Concurrent and carryover effects of feeding blends of protein and amino acids in high-protein diets with different concentrations of forage fiber to fresh cows. 2. Protein balance and body composition.

Increasing the supply of metabolizable protein (MP) and improving its AA profile may attenuate body protein mobilization in fresh cows and lead to increased milk production. Increasing the concentration of rumen-undegradable protein (RUP) to increase MP supply and replacing RUP sources from forages instead of nonforage fiber sources may further decrease tissue mobilization if it improves dry matter intake (DMI). Our objective was to determine whether increasing MP concentrations and improving the AA profile at the expense of either nonforage or forage fiber (fNDF) would affect MP balance and empty body (EB) composition (measured using the urea dilution method) in early postpartum dairy cows of different parities. In a randomized block design, 40 primigravid [77 ± 1.5 kg of EB crude protein (CP) at 8 ± 0.6 d before calving] and 40 multigravid (92 ± 1.6 kg of EB CP at 5 ± 0.6 d before calving) Holsteins were blocked by calving date and fed a common prepartum diet (11.5% CP). After calving to 25 d in milk (DIM), cows were fed 1 of 4 diets: (1) a diet deficient in MP meeting 87% of MP requirements (DMP, 17% CP, 24% fNDF), (2) 104% of MP requirements using primarily soy protein to make MP adequate (AMP, 20% CP, 24% fNDF), (3) 110% of MP requirements using a blend of proteins and rumen-protected (RP) AA to make MP adequate (Blend, 20% CP, 24% fNDF), or (4) a diet similar to Blend but substituting added RUP for fNDF rather than nonforage NDF (Blend-fNDF, 20% CP, 19% fNDF). Blend was formulated to have a RUP supply with a similar AA profile to that of casein. Cows were fed a common diet (16.3% CP) from 26 to 50 DIM. Calculated MP balance (supply - requirements) was less than zero for DMP and Blend-fNDF from 1 to 4 wk of lactation (WOL), whereas that for AMP was positive from 1 to 4 WOL and that for Blend was close to zero from 3 to 4 WOL. Daily MP balance was greater from 5 to 7 WOL for DMP compared with AMP and Blend (100 vs. 22 g/d). From -7 to 7 d relative to calving, losses of EB CP were greater for DMP than for AMP and Blend (-121 vs. average of 11 g/d). From 7 to 25 DIM, cows fed AMP (-139 g/d) and Blend-fNDF (-147 g/d) lost EB CP but cows fed Blend (-8 g/d) maintained EB CP. Increased DMI for Blend versus AMP led to reduced losses of EB lipid in primiparous cows from 7 to 25 d relative to calving (-1.0 vs. -1.3 kg/d of EB lipid), whereas lipid mobilization was similar in multiparous cows (average -1.1 kg of EB lipid/d). By 50 DIM, EB lipid and CP were similar across treatments and parities (average 60.2 kg of EB lipid and 81.6 kg of EB CP). Overall, feeding fresh cows a high MP diet with a balanced AA profile improved DMI and attenuated EB CP mobilization, which could partly explain positive carryover effects on milk production for multiparous cows and reduced lipid mobilization for primiparous cows.

Concurrent and carryover effects of feeding blends of protein and amino acids in high-protein diets with different concentrations of forage fiber to fresh cows. 1. Production and blood metabolites.

Because of low feed intake during the first weeks of lactation, dietary concentration of metabolizable protein (MP) must be elevated. We evaluated effects of providing additional rumen-undegradable protein (RUP) from a single source or a blend of protein and AA sources during the first 3 wk of lactation. We also evaluated whether replacing forage fiber (fNDF) or nonforage fiber with the blend affected responses. In a randomized block design, at approximately 2 wk prepartum, 40 primigravid (664 ± 44 kg of body weight) and 40 multigravid (797 ± 81 kg of body weight) Holsteins were blocked by calving date and fed a common diet (11.5% crude protein, CP). After calving to 25 d in milk (DIM), cows were fed 1 of 4 diets formulated to be (1) 20% deficient in metabolizable protein (MP) based on predicted milk production (17% CP, 24% fNDF), (2) adequate in MP using primarily RUP from soy to increase MP concentration (AMP; 20% CP, 24% fNDF), (3) adequate in MP using a blend of RUP and rumen-protected AA sources to increase MP concentration (Blend; 20% CP, 24% fNDF), or (4) similar to Blend but substituting fNDF with added RUP rather than nonforage neutral detergent fiber (Blend-fNDF; 20% CP, 19% fNDF). The blend was formulated to have a RUP supply with an AA profile similar to that of casein. A common diet (17% CP) was fed from 26 to 92 DIM, and milk production and composition were measured from 26 to 92 DIM, but individual dry matter intake (DMI) was measured only until 50 DIM. During the treatment period for both parities, AMP and Blend increased energy-corrected milk (ECM) yields compared with the diet deficient in MP based on predicted milk production (40.7 vs. 37.8 kg/d) and reduced concentrations of plasma 3-methyl-His (4.1 vs. 5.3 µmol/L) and growth hormone (9.0 vs. 11.9 ng/mL). Blend had greater DMI than AMP (17.4 vs. 16.1 kg/d), but ECM yields were similar. Blend had greater plasma Met (42.0 vs. 26.4 µmol/L) and altered metabolites associated with antioxidant production and methyl donation compared with AMP. Conversely, the concentration of total essential AA in plasma was less in Blend versus AMP (837 vs. 935 µmol/L). In multiparous cows, Blend-fNDF decreased DMI and ECM yield compared with Blend (19.2 vs. 20.1 kg/d of DMI, 45.3 vs. 51.1 kg/d of ECM), whereas primiparous cows showed the opposite response (15.3 vs. 14.6 kg/d of DMI, 32.9 vs. 31.4 kg/d of ECM). Greater DMI for multiparous cows fed Blend carried over from 26 to 50 DIM and was greater compared with AMP (23.1 vs. 21.2 kg /d) and Blend-fNDF (21.3 kg/d). Blend also increased ECM yield compared with AMP (49.2 vs. 43.5 kg/d) and Blend-fNDF (45.4 kg/d) from 26 to 92 DIM. Few carryover effects of fresh cow treatments on production were found in primiparous cows. Overall, feeding blends of RUP and AA may improve the balance of AA for fresh cows fed high MP diets and improve concurrent and longer-term milk production in multiparous cows. However, with high MP diets, multiparous fresh cows require greater concentrations of fNDF than primiparous cows.

[Nerve transfer in patients with tetraplegia: improvement in hand function]. / Zenuwtransfer bij patiënten met een tetraplegie.

Reconstruction of arm and hand function in patients with a cervical spinal cord injury can improve their quality of life. Elbow extension, wrist extension, grip function and opening of the hand can be reconstructed. Traditionally, this has been done through tendon transpositions. Nerve transfer is a new technique. A functioning motor nerve branch is moved and connected to a muscle or muscle group damaged by the spinal cord injury. This technique has several advantages. Multiple functions can be restored by one nerve transfer, no long-term hand-rehabilitation is required and there is no risk of adhesions of the transposition. The most important disadvantage is the recovery time, as a results of the slow ingrowth of the nerve transfer, which takes at least 12 to 18 months. For each spinal cord injury patient, an individual action plan must be made, because not every patient has the same options and these are sometimes very limited.

Effects of oscillating dietary crude protein concentrations on production, nutrient digestion, plasma metabolites, and body composition in lactating dairy cows.

We hypothesized that dairy cows fed oscillating metabolizable protein (MP) and crude protein (CP) concentrations on a 24-h frequency for a diet formulated to be below MP requirements would use N more efficiently (i.e., increased milk protein yields and less manure N) without increasing mobilization of body protein stores than would cows fed the same deficient MP diet continuously, although both treatments would on average have equal MP concentrations. In a randomized block design, 30 Holstein cows (119 ± 21 d in milk; 667 ± 69 kg of body weight) were blocked according to milk yield within a parity (3 primiparous and 7 multiparous blocks) and fed 1 of 3 treatments: (1) diet with 16.2% CP (109% of MP requirements) fed continuously (109MP), (2) diet with 14.1% CP (95% of MP requirements) fed continuously (95MP), or (3) diets oscillating on a 24-h cycle from the 109MP diet and a diet with 11.9% CP (∼78% of MP requirements) such that average CP and MP concentration would be the same as 95MP (OSC). Dry matter intake was similar between 109MP and 95MP (22.9 vs. 23.2 kg/d) but tended to be lower for OSC (22.2 kg/d) compared with 95MP. Milk yield was greater for 109MP compared with 95MP (36.6 vs. 35.1 kg/d) and similar between 95MP and OSC (35.3 kg/d). Milk protein and energy-corrected milk yields were similar among treatments. Milk urea N (MUN) concentration was higher for 109MP compared with 95MP (12.8 vs. 10.2 mg/dL), and tended to be higher for OSC (10.9 mg/dL) compared with 95MP. Higher MUN concentration for OSC occurred despite lower N intake (474 vs. 512 g of N/d) and similar milk N outputs compared with 95MP (164 vs. 179 g/d). On days when cows on OSC were fed high versus low MP diets, yields of milk (34.8 vs. 36.3 kg/d) and milk protein (1.0 vs. 1.1 kg/d) and MUN concentration (9.3 vs. 12.5 mg/dL) followed the oscillation pattern but lagged the change in diet CP by 1 d, whereas dry matter intake, yields of milk fat, plasma energy metabolites, AA, and 3-methyl-His were similar between days. Nutrient digestibility was similar for major nutrients across treatments except for CP, which was greater for 109MP (65.2%) and OSC (65.3%) compared with 95MP (61.7%). Compared with 95MP, OSC did not increase milk N relative to N intake (averaged 0.35 g of milk N/g of N intake) or N balance; however, urinary N output was increased for OSC versus 95MP (0.32 vs. 0.24 g of urine N/g of N intake). Body composition estimated using urea dilution was similar across treatments, and all cows accreted lipid and energy during the trial. Empty body CP did not change over the 50-d treatment period. Overall, greater CP digestion, urinary N excretion, and MUN concentrations with lesser N intake and similar milk N outputs for OSC compared with 95MP suggests that the lower energy intake by OSC cows may have limited potential responses to altered N metabolism.

Short communication: Effects of drying and analytical methods on nitrogen concentrations of feeds, feces, milk, and urine of dairy cows.

Nitrogen concentrations in feeds, feces, milk, and urine samples were measured using 2 analytical methods following different drying procedures. Ten samples of corn silage, alfalfa silage, and concentrates collected from 2017 to 2018 at Krauss Dairy Research Center, The Ohio State University (Wooster), were used. A 4-d total collection digestion trial provided fecal samples from 10 cows (1 sample/cow), and another 10 cows were used to collect milk samples (1 sample/cow) and spot urine samples (1 sample/cow). Spot urine samples were acidified immediately to pH <3.0 when collected. Feed samples were oven dried (55°C) or lyophilized and analyzed using the Kjeldahl (KJ; copper sulfate as a catalyst) method and a combustion method (elemental analyzer; EA). Feces, urine, and milk samples were analyzed for N using the following methods: (1) fresh samples by KJ (referred to as wet KJ), (2) lyophilization (urine and milk for 8 h; feces for 120 h) followed by EA (LYO-EA), and (3) oven drying (milk and urine for 1 h; feces for 72 h at 55°C) followed by EA (OD-EA). Additionally, changes in N content of acidified urine at -20° over 180 d of storage were examined. Nitrogen concentrations in corn silage, alfalfa silage, and concentrates were greater for EA by 6.1, 4.8, and 8.3%, respectively, compared with KJ. Analysis of dried samples via EA compared with wet KJ resulted in lower fecal N content (27.8 vs. 29.3 g/kg of DM). Nitrogen concentration in fecal samples via KJ after lyophilization was lower by 5% compared with wet KJ but did not differ from LYO-EA, suggesting that N losses occurred during drying. Nitrogen determination with EA after drying of samples resulted in greater milk N (5.70 vs. 5.50 g/kg) and urinary N (9.16 vs. 9.06 g/kg) content compared with wet KJ. However, drying method (i.e., lyophilization vs. oven drying) did not affect N content of milk, urine, or feces. The use of EA resulted in lower percentage deviation of N content from duplicate sample assays for most samples (no difference was found for concentrate and fecal N), suggesting that EA was more precise than KJ. In conclusion, drying of feces caused N losses regardless of drying methods. For urine and milk samples, if drying is necessary (i.e., EA), oven drying at 55°C can be used rather than lyophilization. The N content was greater in feeds, milk, and urine when determined with EA versus KJ. In addition, N content in acidified and undiluted urine at -20° changed and should be analyzed within 90 d of storage. The results in the current study, however, did not account for laboratory-to-laboratory variation.

The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15): Validation of the Dutch version in patients with multiple sclerosis and spinal cord injury.

AIMS: The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15) evaluates symptoms of sexual dysfunction in patients with multiple sclerosis (MS). The objective of this study was to provide and validate a Dutch version of the MSISQ-15 in patients with neurological disease such as MS and spinal cord injury (SCI). METHODS: The linguistic validation process of the original English MSISQ-15 into Dutch was performed according to standardized guidelines. Sexually active patients with MS or spinal cord disorders, including SCI and cauda equine syndrome, who visited a tertiary urology center or a rehabilitation center completed the MSISQ-15, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in women, or International Index of Erection Function (IIEF-15) in men at baseline (test) and 2 weeks later (retest). A reference group recruited from a general medical practice completed the questionnaires once. Data were analyzed for measurement properties. RESULTS: Fifty-three patients with MS, 49 patients with spinal cord disorder, and 50 references were included. Content validity was adequate. Internal consistency (Cronbach's alpha >0.8) and reproducibility (intraclass correlation coefficient >0.8) of the MSISQ-15 were excellent. Patients' MSISQ-15 scores were correlated with severity of symptoms of sexual dysfunction measured by PISQ-12 or IIEF-15 and confirmed positive rating for criterion validity. MSISQ-15 scores in patients were higher than in references (on a scale of 15-75: 38.9 ± 11.4 vs 21.1 ± 5.4; P < 0.001), indicating good construct validity. CONCLUSIONS: The Dutch MSISQ-15 is a reliable and valid measure to evaluate symptoms of sexual dysfunction in patients with MS or with SCI.

Effects of spray-dried plasma protein product on early-lactation dairy cows.

Spray-dried plasma protein (SDP) compared with blood meal (BM) may contain various functional and active components that may benefit animal health. The objective of this experiment was to investigate the effects of feeding SDP or BM on production and blood profile in dairy cows during the transition and early-lactation periods. Seventy-two Holstein cows at 14 d before calving were used in a randomized block design. During the prepartum period, cows were fed a typical late-gestation diet containing BM (100 g/cow per day; 100BM, n = 24) or SDP (100 g/cow per day; 100SDP; n = 48). After calving, cows that were fed BM prepartum were fed a typical lactation diet formulated to provide 100 g/d of BM (100BM). Half the cows that were fed 100SDP prepartum were fed a lactation diet formulated to provide 100 g/d of SDP (100SDP; n = 24), and half were fed a diet formulated to provide 400 g/d of SDP (400SDP; n = 24) on a dry matter basis where SDP replaced BM (100SDP) or BM and soybean products (400SDP). All diets were balanced for crude protein concentration and metabolizable protein supply assuming BM and SDP were equal in rumen-degradable protein and rumen-undegradable protein. All data were analyzed using the MIXED procedure of SAS (SAS Institute Inc., Cary, NC) as a randomized block design where contrasts were made for 100BM versus 100SDP for prepartum variables and 100BM versus 100SDP and 100SDP versus 400SDP for postpartum variables. Prepartum supplementation of SDP had no effect on plasma fatty acids and ß-hydroxybutyrate (2 d before calving). Plasma fatty acids (255 ± 29 µEq/mL) and ß-hydroxybutyrate (675 ± 70 µmol/L) at 8 and 14 d of lactation were not affected by SDP in the diet. Feeding SDP at 100 g/d compared with 100BM increased or tended to increase milk fat, protein, and lactose contents for 16 wk after parturition. Providing SDP at 400 g/d in the diet increased milk yield (42 vs. 39 kg/d), energy-corrected milk (44 vs. 41 kg/d), energy-corrected milk per kilogram of dry matter intake, and yields of milk fat (1.60 vs. 1.48 kg/d), protein (1.21 vs. 1.16 kg/d), and lactose compared with 100SDP. Body weight losses tended to be lower for 100SDP compared with 100BM without a difference between 100SDP and 400SDP. Plasma histidine concentration (d 14 of lactation) was lower for SDP compared with 100BM. In addition, plasma 1-methyl-l-histidine tended to be lower as inclusion rate of SDP increased. In conclusion, SDP at 400 g/d increased milk and milk component yields without an increase in feed intake. Studies evaluating effects of functional and active compounds in SDP on gut microbiome, gut health, and immune functions may be needed to determine mode of action.

Evaluation of creatinine as a urine marker and factors affecting urinary excretion of magnesium by dairy cows.

Nutrient balance studies require measuring urine volume, and urinary excretion can be used to assess Mg bioavailability. A less laborious method than total collection of urine could make balance studies more feasible and expand the utility of using urinary Mg as an index of bioavailability, but the method needs to be accurate and sensitive. Sampling interval can affect accuracy because excretion must be at steady state. Two experiments were conducted to (1) determine whether urinary creatinine could be used to accurately estimate urinary output of nutrients markedly excreted via urine (N, K, Na, S, and Mg; experiment 1) and (2) determine the appropriate sampling schedule to evaluate Mg excretion after abrupt diet changes (experiment 2). Experiment 1 was originally designed to evaluate the interaction of monensin [0 vs. 14 mg of monensin/kg of dry matter (DM)] and Mg source (MgO vs. MgSO4; total diet Mg: 0.36% of DM) under antagonism from increased dietary K (2.11% of DM) on urinary Mg excretion. Experiment 2 evaluated the interaction of Mg concentration (basal vs. supplemental MgO; total diet Mg: 0.20 vs. 0.42% of DM) and K (basal vs. supplemental K2CO3; total diet K: 1.60 vs. 2.57% of DM) on urinary Mg excretion over time. Using 4-d composite samples from total collection of urine (n = 34 cow-periods), the average daily excretion of creatinine was similar to previous estimates (29.0 ± 1.16 mg of creatinine/kg of body weight) but was variable among cows (root mean squared error = 2,980 mg/d; 14% of mean). Treatment-average estimated excretion of urine and urinary N, K, Na, S, and Mg were similar to actual values; however, differences between actual and estimated values could be substantial for individual cows. Using the mean creatinine excretion per kilogram of body weight for all cows to estimate urine eliminates the lack of fit variance resulting in artificially low within-treatment variation for estimated urine volume. The standard error of the mean for estimated urine volume was 23% less (1.93 vs. 2.51) than that for actual urine production. This inflated the type I error rate, and, consequently, statistical inferences on N and K excretion differed when urine output was estimated rather than measured. The standard error of the mean for excretion of Mg calculated with actual or estimated urine production were almost identical (0.92 vs. 0.97); however, similar standard error of the mean was likely caused by differences in the covariance of urinary Mg concentration with estimated or actual urine output. Based on spot sampling (experiment 2), urinary Mg reached steady state by 2 d following an increase in dietary K regardless of Mg level, whereas excretion of urinary Mg following an increase in dietary Mg continued to increase through 7 d. Estimating nutrient excretion with urinary creatinine and body weight on average is accurate, but variance is likely underestimated. Knowing the time course of urinary Mg excretion will improve the value of using urinary Mg concentration to assess diet adequacy or Mg bioavailability.

Effects of magnesium source and monensin on nutrient digestibility and mineral balance in lactating dairy cows.

The interaction of monensin and 2 supplemental Mg sources (MgO and MgSO4) on total-tract digestion of minerals and organic nutrients and milk production was evaluated in lactating dairy cattle. Eighteen multiparous Holstein cows (139 ± 35 DIM) were used in a split-plot experiment with 0 or 14 mg/kg diet DM of monensin as the whole-plot treatments and Mg source as split-plot treatments. During the entire experiment (42 d), cows remained on the same monensin treatment but received a different Mg source in each period (21 d) of the Latin square. Diets were formulated to contain 0.35% Mg with about 40% of that provided by MgO or MgSO4. Diets were formulated to have similar concentrations of major nutrients and K concentrations were elevated (2.1% of DM) with K2CO3 to create antagonism to Mg absorption. Apparent digestibility was measured by total collection of urine and feces. Supplemental MgSO4 decreased DMI (26.9 vs. 25.7 kg/d) and tended to decrease milk yield (40.2 vs. 39.3 kg/d), but increased the digestibility of OM (68.3 vs. 69.2%) and starch (91.9 vs. 94.4%) compared with MgO. Feeding MgSO4 with monensin decreased NDF digestibility compared with other treatments (46.7 vs. 50.2%). That diet also had decreased apparent absorption of Mg compared with diets without monensin (15.6 vs. 19.2%), whereas MgO with monensin had greater apparent absorption of Mg (23.0%) than other treatments. Cows consuming MgSO4 had increased apparent Ca absorption (32.2 vs. 28.1%) and balance. A diet with MgSO4 without monensin increased the concentration of long-chain fatty acids in milk, suggesting increased mobilization of body fat or decreased de novo fatty acid synthesis in the mammary gland. Overall, when dietary Mg was similar, MgO was the superior Mg source for lactating dairy cattle, but inclusion of monensin in diets should be considered when evaluating Mg sources.

The validation of the Dutch SF-Qualiveen, a questionnaire on urinary-specific quality of life, in spinal cord injury patients.

BACKGROUND: Optimizing the patients' quality of life is one of the main goals in the urological management of spinal cord injury (SCI) patients. In this study we validated the Dutch SF-Qualiveen, a short questionnaire that measures the urinary-specific quality of life, in SCI patients. No such measure is yet available for this patient group. METHODS: In 2015-2016 SCI patients with urinary symptomatology who visited the outpatient clinics of Urology at the Erasmus Medical Centre and Rehabilitation at Rijndam Revalidation completed the SF-Qualiveen and UDI-6 during the visit and 1-2 weeks later. The UDI-6, a urinary tract symptom inventory, served as gold standard. Controls, recruited from the Otolaryngology outpatient clinic, completed the questionnaires once. Content-, construct-, and criterion validity and reliability (internal consistency and reproducibility) of the SF-Qualiveen were determined. RESULTS: Fifty seven SCI patients and 50 controls were included. 12 SCI patients asserted that the SF-Qualiveen covered their bladder problems (good content validity). Patients' SF-Qualiveen scores being positively associated with severity of urinary symptoms and patients' scores being higher than those of controls indicated good construct validity. The positive association that was found between SF-Qualiveen and UDI-6 in patients (r = 0.66-0.67, P < 0.001) and controls (r = 0.63, P < 0.001) confirmed good criterion validity. Internal consistency (Cronbach's alpha 0.89-0.92) and reproducibility (intraclass correlation coefficient 0.94) of the SF-Qualiveen were good. CONCLUSIONS: The Dutch SF-Qualiveen is a valid and reliable tool to measure the urinary-specific quality of life in SCI patients.

Effect of partitioning the nonfiber carbohydrate fraction and neutral detergent fiber method on digestibility of carbohydrates by dairy cows.

Many nutrition models rely on summative equations to estimate feed and diet energy concentrations. These models partition feed into nutrient fractions and multiply the fractions by their estimated true digestibility, and the digestible mass provided by each fraction is then summed and converted to an energy value. Nonfiber carbohydrate (NFC) is used in many models. Although it behaves as a nutritionally uniform fraction, it is a heterogeneous mixture of components. To reduce the heterogeneity, we partitioned NFC into starch and residual organic matter (ROM), which is calculated as 100 - CP - LCFA - ash - starch - NDF, where crude protein (CP), long-chain fatty acids (LCFA), ash, starch, and neutral detergent fiber (NDF) are a percentage of DM. However, the true digestibility of ROM is unknown, and because NDF is contaminated with both ash and CP, those components are subtracted twice. The effect of ash and CP contamination of NDF on in vivo digestibility of NDF and ROM was evaluated using data from 2 total-collection digestibility experiments using lactating dairy cows. Digestibility of NDF was greater when it was corrected for ash and CP than without correction. Conversely, ROM apparent digestibility decreased when NDF was corrected for contamination. Although correcting for contamination statistically increased NDF digestibility, the effect was small; the average increase was 3.4%. The decrease in ROM digestibility was 7.4%. True digestibility of ROM is needed to incorporate ROM into summative equations. Data from multiple digestibility experiments (38 diets) using dairy cows were collated, and ROM concentrations were regressed on concentration of digestible ROM (ROM was calculated without adjusting for ash and CP contamination). The estimated true digestibility coefficient of ROM was 0.96 (SE = 0.021), and metabolic fecal ROM was 3.43 g/100 g of dry matter intake (SE = 0.30). Using a smaller data set (7 diets), estimated true digestibility of ROM when calculated using NDF corrected for ash and CP contamination was 0.87 (SE = 0.025), and metabolic fecal ROM was 3.76 g/100 g (SE = 0.60). Regardless of NDF method, ROM exhibited nutritional uniformity. The ROM fraction also had lower errors associated with the estimated true digestibility and its metabolic fecal fraction than did NFC. Therefore, ROM may result in more accurate estimates of available energy if integrated into models.

Working mechanisms of a behavioural intervention promoting physical activity in persons with subacute spinal cord injury.

OBJECTIVE: In order to unravel the working mechanisms that underlie the effectiveness of a behavioural intervention promoting physical activity in persons with subacute spinal cord injury, the aim of this study was to assess the mediating effects of physical and psychosocial factors on the intervention effect on physical activity. DESIGN: Randomized controlled trial. SETTING: Four rehabilitation centres in the Netherlands. SUBJECTS: Thirty-nine persons with subacute spinal cord injury. INTERVENTION: Behavioural intervention promoting an active lifestyle, based on motivational interviewing. The intervention involved a total of 13 individual sessions beginning 2 months before and ending 6 months after discharge from initial inpatient rehabilitation. MAIN MEASURES: The potential mediating effects of fatigue, pain, depression, illness cognition, exercise self-efficacy, coping and social support on the effect of the behavioural intervention on objectively measured physical activity (B = 0.35 h, p < 0.01) were studied. Measurements were performed at baseline, discharge, 6 months and 1 year after discharge. RESULTS: No single factor was found that strongly mediated the effect of the behavioural intervention on physical activity; however, multiple factors could partly explain the effect. Mediating effects greater than 10% were found for proactive coping (17.6%), exercise self-efficacy (15.9%), pain disability (15.3%) and helplessness (12.5%). DISCUSSION: Proactive coping (the ability to anticipate and deal with potential threats before they occur), exercise self-efficacy (self-confidence with respect to performing exercise and daily physical activities), pain disability (interference by pain of daily activities) and helplessness (emphasizing the aversive meaning of the disease) are important concepts in interventions promoting physical activity in persons with subacute spinal cord injury.

Evaluation of trichodynia (hair pain) during chemotherapy or tamoxifen treatment in breast cancer patients.

INTRODUCTION: In women receiving antineoplastic therapy, hair loss is often accompanied by distressing hair or scalp sensations, such as hair pain (trichodynia) and pruritus. A scientific approach to objectively evaluate the course and characteristics of these unpleasant sensations is of great importance for the establishment of treatment strategies. METHODS: An observational cohort study was conducted in 34 female breast cancer patients, postoperatively undergoing chemotherapy (group C, n = 17) or endocrine therapy with tamoxifen (group T, n = 17). For 28 weeks after therapy initiation, patients experiencing hair pain and/or scalp pruritus were required to complete a specially developed diary, based on a modification of pain questionnaires. Sensations were journalized in terms of time of onset, duration, intensity on a numeric rating scale, dependence on touching the scalp or hair and character of the sensation, chosen from given descriptors or using own words. RESULTS: In group C, all patients who completed the questionnaire experienced hair and scalp sensations: 87% both trichodynia and pruritus, 13% trichodynia only. Reported intensities ranged between 1 and 10. In group T, 31% of participants reported hair and scalp sensations: 12% both trichodynia and pruritus, 12% pruritus only, 7% trichodynia only. Intensities were rated between 1 and 5. No sensations were reported after week 11 in either group. CONCLUSIONS: Hair and scalp sensations in group C were significantly more common, lasted longer, and were of greater intensity and more differentiated qualities than in group T. The occurrence of trichodynia in chemotherapy patients corresponded with the onset and duration of hair loss, thus suggesting a possible correlation.

Exercise self-efficacy and the relation with physical behavior and physical capacity in wheelchair-dependent persons with subacute spinal cord injury.

BACKGROUND: Since physical activity and exercise levels are known to be generally low in persons with spinal cord injury (SCI), there seems to be a need for intervention. Exercise self-efficacy (ESE), the confidence persons have in their ability to be physically active and exercise, is an important and modifiable predictor of physical behavior. The goal of this study was to 1) describe ESE in persons with subacute SCI, 2) to assess ESE in subgroups based on demographic and lesion characteristics, and 3) to explore the relation between ESE and physical behavior and physical capacity. METHODS: Thirthy-seven persons with subacute SCI who are wheelchair dependent participated. Participants completed the Exercise Self-Efficacy Scale. We recorded age and lesion characteristics, measured physical behavior (physical activity, motility and sedentary day time, n = 35) with an accelerometer-based activity monitor and measured physical capacity (peak power output, n = 28 and peak oxygen uptake, n = 24) during a maximal hand-cycling test. Measurements were performed 2 months prior to discharge from inpatient rehabilitation. Mann-Whitney tests were used to test for differences between subgroups based on age and lesion characteristics and spearman correlations were used to assess the relation between ESE and physical activity and physical capacity. RESULTS: Persons with tetraplegia had lower ESE compared to persons with paraplegia (Z = -1.93, p = 0.05). No differences in ESE were found between subgroups based on age and motor completeness of the lesion. In persons with paraplegia, ESE was positively related to peak power output (ρ = 0.58, p = 0.02). The relation of ESE with wheeled physical activity was ρ = 0.36, p = 0.09. CONCLUSIONS: In persons with SCI who are dependent on a manual wheelchair, lesion level when categorized as paraplegic and tetraplegic affected ESE whereas age categories and completeness categories did not. Persons with tetraplegia were found to have lower confidence with regard to physical activity and exercise indicating that this subgroup can benefit from extra attention in the promotion of physical activity and exercise. In persons with paraplegia, ESE seemed to be lower in persons with less peak power output and less daily physical activity.

Longitudinal association between respiratory muscle strength and cough capacity in persons with spinal cord injury: An explorative analysis of data from a randomized controlled trial.

OBJECTIVE: To assess the longitudinal association between respiratory muscle strength and cough capacity in persons with recent spinal cord injury. DESIGN: Longitudinal analyses. SUBJECTS: Forty persons with recent spinal cord injury and impaired pulmonary function. METHODS: Measurements were performed 4 weeks after the start of rehabilitation, 9 and 17 weeks after the first measurement, and one year after discharge from inpatient rehabilitation. Peak cough flow was measured with a spirometer. Maximum inspiratory and expiratory pressures (MIP and MEP), expressed in cmH2O, were measured at the mouth. RESULTS: Both MIP and MEP were significantly positively associated with peak cough flow. After correction for confounders and time 10 cmH2O higher MIP was associated with a 0.32 l/s higher peak cough flow, and a 10 cmH2O higher MEP was associated with a 0.15 l/s higher peak cough flow. The association between MIP and peak cough flow was mainly based on within-subject variance. The association between MIP and peak cough flow was stronger than between MEP and peak cough flow. CONCLUSION: Improvement in respiratory muscle strength is associated with improvement in cough capacity in persons with recent spinal cord injury who have impaired pulmonary function.

Analysis of quantitative changes in hair growth during treatment with chemotherapy or tamoxifen in patients with breast cancer: a cohort study.

BACKGROUND: In women with breast cancer, chemotherapy-induced alopecia is a highly feared but common side-effect of antineoplastic treatment. The onset, pattern and amount of hair loss differ depending on the therapy regimen and have not yet been quantified using standardized techniques. OBJECTIVES: To evaluate objectively and compare the effect of antineoplastic therapy with chemotherapy or tamoxifen on hair loss, quantifying trichological parameters. METHODS: Female patients with breast cancer were included (n = 34), who were receiving chemotherapy (group C, n = 17) or tamoxifen (group T, n = 17) after surgery. Trichological parameters were evaluated once before [week 0 (w0)], twice during (w3, w6) and twice after (w18, w28) the normal 16-week course of chemotherapy, or at corresponding time points during continuous tamoxifen intake. At each visit, anagen and telogen hairs and hair density were quantified by automated phototrichogram in two defined areas: frontal and occipital. RESULTS: Group T generally showed no changes in anagen and telogen hairs or hair density. In group C, anagen hairs and hair density generally followed the same course, decreasing until w6, remaining at a low level during w6-18 and increasing after cessation of chemotherapy, reaching values comparable with or higher than baseline at w28. Telogen hairs increased until w3 then decreased until w6, remaining stable afterwards. CONCLUSIONS: Diffuse hair loss begins shortly after initiation of chemotherapy, mainly as anagen effluvium, with a proportion of anagen to telogen conversion. Hair loss is most prominent after 6 weeks of chemotherapy. Within 3 months after cessation of chemotherapy, hair growth rate returns to baseline values. Tamoxifen did not affect hair growth parameters.

The influence of time and adaptation on health state valuations in patients with spinal cord injury.

OBJECTIVES: One of the explanations for the difference between health state utilities elicited from patients and the public--often provided but seldom studied--is adaptation. The influence of adaptation on utilities was investigated in patients with spinal cord injury. METHODS: Interviews were held at 3 time points (T1, after admission to the rehabilitation center; T2, during active rehabilitation; T3, at least half a year after discharge). At T1, 60 patients were interviewed; 10 patients withdrew at T2 and T3. At all time points, patients were asked to value their own health and a health state description of rheumatoid arthritis on a time trade-off and a visual analogue scale. The Barthel Index, a measure of independence from help in activities of daily living, and the adjustment ladder were filled out. Main analyses were performed using mixed linear models taking the time-dependent covariates (Barthel Index and adjustment ladder) into account. RESULTS: Time trade-off valuations for patients' own health changed over time, even after correction for gain in independence from help in activities of daily living, F(2, 59) = 8.86, P < 0.001. This change was related to overall adaptation. Both a main effect for adaptation, F(87, 1) = 10.05; P = 0.002, and an interaction effect between adaptation and time, F(41, 1)= 4.10, P = 0.024, were seen for time trade-off valuations. Valuations given for one's own health on the visual analogue scale did not significantly change over time, nor did the valuations for the hypothetical health state. CONCLUSION: Patients' health state valuations change over time, over and above the change expected by the rehabilitation process, and this change is partly explained by adaptation. Experience with a chronic illness did not lead to change in valuations of hypothetical health states.

Prospective analysis of body mass index during and up to 5 years after discharge from inpatient spinal cord injury rehabilitation.

OBJECTIVE: To investigate the prevalence of overweight/obesity and the course of the body mass index (BMI) in persons with spinal cord injury during and after inpatient rehabilitation. DESIGN: Multi-centre longitudinal study. SUBJECTS: A total of 184 persons with spinal cord injury. METHODS: BMI was determined at the start of active rehabilitation, 3 months later, at discharge, and 1, 2 and 5 years after discharge. RESULTS: The percentage of persons who were overweight/obese (BMI ≥ 22 kg/m2) increased over the years from 56% to 75%. The absolute BMI did not significantly increase during rehabilitation, but showed a significant increase the year after discharge from inpatient rehabilitation (p < 0.001). From examining the personal or lesion characteristics, age was the only factor that was related to the absolute BMI. BMI increased by 1 kg/m2 for each 10-year increase in age. Men, persons with paraplegia and older people had more chance of being overweight/obese compared with women, persons with tetraplegia and younger people. CONCLUSION: The BMI of people with spinal cord injuries gradually increases during and after inpatient rehabilitation, with significant increases in the first year after discharge. It is recommended that emphasis is placed on weight-management protocols (diet and exercise) to encourage a healthy lifestyle.