In vitro screening of technical lignins to determine their potential as hay preservatives.

Our objectives were to evaluate technical lignins for their antifungal properties against 3 molds and 1 yeast causing hay spoilage, and their ability to preserve ground high-moisture alfalfa hay nutritive value in vitro. In experiment 1, 8 technical lignins and propionic acid (PRP; positive control) were tested at a dose of 40 mg/mL. The experiment had a randomized complete block design (RCBD, 4 runs) and a factorial arrangement of 3 molds × 10 additives (ADV). The effects of the ADV on yeast were evaluated separately with a RCBD. Sodium lignosulfonate (NaL) and PRP were the only treatments with 100 ± 2.8% inhibition of fungi. In experiment 2, the minimum inhibitory concentration (MIC) for selected lignins and PRP were determined. At pH 4, NaL had the lowest MIC across the molds (20-33.3 mg/mL) and magnesium lignosulfonate (MgL) for the yeast (26.7) among the lignins. However, PRP had MIC values that were several-fold lower across all fungi (1.25-3.33). In experiment 3, a RCBD (5 blocks) with a 3 (ADV; NaL, MgL, and PRP) × 4 (doses: 0, 0.5, 1, and 3% wt/wt fresh basis) factorial arrangement of treatments was used to evaluate the preservative effects of ADV in ground high-moisture alfalfa hay inoculated with a mixture of the fungi previously tested and incubated under aerobic conditions in vitro. After 15 d, relative to untreated hay (14.9), dry matter (DM) losses were lessened by doses as low as 1% for NaL (3.39) and 0.5% for PRP (0.81 ± 0.77%). The mold count was reduced in both NaL at 3% (3.92) and PRP as low as 0.5% (3.94) relative to untreated hay (7.76 ± 0.55 log cfu/fresh g). Consequently, sugars were best preserved by NaL at 3% (10.1) and PRP as low as 0.5% (10.5) versus untreated (7.99 ± 0.283% DM), while keeping neutral detergent fiber values lower in NaL (45.9) and PRP-treated (45.1) hays at the same doses, respectively, relative to untreated (49.7 ± 0.66% DM). Hay DM digestibility was increased by doses as low as 3% for NaL (67.5), 1% MgL (67.0), and 0.5% PRP (68.5) versus untreated hay (61.8 ± 0.77%). The lowest doses increasing neutral detergent fiber digestibility relative to untreated hay (23.3) were 0.5% for MgL and PRP (30.5 and 30.1, respectively) and 1% for NaL (30.7 ± 1.09% DM). Across technical lignins, NaL showed the most promise as a potential hay preservative. However, its effects were limited compared with PRP at equivalent doses. Despite not having an effect on preservation, MgL improved DM digestibility by stimulating neutral detergent fiber digestibility. This study warrants further development of NaL under field conditions.

Bacterial and fungal communities, fermentation, and aerobic stability of conventional hybrids and brown midrib hybrids ensiled at low moisture with or without a homo- and heterofermentative inoculant.

We evaluated the effects of adding a combination inoculant to 4 corn (Zea mays L.) hybrids harvested at low moisture on the nutritive value, fermentation profile, aerobic stability, bacterial and fungal populations, and community structure. The treatment design was the factorial combination of 4 corn hybrids ensiled with (INO) and without (CON) inoculant. The hybrids were TMF2R737 (MCN), F2F817 (MBR), P2089YHR (PCN), and PI144XR (PBR), ensiled at 44.0, 38.1, 42.0, and 41.3% of dry matter, respectively; MBR and PBR were brown midrib mutants. The inoculant contained Lactobacillus buchneri and Pediococcus pentosaceus (4 × 105 and 1 × 105 cfu/g of fresh corn). The experimental design was a complete randomized design with treatments replicated 6 times. Corn was chopped, treated or not with inoculant, packed into 7.6-L bucket silos, and stored for 100 d. At d 0, we found higher bacterial observed operational taxonomic units in the brown midrib mutants (MBR and PBR) relative to MCN and PCN (654 and 534 vs. 434 and 444 ± 15.5, respectively). The bacterial and fungal families with the highest relative abundance (RA) were Enterobacteriaceae (61.4%) and incertae sedis Tremellales (12.5%). At silo opening, we observed no effects of INO treatment on dry matter recovery (∼94.3 ± 1.07%), but aerobic stability was extended for all INO-treated hybrids (∼217 vs. ∼34.7 h), except for MBR (∼49 ± 38 h), due to a decreased yeast population (3.78 vs. 5.13 ± 0.440 log cfu/g of fresh corn) and increased acetic acid concentration (1.69 vs. 0.51 ± 0.132%) compared with the control. Furthermore, INO treatment reduced bacterial (61.2 vs. 276 ± 8.70) and increased fungal (59.8 vs. 43.6 ± 2.95) observed operational taxonomic units compared with CON. We observed that INO treatment increased the RA of Lactobacillaceae across all hybrids (∼99.1 vs. ∼58.9), and to larger extent MBR (98.3 vs. 34.3 ± 5.29), and decreased Enterobacteriaceae (0.614 vs. 23.5 ± 2.825%) among 4 other bacterial families relative to CON. For fungi, INO treatment increased the RA of Debaryomycetaceae (63.1 vs. 17.3 ± 8.55) and 5 other fungal families and decreased the RA of Pichiaceae (6.47 vs. 47.3 ± 10.95) and incertae sedis Saccharomycetales (8.47 vs. 25.9 ± 5.748) compared with CON. The bacterial and fungal community structures changed, due to ensiling, to a distinct and more stable community dominated by Lactobacillaceae and Debaryomycetaceae, respectively, when INO treatment was applied relative to CON. In conclusion, the INO treatment used in this study improved low-moisture whole-crop corn silage quality because of a shift in the bacterial and fungal community composition during ensiling.

Laboratory silo type and inoculation effects on nutritional composition, fermentation, and bacterial and fungal communities of oat silage.

The objectives were to evaluate (1) the use of 2 types of experimental silos (S) to characterize whole-crop oat (Avena sativa L.) silage with or without addition of an inoculant (I), and (2) the effect of inoculation on the microbial community structure of oats ensiled using only plastic bucket silos (BKT). From each of 6 sections in a field, oats were harvested, treated (INO) or not (CON) with inoculant, packed into 19-L BKT or vacuum bags (BG), and ensiled for 217 d. The inoculant added contained Lactobacillus buchneri and Pediococcus pentosaceus (4 × 105 and 1 × 105 cfu/g of fresh oats, respectively). The experimental design was a complete randomized design replicated 6 times. Treatment design was the factorial combination of 2 S × 2 I. Some differences existed between BG versus BKT at silo opening (217 d), including a decreased CP (7.73 vs. 7.04 ± 0.247% of DM) and ethanol (1.93 vs. 1.55 ± 0.155) and increased lactic acid (4.28 vs. 3.65 ± 0.241), respectively. Also, WSC and mold counts were reduced in BG versus BKT for CON (1.78 vs. 2.70 ± 0.162% of DM and 0.8 vs. 2.82 ± 0.409 log cfu/fresh g) but not for INO (∼1.53 and 1.55), respectively. Application of INO increased DM recovery (96.1 vs. 92.9 ± 0.63%), aerobic stability (565 vs. 133 ± 29.2 h), acetic acid (2.38 vs. 1.22 ± 0.116% of DM), and reduced NDF (65.0 vs. 67.0 ± 0.57), ADF (36.7 vs. 38.1 ± 0.60), ethanol (0.63 vs. 2.85 ± 0.155), and yeast counts (1.10 vs. 4.13 ± 0.484 log cfu/fresh g) in INO versus CON, respectively. At d 0, no differences were found for S and I on the nutritional composition and background microbial counts. Leuconostocaceae (82.9 ± 4.27%) and Enterobacteriaceae (15.2 ± 3.52) were the predominant bacterial families and unidentified sequences were predominant for fungi. A higher relative abundance of the Davidiellaceae fungal family (34.3 vs. 19.6 ± 4.47) was observed in INO versus CON. At opening (217 d), INO had a lower relative abundance of Leuconostocaceae (42.3 vs. 95.8 ± 4.64) and higher Lactobacillaceae (57.4 vs. 3.9 ± 4.65) versus CON. Despite several differences were found between BKT and BG, both techniques can be comparable for characterizing effects of INO on the most basic measures used in silage evaluation. The use of inoculant improved oat silage quality partially by a shift in the bacterial community composition during ensiling, which mainly consisted of an increased relative abundance of Lactobacillaceae and reduction of Leuconostocaceae relative to CON.

Analgesic effect of a single-dose of perineural dexamethasone on ultrasound-guided femoral nerve block after total knee replacement. / Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla.

INTRODUCTION: Total knee replacement is usually a very painful procedure. A single-dose of femoral nerve block has been shown to provide similar analgesia to an epidural, with fewer side effects, but limited in time. OBJECTIVE: To compare the analgesia provided by dexamethasone used at perineural level in the femoral nerve block after total knee replacement with the one used at intravenous level, and with that of a control group. MATERIAL AND METHODS: A prospective, randomised, double-blind controlled trial was conducted on 81 patients randomly assigned to one of three groups: 1)IV dexamethasone (8mg); 2)perineural dexamethasone (8mg), and 3)placebo. All patients received 20ml of ropivacaine 0.5% for femoral nerve block. The primary outcome was the duration of the sensory-analgesic block of the femoral nerve block. The secondary outcomes included pain intensity measurements, patient satisfaction, and incidence of complications. RESULTS: Randomisation was effective. Analgesia duration was significantly higher (P<.0001) in the perineural dexamethasone group (mean 1152.2min, 95% confidence interval [95% CI]: 756.9-1547.6) in comparison with the control group (mean 186min, 95%CI: 81.2-292) and dexamethasone IV group (mean 159.4min, 95%CI: 109.8-209). Postoperative pain, complications and side effects were also lower in this group. CONCLUSIONS: Dexamethasone prolongs sensory block of single dose of femoral nerve block using ropivacaine. It also provides better analgesia and patient satisfaction, with fewer side effects.

Turning Disaster into an Opportunity for Quality Improvement in Essential Intrapartum and Newborn Care Services in the Philippines: Pre- to Posttraining Assessments.

Background. On 8 November 2013, supertyphoon Haiyan made landfall in the Philippines, severely disrupting health service delivery. Reestablishment of essential services for birthing mothers and their newborns became high priority. Methodology. Following a baseline assessment, an Essential Intrapartum and Newborn Care (EINC) training package was implemented and posttraining assessments (1 and 3 months after training) were undertaken. Results. Baseline assessments (n = 56 facilities) revealed gaps in provider's skill and shortage of life-saving commodities. Facilities lacked newborn bags/masks (9%), towels (6%), and magnesium sulfate (39%). Service providers lacked skills in partograph use (54%), antenatal steroid (44%) use, and breastfeeding initiation (50%). At 3 months after training (n = 51 facilities), dramatic increases in correct partograph use (to 92%), antenatal steroid use (to 98%), breastfeeding initiation (to 86%), kangaroo mother care (to 94%), availability of magnesium sulfate (to 94%), and bag/masks (to 88%) were documented. Gaps persisted for skills in assisted vaginal delivery and removal of placental fragments. Conclusion. Health services were severely disrupted after supertyphoon Haiyan. Our study demonstrates that essential birthing services and quality improvements to strengthen local health systems can be restored in a timely manner even in immediate postdisaster settings.

Influence of acute unilateral vestibular lesions on the respiratory rhythm after active change of posture in human subjects.

The influence of acute unilateral vestibular lesions on respiratory rhythm after active change of posture, was evaluated by comparing responses from patients with acute vestibular neuritis, with those from normal subjects with minor injuries other than vestibular (e.g. epistaxis, headache) and patients with chronic bilateral vestibular dysfunction. Respiratory movements of the thorax-abdomen were recorded during 5 minutes in supine position, 5 minutes of back-unsupported sitting and 5 minutes of upright stance. Compared to supine position, sitting-up induced different responses in each group (p < 0.05, ANOVA). The healthy subjects showed a consistent decrease in the mean respiratory frequency related to an increase of the expiration time, which was absent in patients with vestibular neuritis. Subjects with minor injuries showed the opposite changes of expiration time and inspiration time with no change of the respiratory frequency and patients with bilateral vestibular dysfunction showed a trend to increase their respiratory frequency. Standing-up did not evoke any further changes in any group. We conclude that the vestibular system modulates the respiratory response to reorientation of the head and trunk to upright position and this influence is reduced during the acute stage of a vestibular lesion.

Management of severe postpartum hemorrhage with a prostaglandin F2 alpha analogue.

Presented is a three-year study using a 15-methyl analogue of prostaglandin F2 alpha, in the management of severe postpartum hemorrhage due to uterine atony in patients who were unresponsive to conventional therapies. Fifty-four patients were entered into the study, but 51 were analyzed for efficacy. Successful control of postpartum hemorrhage occurred in 86%. Of the seven in whom therapy failed and who subsequently required surgical therapy, four had chorioamnionitis. Six subjects had intramyometrial injection of the agent, with dramatic results in five. Mild transient side effects occurred in less than 10% of subjects.

Management of severe postpartum hemorrhage due to uterine atony using an analogue of prostaglandin F2 alpha.

Twenty patients with severe postpartum hemorrhage due to uterine atony who were unresponsive to conventional therapy were treated with 0.25-mg intramuscular injections of (15-S)-15-methyl prostaglandin F2 alpha-tromethamine. A rapid and successful response was obtained in 18 patients. Two patients required surgical procedures to control bleeding. Both patients with treatment failure had chorioamnionitis. Side effects of the prostaglandin therapy included nausea, vomiting and diarrhea, a transient mild temperature elevation, and a transient moderate blood pressure elevation. Those subjects with preeclampsia did not demonstrate a serious elevation of blood pressure. The prostaglandin F2 alpha analogue appears to be very effective in the treatment of postpartum hemorrhage due to uterine atony.

Bacteriologic effects of antibiotic prophylaxis in high-risk cesarean section.

A double-blind placebo-controlled experiment was performed in 100 patients in labor with membrane rupture to determine the bacteriologic effects of antibiotic prophylaxis. Each subject received either 2.0 g cefamandole or placebo after cord clamping and 4 and 8 hours later. The cefamandole group had significantly less endometritis, but did not have significantly fewer major complications. Amniotic fluid cultures of the 2 groups were similar, but uterine lavage cultures of the cefamandole group showed significant increases in enterococci and gram-negative aerobes and decreases in gram-positive anerobes and low virulence organisms (Staphylococcus epidermidis, lactobacilli, and diphtheroids). Although clinical problems did not regularly accompany these changes, it would be foolhardy to ignore them. Thus, when patients develop infection after antibiotic prophylaxis, the physician should check for infection with resistant organisms.

Use of ultrasound biparietal diameter in timing of repeat cesarean section.

The aim of the study was to evaluate the use of ultrasound biparietal diameter (BPD) in the timing of elective repeat cesarean section on a large indigent service. One hundred sixty-five patients were evaluated over 2 years. If the BPD was 9.3 cm or more at or later than 38 weeks' gestation, a repeat procedure was undertaken without further testing of fetal maturity. This occurred in 55% of the study group. None of these neonates developed hyaline membrane disease (HMD). The remainder of the study group either did not attain a BPD of 9.3 cm by term, were diabetic, or had other factors to determine timing of delivery. Of this group, 50% underwent amniocentesis for a lecithin:sphingomyelin ratio. Three patients had fetal bleeding, 1 had rupture of membranes, and 1 began labor following amniocentesis. All neonates were healthy except 1 who had mild HMD. That neonate had not reached 9.3 cm BPD. Ultrasound has allowed development of a management program for elective repeat cesarean section that is reliable, cost-effective, and beneficial to the mother and neonate.

Treatment of premature labor with beta sympathomimetics: results with isoxsuprine.

This prospective study presents a protocol for the treatment of premature labor with beta sympathomimetics and the results when isoxsuprine was used. Seventy-two patients from 25 to 36 weeks' gestation were treated. All patients were placed at bed rest, hydrated, and given parenteral sedation prior to the intravenous use of isoxsuprine. Treatment was continued via the intramuscular and oral routes until the thirty-seventh week of gestation. Three patients (4.2%) were delivered of infants during the initial infusion, and 15 (20.2%) were delivered of infants within 2 weeks after the onset of therapy. Forty-nine (68%) were delivered of infants after 37 weeks' gestation, and their infants weighed more than 2,500 grams. Maternal side effects were common, but none necessitated termination of therapy. There were six neonatal deaths, the causes of which were respiratory distress syndrome in two infants, necrotizing enterocolitis in one, group B streptococcal sepsis in one, congenital anomalies with sepsis in one, and multiple congenital anomalies in one.

Management of acute chorioamnionitis.

Acute chorioamnionitis has been recognized as a major threat to both mother and fetus, but there has been little study of its therapy. On this service, the plan of management consists of parenteral, broad-spectrum antibiotic therapy and prompt action to effect delivery. Cesarean section was generally performed only when there were additional obstetric indications. No arbitrary time limit was set for the diagnosis-to-delivery interval. The perinatal mortality rate was increased fourfold, but few deaths could be attributed to infection. Maternal outcome was usually good following vaginal delivery and more complicated following abdominal delivery. Over 90% of patients were delivered within 12 hours of diagnosis of chorioamnionitis.