Effects of starch content of calf starter on rumen properties and blood concentrations of metabolites and hormones in dairy calves under a high plane of milk feeding.

The objective of this study was to investigate the effects of calf starters with different starch content on rumen and blood properties in calves fed under a high plane of nutrition program. Twenty-seven Holstein calves (14 female, 13 male) were assigned to one of three starter treatment groups in a randomized block design: high-starch (41.8%) (n = 9), H; medium-starch (31.9%) (n = 9), M; low-starch (22.0%) (n = 9), L. Milk replacer on powder basis was fed up to 1.2 kg/day as fed, gradually reduced from 6 weeks of age; calves were weaned at 8 weeks of age. Each starter (up to 3.5 kg/day as fed) and chopped hay were provided ad libitum from 5 days of age. Blood was collected from 4 to 13 weeks of age. Rumen fluid was collected at 6, 8, 10, and 13 weeks of age. Serum urea nitrogen concentration after weaning was the lowest in H. Plasma IGF-1 concentrations were higher in H than in L. Ruminal pH was not different, but the molar proportion of ruminal propionate was higher in H than in L throughout the study period. In summary, a high-starch starter may increase propionate production and microbial protein synthesis in the rumen, inducing higher plasma IGF-1 concentrations.

Effects of starch content of calf starter on feed intake, growth performance, and fecal properties in dairy calves under a high plane of milk replacer feeding.

The objective of this study was to investigate the effects of different starch contents in calf starter on the growth, feed intake, and fecal characteristics in dairy calves fed under a high plane of nutrition. Twenty-seven Holstein calves were assigned equally to one of three calf starter treatment groups in a randomized block design: high (H) starch (41.8%); medium (M) starch (31.9%); and low (L) starch (22.0%). Milk replacer was fed up to 1.2 kg/day as fed, gradually reduced from 6 weeks of age; calves were weaned at 8 weeks of age. Each starter (up to 3.5 kg/day as fed) and chopped hay were provided ad libitum from 5 days of age. Fecal samples, along with body measurements, were collected from 4 to 13 weeks of age. The average daily gain after weaning was greater in the H group than in the L group. The average starter intake for 3 days before weaning was not different among treatments but was greater after weaning in the H group than in the L group. Starter starch content did not affect the number of days with diarrhea or fecal starch concentration. The high-starch starter had no adverse effects during the weaning transition.

Impact of COVID-19 on pediatric surgery cancellations: A retrospective study.

BACKGROUND: Prevalence trends and reasons for pediatric surgery cancellation in Japan during the coronavirus disease 2019 (COVID-19) pandemic have not previously been reported. This study aimed to compare the prevalence and reasons for cancellation of pediatric surgeries in Japan before and during the COVID-19 pandemic. METHODS: This single-center retrospective cohort study reviewed the reasons for surgery cancellations scheduled for patients aged <18 years between the prepandemic period (September 2017-December 2019) and the COVID-19 pandemic period (January 2020-April 2022). The cancellation reasons were classified into four major categories: medical, surgical, patient-related, and administrative. RESULTS: Of the 3395 and 3455 surgeries scheduled before and during the COVID-19 pandemic, 305 (9.0%) and 319 (9.2%) surgeries were canceled (p = 0.737), respectively. The proportion of cancellations due to infections or fever in medical reasons decreased from 67.9% to 56.1% (p = 0.003) and that due to patient-related reasons increased from 6.6% to 15.1% (p = 0.001). Further, the proportion of cancellations due to staff shortages in staff administrative reasons increased from 0.3% to 3.1% (p = 0.011). There was no significant difference in the proportion of surgeries canceled due to surgical reasons between the two periods. CONCLUSIONS: The proportion of cancellations due to infections or fever decreased during the COVID-19 pandemic, while that due to staff shortages increased. Infection prevention is an important measure to address the staff shortages. Implementation of national or regional policies and additional strategic interventions may be required to prepare for disasters like the COVID-19 pandemic.

Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviews.

OBJECTIVE: The COVID-19 pandemic has impacted the capacity for advance care planning (ACP) among patients, families and healthcare teams. We sought to identify and review the barriers to and facilitators of ACP implementation for medical staff in different settings (eg, hospitals, outpatient palliative care, nursing and care homes) during the pandemic. DESIGN: This study employed an overview of reviews design. We searched the MEDLINE, CENTRAL, Web of Science and Embase databases for studies published between 8 December 2019 and 30 July 2023. We used AMSTAR 2 to assess the risk of bias. RESULTS: We included seven reviews. Common barriers to ACP implementation included visitation restrictions, limited resources and personnel and a lack of coordination among healthcare professionals. In care and nursing homes, barriers included a dearth of palliative care physicians and the psychological burden on facility staff. Using telemedicine for information sharing was a common facilitator across settings. In hospitals, facilitators included short-term training in palliative care and palliative care physicians joining the acute care team. In care and nursing homes, facilitators included ACP education and emotional support for staff. CONCLUSIONS: Visitation restrictions and limited resources during the pandemic posed obstacles; however, the implementation of ACP was further hindered by insufficient staff education on ACP in hospitals and facilities, as well as a scarcity of information sharing at the community level. These pre-existing issues were magnified by the pandemic, drawing attention to their significance. Short-term staff training programmes and immediate information sharing could better enable ACP. PROSPERO REGISTRATION NUMBER: CRD42022351362.

Comparison of Postextubation Complications Between Positive-Pressure and Suctioning Techniques: A Systematic Review.

BACKGROUND: Several studies have investigated postextubation complications of the positive-pressure and suctioning techniques; however, these studies yielded inconsistent results. Therefore, in this systematic review, we aimed to assess and compare the risk of complications between these techniques after extubation. METHODS: This study was registered with the International Prospective Register of Systematic Reviews (CRD42021272068). We searched for randomized controlled trials (RCT) or observational studies that compared positive-pressure and suctioning extubation techniques in medical literature databases. Our search was conducted from the databases' inception to July 7, 2022. The included studies were assessed for quality by using a risk of bias tool. RESULTS: Six RCTs and 1 non-randomized controlled study were included in this systematic review (N = 1,575 subjects), wherein the positive-pressure and suctioning techniques were applied to 762 and 813 subjects, respectively. Three studies were conducted in operating rooms, and 4 studies were conducted in ICUs. Five studies were conducted among adults, and 2 studies were conducted among children or neonates. All the studies except 1 RCT showed that the positive-pressure technique tended to have a lower but not statistically different risk of complications, including desaturation, airway obstruction, pneumonia, aspiration, atelectasis, and re-intubation, than the suctioning technique. Three of the 6 RCTs were determined to have a high risk of bias and the 1 non-randomized controlled study was determined to have a serious risk of bias. CONCLUSIONS: The positive-pressure technique tended to have a lower risk of complications than the suctioning technique. Further high-quality studies are warranted.

Effective Treatment of Intraoperative Hiccups With Chlorpromazine Under General Anesthesia Without Muscle Relaxants: A Case Report.

Hiccups are common reflexes and many treatment methods have been reported. Chlorpromazine is a known treatment option for hiccups, but its efficacy under general anesthesia remains unclear. We report the case of a patient with vagal schwannoma who developed hiccups while under general anesthesia. Muscle relaxants were not used because the patient was under neuromonitoring. The depth of anesthesia was deepened; however, the hiccups did not disappear. The hiccups were relieved by intravenous chlorpromazine administration (total; 5 mg), which allowed for surgery under neuromonitoring. This case indicates that chlorpromazine may be effective to treat hiccups under general anesthesia.

Effects of motor imagery combined with action observation training on the lateral specificity of muscle strength in healthy subjects.

Unilateral training of both lateral limbs increases unilateral muscle strength, whereas bilateral training increases bilateral muscle strength, a phenomenon known as lateral specificity in resistance training. Although motor imagery (MI) combined with action observation (AO) (i.e., MI + AO) training increases muscle strength, it is not completely understood whether such training increases the lateral specificity of muscle strength in a way resistance training does. To investigate whether MI + AO induces lateral specificity of muscle strength increase, 18 healthy subjects were divided into groups: MI + AO and the control groups. The control group watched a movie of natural sceneries for ten minutes per day five times a week for three weeks, whereas the MI + AO group imagined bilateral shoulder flexion while watching a movie of athletes performing bilateral shoulder flexion with barbells or dumbbells, with the same time schedule. The MI + AO group alone showed a significant increase in bilateral shoulder strength at three weeks after the intervention compared with the baseline. Unilateral shoulder strength was not significantly altered. These results suggest that MI + AO training increases muscle strength, providing evidence that similar to resistance training, lateral specificity also exists in MI + AO training.

Evaluation of bilateral force deficit in shoulder flexion using a handheld dynamometer in healthy subjects.

[Purpose] This study aimed to develop a simple, inexpensive, and accurate method for measuring the strength of shoulder flexion (Experiment 1) and evaluate the bilateral force deficit in shoulder flexion (Experiment 2) in healthy subjects. [Subjects and Methods] In Experiment 1, maximal voluntary contractions (MVCs) in isometric shoulder flexion were measured on both sides using an isometric dynamometer (ID) and a hand-grip dynamometer (HGD), as an alternative dynamometer, in six subjects. In Experiment 2, bilateral force deficit was evaluated using HGD in 21 subjects who performed unilateral and bilateral MVCs in isometric flexions of the shoulder. The peak value of electromyography (PVE) in the lateral head of the biceps brachii and anterior deltoid was measured during MVCs. [Results] In Experiment 1, ID and HGD showed almost similar coefficients of variation. A strong positive correlation was found between the values obtained using the two methods. In Experiment 2, the bilateral force deficit in shoulder flexion associated with a reduced PVE (‒10.9%) was found in 85.7% of subjects. [Conclusion] The reproducibility of measurements was similar between ID and HGD. HGD could evaluate the bilateral force deficit in shoulder flexion and is a practical tool for measuring shoulder strength.