[Discontinuation or tapering strategies of biologics in rheumatoid arthritis in remission]. / Stratégies d'arrêt ou de réduction des biomédicaments dans la polyarthrite rhumatoïde en rémission.

The arrival of new drugs and new therapeutic strategies allowed to reach sustained remission in an increasing number of patients with rheumatoid arthritis. The study of biologic disease-modifying anti-rheumatic drugs (bDMARDs) adaptation strategies is a need to optimize the benefit/risk balance and cost/effectiveness ratio of these molecules. Current recommendations such as EULAR 2016 propose tapering bDMARDs, especially when combined with a csDMARD, when the patient is in remission after stopping persistent glucocorticoids. The analysis of literature comprising 22 studies shows that a bDMARD adaptation is possible in established rheumatoid arthritis when clinico-biological and ultrasound remission is maintained over six months. Priority should be given to a progressive tapering strategy doses controlled by disease activity while maintaining "tight control" to identify and effectively treat a relapse, a retreatment being usually favorable.

Milk yield, milk composition, and hepatic lipid metabolism in transition dairy cows fed flaxseed or linola.

The response of transition dairy cows to dietary supplementation with fat sources of various fatty acid profiles could affect hepatic fat metabolism differently. Twenty-eight Holstein cows were blocked for similar calving date 4wk before expected parturition to compare the effects of feeding sources of n-3 and n-6 fatty acids on milk production and composition, plasma metabolites, and liver parameters. Cows within each block were assigned to 1 of 3 isonitrogenous and isoenergetic diets: control with a source of calcium salts of palm oil (MEG; 1.1 and 2.6% of the dry matter in prepartum and postpartum diets, respectively); n-3 fatty acids supplied as whole flaxseed (WFL; 4.8 and 7.7% of the dry matter in prepartum and postpartum diets, respectively); and n-6 fatty acids supplied as whole linola (WLO; 4.8 and 7.7% of the dry matter in prepartum and postpartum diets, respectively). Diets were fed until wk 14 of lactation. Contrasts of WFL versus WLO and polyunsaturated fatty acids versus MEG were compared. Cows fed polyunsaturated fatty acids increased dry matter intake over time at a greater extent than those fed MEG, which resulted in enhanced energy balance. Cows fed MEG produced more milk compared with those fed polyunsaturated fatty acids, and there was no difference between those fed WFL and WLO. We found no effect on body condition score and body weight. Plasma concentrations of glucose, fatty acids, and BHB were similar among diets. There was no effect of diet on concentration of glycogen and activities of superoxide dismutase and glutathione peroxidase in the liver. We observed higher concentrations of hepatic lipids and triacylglycerol in cows fed MEG compared with those fed polyunsaturated fatty acids, and no difference between WFL and WLO. Hepatic catalase activity tended to be higher on wk 4 after calving for cows supplemented with WFL compared with those fed WLO. Feeding linoleic and linolenic acids as unprotected oilseeds increased dry matter intake over time at a greater extent for cows fed MEG, improved the energy status, and lowered hepatic lipids and triacylglycerol contents, which may contribute to enhance the health status of transition dairy cows.

Post-acute referral of stroke victims in a French urban area: Results of a specific program.

OBJECTIVE: The main objective of this study was to describe the distribution of referrals offered to patients assessed in the "Post-Acute Stroke program" of Bordeaux University Hospital (France). This program was developed in 2008 to organize the dispensation of care in rehabilitation units specialized in neurological diseases. MATERIAL AND METHODS: This was a single-centre observational study. Between July 2008 and December 2012, data on the number of stroke patients hospitalized at the Bordeaux University Hospital and their post-acute referral were collected from the local hospital discharge database. Some of these patients were assessed by Physical Rehabilitation and Medicine physicians participating in the program. Proposed and actual referrals, time from admission to assessment and functional status were also collected. RESULTS: Among 4189 stroke patients, 1465 (35%) survivors were assessed, of whom 932 (22.2%) were discharged to inpatient rehabilitation facilities. There were no patients discharged to this type of unit without an assessment. Among the 1465 patients who were assessed, 57.2% were referred to specialized rehabilitation units, 6.3% were discharged to non-specialized rehabilitation units and 26% returned home directly. The median total length of stay in acute units varied from 10 to 15days depending on referral orientation. CONCLUSION: Patients that were assessed were more likely to be transferred to specialized rehabilitation units than to non-specialized rehabilitation units. The Post-Acute Stroke program has the particularity of combining private and public specialized rehabilitation units in a common collaborative referral system while retaining the control and flexibility of personalised referral for each patient in the light of local care availability.

Effects of pistachio by-products on digestibility, milk production, milk fatty acid profile and blood metabolites in Saanen dairy goats.

The objective of this study was to investigate the effects of pistachio by-products (PBP) on nutrient digestibility, blood metabolites and milk fatty acid (FA) profile in Saanen dairy goats. Nine multiparous lactating Saanen goats (on day 90 post-partum, 45 ± 2/kg BW) were randomly assigned to a 3 × 3 Latin square design with three treatment diets: 1) control diet (alfalfa hay based), 2) 32% PBP and 3) 32% PBP + polyethylene glycol (PEG-4000; 1 g/kg dry matter). Each period lasted 21 days, including 14 day for treatment adaptation and 7 day for data collection. Pistachio by-products significantly decreased (p < 0.01) crude protein (CP) digestibility compared with the control diet (64.4% vs. 58.7%), but PEG addition did not differ for CP digestibility of goats fed 32% PBP + PEG and those fed the two other diets. The digestibility of NDF tended (p = 0.06) to decrease for goats fed PBP compared with those fed the control diet. Yields of milk and 4% fat-corrected milk were not affected by dietary treatments. Compared with the control diet, PBP supplementation appreciably changed the proportions of almost all the milk FA measured; the main effects were decreases (p < 0.01) in FA from 8:0 to 16:0 and increases (p < 0.01) proportions of cis-9, trans-11 18:2 and trans-11 18:1, monounsaturated FA, polyunsaturated FA and long-chain FA. The saturated FA, short-chain FA and medium-chain FA proportions were lower (p < 0.01) in goats fed the two PBP supplemented diet than in those fed the control diet and PEG addition led to intermediate proportions of saturated FA, unsaturated and monounsaturated FA. Inclusion of PBP in the diet decreased (p < 0.01) plasma concentrations of glucose and urea nitrogen compared with the control diet. It was concluded that PBP can be used as forage in the diet of dairy goats without interfering with milk yield. Inclusion of 32% PBP in the diet of dairy goats had beneficial effects on milk FA profile but PEG addition to PBP did not contribute to enhance further milk FA profile.

Interactions of corn meal or molasses with a soybean-sunflower meal mix or flaxseed meal on production, milk fatty acid composition, and nutrient utilization in dairy cows fed grass hay-based diets.

We investigated the interactions of corn meal or molasses [nonstructural carbohydrate (NSC) supplements] with a soybean-sunflower meal mix or flaxseed meal [rumen-degradable protein (RDP) supplements] on animal production, milk fatty acids profile, and nutrient utilization in dairy cows fed grass hay diets. Eight multiparous and 8 primiparous Jersey cows averaging 135±49d in milk and 386±61kg of body weight in the beginning of the study were randomly assigned to 4 replicated 4×4 Latin squares with a 2×2 factorial arrangement of treatments. Each period lasted 19d with 14d for diet adaptation and 5d for data and sample collection. Cows were fed diets composed of mixed-mostly grass hay plus 1 of the following 4 concentrate blends: (1) corn meal plus a protein mix containing soybean meal and sunflower meal; (2) corn meal plus flaxseed meal; (3) liquid molasses plus a protein mix containing soybean meal and sunflower meal; or (4) liquid molasses plus flaxseed meal. Data were analyzed for main effects of NSC and RDP supplements, and the NSC × RDP supplement interactions. Significant NSC × RDP supplement interactions were observed for milk urea N, milk N efficiency, and the sums of milk saturated, monounsaturated, and polyunsaturated fatty acids. No effect of NSC supplements was observed for nutrient intake and milk yield. However, 4% fat-corrected milk (-0.70kg/d) and energy-corrected milk (-0.60kg/d) were significantly reduced in cows fed liquid molasses due to a trend to decreased concentration of milk fat (-0.17%). Diets with liquid molasses resulted in increased (+35%) concentration and yield of milk enterolactone, indicating that this mammalian lignan can be modulated by supplements with different NSC profiles. Overall, NSC and RDP supplements profoundly changed the milk fatty acid profile, likely because of differences in fatty acids intake, Δ(9)-desaturase indices, and ruminal biohydrogenation pathways. Feeding liquid molasses significantly reduced plasma urea N (-1.2mg/dL), urinary N excretion (-20g/d), and N digestibility (-3.2 percentage units). Flaxseed meal significantly reduced yields of milk (-1.3kg/d), milk fat (-90g/d), and milk lactose (-60g/d), but significantly increased the concentration and yield of milk enterolactone. Further research is needed to elucidate the negative responses of flaxseed meal on yields of milk and milk components.

Effect of prepartal and postpartal dietary fat level on performance and plasma concentration of metabolites in transition dairy cows.

The objective of this study was to determine the effects of 2 levels of dietary fat (low and high) offered during the prepartal and postpartal periods on dry matter intake (DMI), plasma concentration of metabolites, and milk yield and composition. Twenty-four Holstein dry cows were assigned on d 21 relative to expected parturition date to 1 of 4 treatments in a 2×2 factorial arrangement of 2 levels of fat fed during the prepartal period and 2 levels of fat fed during the postpartal period: prepartal low fat and postpartal low fat (LF-LF), prepartal low fat and postpartal high fat (LF-HF), prepartal high fat and postpartal low fat (HF-LF), or prepartal high fat and postpartal high fat (HF-HF). Prepartal and postpartal LF diets contained no fat supplement. Prepartal HF diets contained 1.60% calcium salts of soybean oil. The proportion of calcium salts of soybean oil was increased to 1.70% of DM for the first 21 d of lactation and to 2.27% of DM from d 21 to 56 of lactation in the HF diet. Diets were fed for ad libitum intake from d 21 before calving until d 56 of gestation. Prepartal DMI was lower for cows fed the HF diet compared with those fed the LF diet (12.6 vs. 16.2kg/d). Postpartum, cows fed the HF-HF and HF-LF diets had, respectively, the lowest and highest DMI, although no significant differences existed between HF-LF and LF-LF. Net energy intake was higher for cows fed the postpartal HF diets compared with those fed the LF diets. Prepartal fat level had no effect on net energy intake. Cows offered the prepartal HF diet had higher milk yield when offered the postpartal LF diet compared with those offered the postpartal HF diet and no effect of the postpartal fat level was detected when cows were fed the prepartal LF diet. Milk composition was similar among treatments. Plasma cholesterol concentration postpartum was higher for cows fed the prepartal LF diet than for those fed the prepartal HF diet (5.16 vs. 3.74mmol/L) and postpartal fat level had no effect. Prepartal diet had no significant effect on postpartal plasma triglyceride concentration but the postpartal HF diet increased triglyceride and low-density lipoprotein concentrations compared with the postpartal LF diet. In conclusion, switching from a high to a low fat proportion in the postpartal diet may alleviate the negative effects of a high proportion of fat in the prepartal diet as shown by increased feed intake and milk production during the first 56 d of lactation.

Methane production, nutrient digestion, ruminal fermentation, N balance, and milk production of cows fed timothy silage- or alfalfa silage-based diets.

The objective of this study was to investigate the effects of changing forage source in dairy cow diets from timothy silage (TS) to alfalfa silage (AS) on enteric CH4 emissions, ruminal fermentation characteristics, digestion, milk production, and N balance. Nine ruminally cannulated lactating cows were used in a replicated 3 × 3 Latin square design (32-d period) and fed (ad libitum) a total mixed ration (TMR; forage:concentrate ratio of 60:40, dry matter basis), with the forage portion consisting of either TS (0% AS; 0% AS and 54.4% TS in the TMR), a 50:50 mixture of both silages (50% AS; 27.2% AS and 27.2% TS in the TMR), or AS (100% AS; 54.4% AS and 0% TS in the TMR). Compared with TS, AS contained less (36.9 vs. 52.1%) neutral detergent fiber but more (20.5 vs. 13.6%) crude protein (CP). In sacco 24-h ruminal degradability of organic matter (OM) was higher for AS than for TS (73.5 vs. 66.9%). Replacement of TS with AS in the diet entailed increasing proportions of corn grain and bypass protein supplement at the expense of soybean meal. As the dietary proportion of AS increased, CP and starch concentrations increased, whereas fiber content declined in the TMR. Dry matter intake increased linearly with increasing AS proportions in the diet. Apparent total-tract digestibility of OM and gross energy remained unaffected, whereas CP digestibility increased linearly and that of fiber decreased linearly with increasing inclusion of AS in the diet. The acetate-to-propionate ratio was not affected, whereas ruminal concentration of ammonia (NH3) and molar proportion of branched-chain VFA increased as the proportion of AS in the diet increased. Daily CH4 emissions tended to increase (476, 483, and 491 g/d for cows fed 0% AS, 50% AS, and 100% AS, respectively) linearly as cows were fed increasing proportions of AS. Methane production adjusted for dry matter intake (average=19.8 g/kg) or gross energy intake (average=5.83%) was not affected by increasing AS inclusion in the diet. When expressed on a fat-corrected milk or energy-corrected milk yield basis, CH4 production increased linearly with increasing AS dietary proportion. Urinary N excretion (g/d) increased linearly when cows were fed increasing amounts of AS in the diet, suggesting a potential for higher nitrous oxide (N2O) and NH3 emissions. Efficiency of dietary N use for milk protein secretion (g of milk N/g of N intake) declined with the inclusion of AS in the diet. Despite marked differences in chemical composition and ruminal degradability, under the conditions of this study, replacing TS with AS in dairy cow diets was not effective in reducing CH4 energy losses.

Postpartum responses of dairy cows supplemented with n-3 fatty acids for different durations during the peripartal period.

The objective of this study was to determine the effect of different durations of n-3 supplementation during the peripartal period on production and reproduction performance of Holstein dairy cows. Thirty-two Holstein dry cows (16 multiparous and 16 primiparous) were blocked within parity for similar expected calving dates 8 wk before calving. Cows within blocks were assigned randomly to 1 of 4 treatments: (1) control without n-3 fatty acid (FA) supplementation during the dry period; (2) n-3 FA supplementation during the whole dry period (8 wk); and (3) n-3 FA supplementation during the early dry period (first 5 wk; far-off), or (4) n-3 FA supplementation during the late dry period (last 3 wk; close-up). All cows received the same diet without n-3 FA after calving for the first 6 wk of lactation. Ovaries of each cow were examined 10, 17, 24, and 34 d from calving (calving=d 0) by transrectal ultrasonography to determine follicular development. Blood samples were collected at 14-d intervals starting on the first day of the dry period (8 wk before expected calving) to determine plasma concentrations of glucose, ß-hydroxybutyrate, nonesterified fatty acids, urea N, aspartate aminotransferase, and insulin. Blood samples were also collected on d 1, 10, 17, 24, 31, and 38 postpartum for determination of progesterone concentration. Milk yield was recorded daily throughout the experiment and samples were taken twice weekly (Monday and Thursday mornings) for analysis of fat, protein, and lactose. Yields of milk and 4% fat-corrected milk and milk composition were similar among treatments except for fat proportion, which tended to be lower in cows that were fed n-3 FA throughout the dry period. We observed no differences among treatments for plasma concentrations of metabolites and hormones. The cows that were fed in the 3 n-3 FA treatments had larger ovulatory follicles compared with those fed the controlled diet. Treatments did not differ significantly in terms of the number of days open, day to first service, or number of services per pregnancy. In conclusion, n-3 FA supplementation throughout the dry period or in the early or late prepartal period had no carryover reproductive postpartum benefits and no effect on the production of Holstein dairy cows.

Methane production, digestion, ruminal fermentation, nitrogen balance, and milk production of cows fed corn silage- or barley silage-based diets.

This study evaluated the effects of replacing barley silage (BS) with corn silage (CS) in dairy cow diets on enteric CH4 emissions, ruminal fermentation characteristics, digestion, milk production, and N balance. Nine ruminally cannulated lactating cows were used in a replicated 3 × 3 Latin square design (32-d period) and fed (ad libitum) a total mixed ration (TMR; forage:concentrate ratio 60:40; dry matter basis) with the forage portion consisting of either barley silage (0% CS; 0% CS and 54.4% BS in the TMR), a 50:50 mixture of both silages (27% CS; 27.2% CS and 27.2% BS in the TMR), or corn silage (54% CS; 0% BS and 54.4% CS in the TMR). Increasing the CS proportion (i.e., at the expense of BS) also involved increasing the proportion of corn grain (at the expense of barley grain). Intake and digestibility of dry matter and milk production increased linearly as the proportion of CS increased in the diet. Increasing dietary CS proportion decreased linearly the acetate molar proportion and increased linearly that of propionate. Daily CH4 emissions tended to respond quadratically to increasing proportions of CS in the diet (487, 540, and 523 g/d for 0, 27, and 54% CS, respectively). Methane production adjusted for dry matter or gross energy intake declined as the amount of CS increased in the diet; this effect was more pronounced when cows were fed the 54% CS diet than the 27% CS diet. Increasing the CS proportion in the diet improved N utilization, as reflected by decreases in ruminal ammonia concentration and urinary N excretion and higher use of dietary N for milk protein secretion. Total replacement of BS with CS in dairy cow diets offers a strategy to decrease CH4 energy losses and control N losses without negatively affecting milk performance.

Plasma concentrations of PGFM and uterine and ovarian responses in early lactation dairy cows fed omega-3 and omega-6 fatty acids.

A total of 120 dairy cows were assigned randomly to three diets to determine the effects of omega-6 or omega-3 fatty acid (FA) supplementation on uterine diseases, ovarian responses, and blood concentrations of estradiol, progesterone, and PGFM in lactating Holstein dairy cows. Diets contained either protected palm oil (C), extruded linseed (L), or roasted whole soybeans (S), and they were fed from calving to Day 70 postpartum. Estrous cycles were synchronized and ovarian follicular development was monitored daily for an entire cycle. There were no differences among diets in the incidence of lameness, mastitis, or metritis, but the incidence of clinical endometritis was lower (P < 0.05) in cows fed S (0%) compared with cows fed C (28.2%) and L (20.5%). Uterine involution in cows fed S occurred 3.77 and 2.78 days earlier, respectively, than in those fed C and L. The PGFM response 60 minutes after an oxytocin challenge was highest for cows fed S and lowest for cows fed L. Mean plasma progesterone concentration on Day 15 of the synchronized cycle was higher in cows fed S (14.5 ng/mL) and L (15.0 ng/mL) than in those fed C (12.0 ng/mL). The ovulatory follicle on Day 21 of the estrous cycle (estrous = Day 0) was larger in cows fed S (16.1 ± 0.9 mm) and L (15.7 ± 0.7 mm) compared with cows fed C (13.2 ± 0.87 mm; P = 0.02) but there were no significant differences between cows fed diets S and L. The mean number of small and medium follicles and diameter of subordinate follicle were similar among diets. In conclusion, feeding a source of omega-6 FA can be a strategy to improve uterine health after calving, although a source of omega-3 FA such as L should be fed after uterine involution to decrease PGF2α secretion.

Replacing alfalfa silage with corn silage in dairy cow diets: Effects on enteric methane production, ruminal fermentation, digestion, N balance, and milk production.

The objective of this study was to determine the effects of replacing alfalfa silage (AS) with corn silage (CS) in dairy cow total mixed rations (TMR) on enteric CH4 emissions, ruminal fermentation characteristics, apparent total-tract digestibility, N balance, and milk production. Nine ruminally cannulated lactating cows were used in a replicated 3×3 Latin square design (32-d period) and fed (ad libitum) a TMR [forage:concentrate ratio of 60:40; dry matter (DM) basis], with the forage portion consisting of either alfalfa silage (0% CS; 56.4% AS in the TMR), a 50:50 mixture of both silages (50% CS; 28.2% AS and 28.2% CS in the TMR), or corn silage (100% CS; 56.4% CS in the TMR). Increasing the CS proportion (i.e., at the expense of AS) in the diet was achieved by decreasing the corn grain proportion and increasing that of soybean meal. Intake of DM and milk yield increased quadratically, whereas DM digestibility increased linearly as the proportion of CS increased in the diet. Increasing the dietary CS proportion resulted in changes (i.e., lower ruminal pH and acetate:propionate ratio, reduced fiber digestibility, decreased protozoa numbers, and lower milk fat and higher milk protein contents) typical of those observed when cows are fed high-starch diets. A quadratic response in daily CH4 emissions was observed in response to increasing the proportion of CS in the diet (440, 483, and 434 g/d for 0% CS, 50% CS, and 100% CS, respectively). Methane production adjusted for intake of DM, and gross or digestible energy was unaffected in cows fed the 50% CS diet, but decreased in cows fed the 100% CS diet (i.e., quadratic effect). Increasing the CS proportion in the diet at the expense of AS improved N utilization, as reflected by the decreases in ruminal NH3 concentration and manure N excretion, suggesting low potential NH3 and N2O emissions. Results from this study, suggest that total replacement of AS with CS in dairy cow diets offers a means of decreasing CH4 output and N losses. However, the reduction in fiber degradation and the resulting increase in volatile solids content of the manure may lead to increased CH4 emissions from manure storage.

Effects of increasing amounts of corn dried distillers grains with solubles in dairy cow diets on methane production, ruminal fermentation, digestion, N balance, and milk production.

The objective of this study was to examine the effects of including corn dried distillers grains with solubles (DDGS) in the diet at the expense of corn and soybean meal on enteric CH4 emissions, ruminal fermentation characteristics, digestion (in sacco and apparent total-tract digestibility), N balance, and milk production of dairy cows. Twelve lactating Holstein cows were used in a triplicated 4×4 Latin square design (35-d periods) and fed (ad libitum intake) a total mixed ration containing (dry matter basis) 0, 10, 20, or 30% DDGS. Dry matter intake increased linearly, whereas apparent-total tract digestibility of dry matter and gross energy declined linearly as DDGS level in the diet increased. Increasing the proportion of DDGS in the diet decreased the acetate:propionate ratio, but this decrease was the result of reduced acetate concentration rather than increased propionate concentration. Milk yield increased linearly (up to +4kg/d) with increasing levels of DDGS in the diet and a tendency was observed for a quadratic increase in energy-corrected milk as the proportion of DDGS in the diet increased. Methane production decreased linearly with increasing levels of DDGS in the diet (495, 490, 477, and 475 g/d for 0, 10, 20, and 30% DDGS diets, respectively). When adjusted for gross energy intake, CH4 losses also decreased linearly as DDGS proportion increased in the diet by 5, 8, and 14% for 10, 20, and 30% DDGS diets, respectively. Similar decreases (up to 12% at 30% DDGS) were also observed when CH4 production was corrected for digestible energy intake. When expressed relative to energy-corrected milk, CH4 production declined linearly as the amount of DDGS increased in the diet. Total N excretion (urinary and fecal; g/d) increased as the amount of DDGS in the diet increased. Efficiency of N utilization (milk N secretion as a proportion of N intake) declined linearly with increasing inclusion of DDGS in the diet. However, productive N increased linearly with increasing proportions of DDGS in the diet, suggesting better efficiency of N use by the animal. Results from this study show that feeding DDGS to dairy cows can help to mitigate enteric CH4 emissions without negatively affecting intake and milk production.

Rumen fermentation and microbial population in lactating dairy cows receiving diets containing oilseeds rich in C-18 fatty acids.

Sixteen Holstein rumen-cannulated primiparous milking dairy cows were fed a control diet (CN) based on maize silage and soyabean meal during a 4-week period before the start of a 21-d experiment with oilseeds containing high concentration of linoleic acid (Linola™) or linolenic acid (NuLin™). Thereafter, four cows received ad libitum one of each of four dietary treatments comprising of CN, Linola (LN), NuLin (NL) and LN/NL (50/50 % combination). Each LN, NL and LN/NL treatment contained 6 % oil of DM. Rumen digesta samples were collected on days 6, 11, 16 and 21 and milk samples on days 13, 15 and 17. There were no effects (P>0.05) of the oilseeds on pH and concentrations of NH3-N and total volatile fatty acids, while the acetate:propionate ratio was decreased (P< 0.05). The oilseeds also decreased (P< 0.05) protozoa and increased (P< 0.1) total cellulolytic bacteria in rumen fluid, especially when containing high dietary linoleic acid (P< 0.05). The milk protein concentration was increased (P< 0.1) by the dietary linoleic acid, which produced most beneficial results. It was concluded that supplements of linoleic acid in diets of ruminants might contribute to better digestion of dietary fibre and increased quality of milk.

Supplementation of increasing amounts of linseed oil to dairy cows fed total mixed rations: effects on digestion, ruminal fermentation characteristics, protozoal populations, and milk fatty acid composition.

The effect of linseed oil (LO) supplementation on nutrient digestibility, forage (i.e., timothy hay) in sacco ruminal degradation, ruminal fermentation characteristics, protozoal populations, milk production, and milk fatty acid (FA) profile in dairy cows was investigated. Four ruminally cannulated, primiparous lactating cows were used in a 4 × 4 Latin square design (28-d periods). They were fed a total mixed ration (50:50 forage:concentrate (F:C) ratio [dry matter (DM) basis] without supplementation (control, CTL), or supplemented (wt/wt; DM basis) with LO at 2, 3, or 4%. Supplementation with LO had no effect on DM intake (19 kg/d) and apparent total-tract digestibility of nutrients (organic matter, neutral detergent fiber, acid detergent fiber, starch, and gross energy). Ruminal pH, ammonia, and total volatile FA concentrations were not changed by LO supplementation to diets. Extent of changes in volatile FA pattern and effective ruminal degradability of DM of timothy hay were minor. Neither the total numbers nor the genera distribution of protozoa was changed by the addition of increasing amounts of LO to the diet. Milk yield increased linearly (26.1, 27.3, 27.4, and 28.4 kg/d for CTL to LO4, respectively) as the amount of LO added to the diet increased. Milk fat content was not affected by LO supplementation, whereas milk protein content decreased linearly with increasing amounts of LO in the diet. Milk fat proportions of several intermediates of ruminal biohydrogenation of polyunsaturated FA (i.e., trans-10 18:1, trans-11 18:1, cis-9,trans-11 18:2, trans-11,cis-15 18:2, and cis-9,trans-11,cis-15 18:3) increased linearly with LO addition to the diet. The proportion of cis-9,cis-12 18:2 decreased linearly (2.06, 1.99, 1.91, and 1.83% for CTL to LO4, respectively) as the amount of LO in the diet increased. Milk fat content of cis-9,cis-12,cis-15 18:3 increased as the level of LO in the diet increased up to 3% but no further increase was observed when 4% of LO was fed (0.33, 0.79, 0.86, and 0.86% for CTL to LO4, respectively). A similar quadratic response to LO supplementation was also observed for cis-5,cis-8,cis-11,cis-14,cis-17 20:5 and cis-5,cis-7,cis-10,cis-13,cis-16 22:5. The results of the present study show that LO can be safely supplemented up to 4% in forage-based diets of dairy cows to enrich milk with potential health beneficial FA (i.e., n-3 FA) without causing any detrimental effects on rumen function, digestion, and milk production.

[ORION®: a simple and effective method for systemic analysis of clinical events and precursors occurring in hospital practice]. / Méthode Orion(®) : analyse systémique simple et efficace des événements cliniques et des précurseurs survenant en pratique médicale hospitalière.

PURPOSE: Morbimortality review is now recommended by the French Health Authority (Haute Autorité de santé [HAS]) in all hospital settings. It could be completed by Comités de retour d'expérience (CREX), making systemic analysis of event precursors which may potentially result in medical damage. As commonly captured by their current practice, medical teams may not favour systemic analysis of events occurring in their setting. They require an easy-to-use method, more or less intuitive and easy-to-learn. It is the reason why ORION(®) has been set up. METHODS: ORION(®) is based on experience acquired in aeronautics which is the main precursor in risk management since aircraft crashes are considered as unacceptable even though the mortality from aircraft crashes is extremely low compared to the mortality from medical errors in hospital settings. The systemic analysis is divided in six steps: (i) collecting data, (ii) rebuilding the chronology of facts, (iii) identifying the gaps, (iv) identifying contributing and influential factors, (v) proposing actions to put in place, (vi) writing the analysis report. When identifying contributing and influential factors, four kinds of factors favouring the event are considered: technical domain, working environment, organisation and procedures, human factors. Although they are essentials, human factors are not always considered correctly. The systemic analysis is done by a pilot, chosen among people trained to use the method, querying information from all categories of people acting in the setting. RESULTS: ORION(®) is now used in more than 400 French hospital settings for systemic analysis of either morbimortality cases or event precursors. It is used, in particular, in 145 radiotherapy centres for supporting CREX. CONCLUSION: As very simple to use and quasi-intuitive, ORION(®) is an asset to reach the objectives defined by HAS: to set up effective morbi-mortality reviews (RMM) and CREX for improving the quality of care in hospital settings. By helping the efforts of medical teams, ORION(®) is an essential tool contributing to the patients' security.

Abomasal or ruminal administration of flax oil and hulls on milk production, digestibility, and milk fatty acid profile of dairy cows.

Four ruminally fistulated primiparous lactating Holstein cows were assigned to a 4 × 4 Latin square design to determine the effects of the site of administration (rumen or abomasum) of flax oil and flax hulls on diet digestibility and milk fatty acid profile of dairy cows. The treatments were 1) oil and hulls administered in the rumen and abomasal infusion of water (RUM/RUM), 2) oil and hulls infused in the abomasum (ABO/ABO), 3) oil administered in the rumen and hulls infused in the abomasum (RUM/ABO), and 4) oil infused in the abomasum and hulls placed in the rumen (ABO/RUM). Cows on the ABO/ABO and RUM/RUM treatments had the highest and lowest amounts of basal dry matter eaten, respectively. Higher dry matter digestibility was obtained when flax oil bypassed the rumen (ABO/ABO and ABO/RUM) compared with when flax oil was administered directly in the rumen (RUM/ABO and RUM/RUM). Apparent digestibility of ether extract was higher when flax hulls were administered in the rumen (RUM/RUM and ABO/RUM) compared with when flax hulls were infused in the abomasum (ABO/ABO and RUM/ABO). The lowest digestibility of acid detergent fiber and neutral detergent fiber was obtained when both flax products were added in the rumen, which may be attributed to the high amount of oil present in the rumen (7.8% of total dry matter input). The lowest yield of 4% fat-corrected milk was obtained for cows on the RUM/RUM treatment, probably as a result of lower dry matter intake and digestibility of fiber. Milk concentrations of protein, fat, total solids, and lactose were similar among treatments. Administration of oil and hulls in the rumen resulted in the highest concentrations of intermediate products of biohydrogenation and total trans fatty acids in milk fat compared with the other treatments. All ratios of n-6 to n-3 fatty acids in milk fat were lower than the 4 to 1 ratio recommended to improve human health. These results suggest that the presence of both flax oil and flax hulls in the rumen decreases 4% fat-corrected milk yield and digestibility but provides a desirable fatty acid profile of milk to enhance consumers' health.

[From Crex mutualisation to clinical audit]. / De la mutualisation des comités de retour d'expérience (Crex) à l'audit des pratiques cliniques.

In mid-2004, following a Mission nationale d'expertise et d'audits hospitaliers (MeaH) proposal, three voluntary cancer centres started setting up a safety procedure in radiotherapy. Their work made it possible to single out the need to continue elaborating a repository, aiming at a "minimal written reference", to take into account the human factor as one of the four families of factors contributing to a systemic deviation and to build collectively, in radiotherapy departments, the experience feedback committee (comité de retour d'expérience [Crex]). Formalizing a comité de retour d'expérience is unavoidable in any safety-management system (SMM or MGS). The comité de retour d'expérience enables every active member of a department to listen to any of the events of the month (incidents and precursors), to select the event which will be under scrutiny for the next systemic analysis (Orion(©) method) and above all to choose the most appropriate correcting action and ensure its proper implementation. That approach has been approved and then acknowledged by the Autorité de sûreté nucléaire (ASN) before being extended to the other radiotherapy departments. The use of the comité de retour d'expérience, which is a safety management tool, should not be limited to a local circle of insiders, but shared to benefit everybody. Putting comité de retour d'expérience together - a move that was hoped for and brought up as soon as the tool was created - is now being implemented. Several initiatives have already permitted to assess its collective interest; other steps have yet to be taken to enable a true collective sharing of experience. On this basis, the definition of quality/safety practices in radiotherapy will allow the professionals to implement clinical audits in 2012.

Milk composition, milk fatty acid profile, digestion, and ruminal fermentation in dairy cows fed whole flaxseed and calcium salts of flaxseed oil.

Four ruminally lactating Holstein cows averaging 602+/-25 kg of body weight and 64+/-6 d in milk at the beginning of the experiment were randomly assigned to a 4 x 4 Latin square design to determine the effects of feeding whole flaxseed and calcium salts of flaxseed oil on dry matter intake, digestibility, ruminal fermentation, milk production and composition, and milk fatty acid profile. The treatments were a control with no flaxseed products (CON) or a diet (on a dry matter basis) of 4.2% whole flaxseed (FLA), 1.9% calcium salts of flaxseed oil (SAL), or 2.3% whole flaxseed and 0.8% calcium salts of flaxseed oil (MIX). The 4 isonitrogenous and isoenergetic diets were fed for ad libitum intake. Experimental periods consisted of 21 d of diet adaptation and 7 d of data collection and sampling. Dry matter intake, digestibility, milk production, and milk concentrations of protein, lactose, urea N, and total solids did not differ among treatments. Ruminal pH was reduced for cows fed the CON diet compared with those fed the SAL diet. Propionate proportion was higher in ruminal fluid of cows fed CON than in that of those fed SAL, and cows fed the SAL and CON diets had ruminal propionate concentrations similar to those of cows fed the FLA and MIX diets. Butyrate concentration was numerically higher for cows fed the SAL diet compared with those fed the FLA diet. Milk fat concentration was lower for cows fed SAL than for those fed CON, and there was no difference between cows fed CON and those fed FLA and MIX. Milk yields of protein, fat, lactose, and total solids were similar among treatments. Concentrations of cis-9 18:1 and of intermediates of ruminal biohydrogenation of fatty acids such as trans-9 18:1 were higher in milk fat of cows fed SAL and MIX than for those fed the CON diet. Concentration of rumenic acid (cis-9, trans-11 18:2) in milk fat was increased by 63% when feeding SAL compared with FLA. Concentration of alpha-linolenic acid was higher in milk fat of cows fed SAL and MIX than in milk of cows fed CON (75 and 61%, respectively), whereas there was no difference between FLA and CON. Flaxseed products (FLA, SAL, and MIX diets) decreased the n-6 to n-3 fatty acid ratio in milk fat. Results confirm that flax products supplying 0.7 to 1.4% supplemental fat in the diet can slightly improve the nutritive value of milk fat for better human health.

Nutritional sub-fertility in the dairy cow: towards improved reproductive management through a better biological understanding.

There has been a significant decline in the reproductive performance of dairy cattle in recent decades. Cows, take longer time to return to the oestrus after calving, have poorer conception rates, and show fewer signs of oestrus. Achieving good reproductive performance is an increasing challenge for the dairy producer. In this study we focus on understanding the overall biological phenomena associated with nutritional sub-fertility rather than the underlying multiplicity of physiological interactions (already described in a number of recent studies). These phenomena are important because they represent the natural adaptations of the animal for dealing with variations in the nutritional environment. They can also be used to monitor and modulate reproductive performance on-farm. There is an underlying trade-off between two aspects of reproduction: investment in the viability of the current calf and investment in future offspring. As the investment in, and viability of, the current calf is related to maternal milk production, we can expect that level of milk production per se has effects on subsequent reproductive performance (investment in future offspring). Lactating cows have a lower proportion of viable embryos, which are of poorer quality, than do non-lactating cows. The same applies to high- compared to medium-genetic merit cows. Another important biological property is the adaptive use of body reserves in support of reproduction. Orchestrated endocrine changes in pregnancy and lactation facilitate the deposition of body lipid during pregnancy and mobilisation in early lactation. When the cow fails to accumulate the reserves she needs to safeguard reproduction she delays committing to further reproductive investment. But how does the cow 'know' that she is failing in energy terms? We argue that the cow does this by 'monitoring' both the body fat mobilisation and body fatness. Excessive body fat mobilisation indicates that current conditions are worse than expected. Body fatness indicates the future ability of the cow to safeguard her reproductive investment is compromised. Both delay further reproductive commitment. The relationship between reproductive performance and; milk production as an index of maternal investment, body fatness as an index of ability to safeguard reproductive investment, and body fat mobilisation as an index of the current nutritional environment - are examined. Nutritional strategies that seek to modulate body mobilisation and the endocrine environment by use of glucogenic and lipogenic diets, and the use of in-line progesterone profiles to monitor reproductive status are then discussed in this biological context.