grass silage and hay or pasture) and the concentrate composition and percentage in the ration. Effects were stable during the first indoor period, repeatable between the 2 outdoor periods, and were similar to effects observed previously in short-term studies (1 to 3 mo).

[Screw arthrodesis of the shoulder]. / Schraubenarthrodese der Schulter.

OBJECTIVE: The aim of the procedure is arthrodesis of the shoulder by osteosynthesis of the glenohumeral and the acromiohumeral joint each with three screws, which results in preservation of scapulothoracic motion and pain relief. INDICATIONS: Traumatic brachial plexus lesions, palsy in infancy, poliomyelitis with preserved or restorable function of the elbow and the hand. Paralysis of the deltoid muscle and the rotator cuff. Nonrestorable vast defect of the rotator cuff with pseudoparalysis. Chronic infectious arthritis resistant to therapy. Unsuccessful attempts to treat glenohumeral instability. Alternative procedure to shoulder arthroplasty in young patients with omarthrosis, who perform hard physical work. CONTRAINDICATIONS: Insufficient strength of the scapular muscles (< grade 4, <75% of normal strength). Insufficient scapulothoracic passive motion. Inadequate soft tissue coverage after burns, excessive previous surgery or radiotherapy. Incomplete rehabilitation (<3 years) after neurosurgical interventions (neurolysis, nerve transplantation). Cases of resection of the proximal humerus. SURGICAL TECHNIQUE: Acampsia of the shoulder joint in 20° of abduction, 30° of anteversion, and 40° of internal rotation using three glenohumeral and three acromiohumeral spongiosa screws as a compression arthrodesis. POSTOPERATIVE MANAGEMENT: Thorax-arm-abduction splint (20° of abduction, 30° of anteversion, and 40° of internal rotation) until the week 6 postoperatively with removal for physiotherapy and personal hygiene. Assisted active and passive motion exercises for the elbow, hand, and fingers after the postoperative day 1. Weaning from the splint after the end of the week 6 postoperatively, full range of motion allowed. RESULTS: In a prospective study from January 2007 to September 2008, 4 patients with a medium age of 35.7 years underwent screw arthrodesis of the shoulder with a follow-up of 1.0 (0.6-1.5) year. Primary fusion of all arthrodesis surfaces was achieved in all patients; no revision surgery was necessary. All patients improved in shoulder function with an average range of motion of 60° abduction and 40° anteversion.

Combination of bevacizumab and 2-weekly pegylated liposomal doxorubicin as first-line therapy for locally recurrent or metastatic breast cancer. A multicenter, single-arm phase II trial (SAKK 24/06).

BACKGROUND: pegylated liposomal doxorubicin (PLD) and bevacizumab are active agents in the treatment of metastatic breast cancer (MBC). We carried out a multicenter, single-arm phase II trial to evaluate the toxicity and efficacy of PLD and bevacizumab as first-line treatment in MBC patients. METHODS: bevacizumab (10 mg/kg) and PLD (20 mg/m(2)) were infused on days 1 and 15 of a 4-week cycle for a maximum of six cycles. Thereafter, bevacizumab monotherapy was continued at the same dose until progression or toxicity. The primary objective was safety and tolerability, and the secondary objective was to evaluate efficacy of the combination. RESULTS: thirty-nine of 43 patients were assessable for the primary end point. Eighteen of 39 patients (46%, 95% confidence interval 30% to 63%) had a grade 3 toxicity. Sixteen (41%) had grade 3 palmar-plantar erythrodysesthesia, one had grade 3 mucositis, and one severe cardiotoxicity. Secondary end point of overall response rate among 43 assessable patients was 21%. CONCLUSIONS: in this nonrandomized single-arm trial, the combination of bimonthly PLD and bevacizumab in locally recurrent and MBC patients demonstrated higher than anticipated toxicity while exhibiting only modest activity. Based on these results, we would not consider this combination for further investigation in this setting.

Effects of supplementation of maize silage diets with extruded linseed, vitamin E and plant extracts rich in polyphenols, and morning v. evening milking on milk fatty acid profiles in Holstein and Montbéliarde cows.

The aim of this study was to evaluate the effects on dairy performance and milk fatty acid (FA) composition of (i) supplementation with extruded linseed (EL), (ii) supplementation with synthetic or natural antioxidants, namely vitamin E and plant extracts rich in polyphenols (PERP), (iii) cow breed (Holstein v. Montbéliarde) and (iv) time of milking (morning v. evening). After a 3-week pre-experimental period 24 lactating cows (12 Holstein and 12 Montbéliarde) were divided up into four groups of six cows: the first group received a daily control diet (diet C) based on maize silage. The second group received the same diet supplemented with EL (diet EL, fat level approximately 5% of dietary dry matter (DM)). The third group received the EL diet plus 375 IU/kg diet DM of vitamin E (diet ELE). The fourth group received the ELE diet plus 10 g/kg diet DM of a PERP mixture (diet ELEP). Compared with the diet C, feeding EL-rich diets led to lower concentrations of total saturated FA (SFA) and higher concentrations of stearic and oleic acids, each trans and cis isomer of 18:1 (except c12-18:1), non-conjugated isomers of 18:2, some isomers (c9t11-, c9c11- and t11t13-) of conjugated linoleic acid (CLA), and 18:3n-3. The vitamin E supplementation had no effect on milk yield, milk fat or protein percentage and only moderate effects on milk concentrations of FA (increase in 16:0, decreases in 18:0 and t6/7/8-18:1). The addition of PERP to vitamin E did not modify milk yield or composition and slightly altered milk FA composition (decrease in total saturated FA (SFA) and increase in monounsaturated FA (MUFA)). The minor effects of vitamin E may be partly linked to the fact that no milk fat depression occurred with the EL diet. During both periods the Holstein cows had higher milk production, milk fat and protein yields, and milk percentages of 4:0 and 18:3n-3, and lower percentages of odd-branched chain FA (OBCFA) than the Montbéliarde cows. During the experimental period the Holstein cows had lower percentages of total cis 18:1, and c9,c11-CLA, and higher percentages of 6:0, 8:0, t12-, t16/c14- and t13/14-18:1, and 18:2n-6 than Montbéliarde cows because of several significant interactions between breed and diet. Also, the total SFA percentage was higher for morning than for evening milkings, whereas those of MUFA, total cis 18:1, OBCFA and 18:2n-6 were lower. Extruded linseed supplementation had higher effect on milk FA composition than antioxidants, breed or time of milking.