Consequences of daily self-weighing: a pilot study in higher-weight women with a history of breast cancer.

Self-monitoring weight is commonly recommended for higher-weight women with a history of breast cancer, despite evidence demonstrating potentially negative psychological consequences of frequent self-weighing. The extent to which higher-weight women with breast cancer experience emotional and behavioral consequences in response to daily self-weighing is unknown. In this pilot study, women (n = 51) with a history of breast cancer in a behavioral weight management program completed a weeklong daily diary protocol. Participants were asked to self-weigh every morning and report on subsequent weight-related shame and guilt, and end-of-day engagement in compensatory exercise, diet, and purging behaviors. Women reported higher levels of guilt on days when their body weight was higher than usual, and when there was more discrepancy between their current vs. goal weight. Additionally, women engaged in higher levels of compensatory diet behavior on days when they experienced more weight-related guilt than usual. Based on these preliminary findings, daily self-weighing may be associated with harmful emotional and behavioral consequences among higher-weight women with a history of breast cancer.

Factors associated with complementary and alternative medicine use among women at midlife.

Hormone replacement therapy (HRT) has been established as the first-line treatment for women experiencing menopausal symptoms. The use of complementary and alternative medicine (CAM), however, is becoming increasingly popular among women at midlife for management of such symptoms. Despite the equivocal evidence of CAM's efficacy in the reduction and alleviation of menopausal symptoms in placebo-controlled, randomized trials, 50% of women at midlife use CAM. To date, several large, population-based studies have focused upon CAM use amongst menopausal women and the factors associated with the adoption of such therapies. By identifying women in the menopausal transition who tend to use CAM, this narrative review highlights evidence that aids women at this stage of life make better and individualized treatment choices to relieve these symptoms. The available evidence suggests that the prevalence of CAM use among menopausal women is high world-wide, but there is a paucity of high-quality studies that adequately assess the factors associated with its use. Further studies are needed to confirm the characteristics of women who employ CAM to manage their night sweats and hot flushes. Results of this study might enable the development of policies catering to the needs of those women and provide a resource to support their decision-making regarding treatment options.

The associations of resting metabolic rate with chronic conditions and weight loss.

The aim of this study was to examine the associations between baseline and changes in resting metabolic rate (RMR) with chronic condition(s) and weight loss (WL). Sex stratified analysis was undertaken on 393 adults from the Wharton Weight Management Clinics. The association between baseline RMR and WL was examined adjusting for age, BMI, ethnicity and treatment time. The association between changes in RMR (ΔRMR) and WL was also examined adjusting for baseline RMR and above covariates. Models were further adjusted for high glucose, triglycerides, blood pressure, low-density lipoprotein (LDL) and low high-density lipoprotein (HDL). While men (6.0 ± 8.6 kg) and women (5.6 ± 8.3 kg) had significant WL throughout the intervention, their measured decreases in RMR (-48 ± 322 kcal and -5 ± 322 kcal, respectively) were non-significant (P > 0.05). Individuals with a high blood pressure had a higher baseline RMR and women with a high LDL had a lower baseline RMR than those without the chronic condition (P < 0.05). Regardless of sex, WL was not significantly associated with baseline RMR or ΔRMR (P > 0.05) in both models. Participants with a low baseline RMR do not appear to be at a disadvantage for WL. Further, WL can occur without decreases in RMR in populations with high levels of obesity and obesity-related comorbidities.

The association between obesity and self-reported sinus infection in non-smoking adults: a cross-sectional study.

The aim of this article was to examine the associations between having had a sinus infection (SI) and BMI and physical activity (PA), diet quality, stress and/or sleep. A total of 2915 adults from the National Health and Nutrition Examination Survey 2005-2006 were examined. Logistic regression analysis was used to examine the association between having had an SI with BMI and PA, diet quality, stress or sleep. As these factors are known to influence one another, a fully adjusted model with PA, diet quality, stress and sleep was also constructed to examine their independent associations with having had an SI. Overall, 15.5 ± 1.2% of the population report having had an SI in the past year. In all models, individuals with obesity were approximately twice as likely to have had an SI compared to those of normal weight (P < 0.05). While PA and diet quality were not significantly associated with having had an SI (P > 0.05), individuals with stress and sleep troubles were also twice as likely to have had an SI (P < 0.05) independent of BMI. In the fully adjusted model, only the associations for BMI and sleep troubles remained significant (P < 0.05). Results from this study suggest that obesity and sleep troubles, but not PA, quality of diet and stress, are associated with having had an SI. As interactions exist between obesity, immune system factors and exposure to infectious disease(s), more research is necessary to understand the directionality of these relationships.

Effects of sodium sesquicarbonate on dry matter intake and production of milk and milk components by Holstein cows.

Forty-six multiparous Holstein cows were used to investigate the effects of sodium sesquicarbonate on dry matter intake, body weight, and production and composition of milk during a 308-d lactation. Diets contained alfalfa silage, corn silage, and concentrate. Composition of diets was changed twice during the 308-d lactation experiment. Diets fed during d 1 to 175 and d 176 to 245 were formulated to contain more rumen-undegradable protein and fat, and less forage than that fed during d 246 to 308. Sodium sesquicarbonate did not affect yields of milk, 4% fat-corrected milk, and components in milk, or percentages of components in milk during the complete 308-d lactation or during d 1 to 175 or d 176 to 245. However, from d 246 to 308, cows fed sodium sesquicarbonate produced more milk, 4% fat-corrected milk, fat, protein, and solids-not-fat than did control cows. Milk composition was not altered. These data suggest that composition of the diet has a significant effect on the response to dietary buffers by lactating dairy cows.

Role of PI 3-kinase in angiopoietin-1-mediated migration and attachment-dependent survival of endothelial cells.

Angiopoietin-1 is a unique growth factor which induces Tie2 receptor autophosphorylation and interaction with signal transduction molecules, GRB2 and p85 subunit of PI 3-kinase, but no detectable mitogenic response. Here we show that PI 3-kinase-dependent activation of Akt and attachment to extracellular matrix are required for angiopoietin-1-mediated endothelial cell survival. Apoptosis of growth factor-deprived cells grown in monolayer was decreased by angiopoietin-1 and correlated with Akt activation. In contrast, angiopoietin-1, bFGF or VEGF failed to protect cells in suspension culture. Ceramide, an intermediate of several apoptotic pathways, interferes with growth factor-mediated Akt activation. Ceramide induced endothelial cell death and abolished angiopoietin-1-mediated activation of Akt and the effect on cell survival. In addition, we found that PI 3-kinase activity is necessary for migration of endothelial cells in response to Angiopoietin-1. A transient activation of MAPK/ERKs was also detected within 10 min after stimulation with angiopoietin-1. In contrast to VEGF-mediated biological effects, inhibition of MAPK/ERKs by PD98059 in endothelial cells did not affect angiopoietin-1 mediated survival or migration. These findings indicate significant differences in intracellular signaling between VEGF and angiopoietin-1 and that PI 3-kinase lipid products are key mediators of the biological effects of angiopoietin-1.

Fatty acid flow to the duodenum and in milk from cows fed diets that contained fat and nicotinic acid.

Four cows fitted with ruminal and duodenal cannulas were used in a 4 x 4 Latin square design; treatments were arranged in a 2 x 2 factorial. Treatments were 1) low fat diet, no nicotinic acid; 2) low fat diet, 12 g/d of nicotinic acid; 3) high fat diet, no nicotinic acid; and 4) high fat diet, 12 g/d of nicotinic acid. Cows were fed for ad libitum intake diets consisting of 35% alfalfa silage, 15% corn silage, and either 50% low fat concentrate or 40% high fat concentrate (tallow supplied 6.25% of concentrate) and 10% whole raw soybeans (dry matter basis). Intake of gross energy (104 Mcal/d) was not different among treatments. Ruminal and postruminal digestibility of energy was not altered by fat or nicotinic acid. Fatty acid intake and flow to the duodenum were increased by fat but were not affected by nicotinic acid. For all diets, flows to the duodenum of C16:0, C18:0, total C18, and total fatty acids increased, and flows of C16:1, C18:1, C18:2, and C18:3 decreased, compared with their intakes. Biohydrogenation of unsaturated C18 was decreased by fat but was not affected by nicotinic acid. Digestibilities of C18:0, C18:1, C18:2, C18:3, and total fatty acids that flowed to the duodenum were decreased by fat but were not affected by nicotinic acid. The yield of C18:0 in milk was increased, and yields of C6:0 to C16:0 fatty acids were decreased, by fat, but yields were not affected by nicotinic acid.

Chronic recombinant equine somatotropin (eST) administration does not affect aerobic capacity or exercise performance in geriatric mares.

The purpose of this experiment was to test the hypothesis that chronic (89 days) administration of recombinant equine somatotropin (eST) would increase aerobic capacity and improve exercise performance in old mares. Fifteen, healthy, unfit, aged (20-26 year old) mares were randomly assigned to a treatment (eST, 12.5 mg day-1 in 3 ml glycine/manitol buffer, s.c., n = 7) or control (vehicle, 3 ml day-1, s.c., n = 8) group. Aerobic capacity and exercise performance were measured using a standardized exercise test (SET) performed on a high speed treadmill. Tests were conducted before (-21 days), during (+43 days and +89 days) and after (+127 days) treatment. During the SET, resting data were collected and the horses then ran up a fixed 6% grade, starting at 4 m s-1, with a 1 m s-1 increase every 60 s (omitting 5 m s-1) until fatigue. Oxygen uptake (VO2) was measured using an open flow calorimeter and blood lactate concentration (LA) via a lactate analyser. Venous blood samples (10 ml) were collected at rest, during the last 10 s of each step of the SET, and after exercise and used to measure LA, plasma protein concentration (PP), hematocrit (HCT), and the plasma concentrations of creatine kinase (CK) and aspartamine transferase (AST). There were no differences (P > 0.05) in resting VO2, LA, TPP, or HCT due to treatment or test time. Furthermore, there were no differences (P > 0.05) in maximal oxygen uptake (VO2max), top run velocity, run time, watts at VO2max, velocity to produce a lactate of 4 mmoll-1 (VLA4), watts at VLA4, peak HCT or peak LA. Finally, there were no differences (P > 0.05) in resting or post-exercise CK or AST. These data indicate that chronic eST administration does not affect aerobic capacity or indices of exercise performance in unfit aged mares.

Pulsatile release of somatotropin related to meal feeding and somatotropin response to secretagogues in horses.

Our goal was to establish a time of day and(or) interval from feeding that would avoid the refractory period after a somatotropin (ST) surge and optimize the responsiveness of horses to ST secretagogues. Two experiments were conducted with eight geldings conditioned to consume grain at 0800 and 1600 daily. In Exp. 1, during a 24-h period, these geldings averaged 3.2 +/- .3 pulses of ST with peak amplitude of 4.2 +/- .4 ng/mL, pulse duration of 55 +/- 6 min, and interpeak interval of 400 +/- 57 min. No ST peaks occurred within 2 h after either grain feeding. In Exp. 2, eight geldings were given 50 micrograms of ST-releasing factor (STRF) at 0800. Two geldings that had a pulse of ST between 0700 and 0800 failed to respond to STRF, but the other six responded with a pulse of ST at 37 +/- 3 min; peak amplitude was 4.6 +/- 2.2 ng/mL and duration was 123 +/- 25 min. Experiments 3 and 4 were with mares aged 20 to 26 yr and conditioned to be fed grain at 0800 daily. In Exp. 3, blood was sampled for 8 h beginning at 0500. Seven of the eight mares had a ST pulse in progress at 0500. Five additional pulses were detected, all from 0740 to 0940, but none from 0600 to 0700 or from 1000 to 1300. In Exp. 4, four of the same eight mares were given 50 micrograms of STRF at 0700 and the other four at 1300. Three of the four treated at 0700 and all four treated at 1300 responded to STRF with ST peaks at 20 +/- 5 min; peak amplitude was 12.7 +/- 9.5 ng/mL and duration was 69 +/- 6 min. In Exp. 5, nine mares aged 20 to 26 yr were fed grain at 0800 and 1600 as in Exp. 1 and 2 and given a nonpeptidal ST secretagogue (STS, Merck L-163,255) i.v. at 0, 1, or 5 mg/kg (n = 3 mares/dose) at 1300. No mare had a pulse of ST during the 1 h before treatment. All six mares given STS responded with ST pulses. The ST responses to STS at 1 and 5 mg/kg did not differ (P > .05); time to ST peak was 35 +/- 4 min, pulse amplitude was 24.0 +/- 6.3 ng/mL, and pulse duration was 100 +/- 9 min. We conclude that mares and geldings fed grain once or twice daily usually have a period of 2 to 5 h after feeding with no ST pulses. When horses are fed grain at 0800, one may give a ST secretagogue at 1300 to avoid a refractory period and improve the probability of an ST response.

Acute effects of short-term feed deprivation and refeeding on circulating concentrations of metabolites, insulin-like growth factor I, insulin-like growth factor binding proteins, somatotropin, and thyroid hormones in adult geldings.

Two studies were performed with Standardbred geldings 7 to 21 yr of age to determine the sequence of changes in blood plasma concentrations of some hormones and metabolites during feed deprivation for 48 h and for 12 h after refeeding. Plasma hormone and metabolite concentrations were determined with methods validated for horse plasma. Insulin-like growth factor binding proteins (IGFBP) were determined with radioligand analysis following SDS-PAGE electrophoresis. In both experiments, plasma concentrations of triiodothyronine and thyroxine decreased (P < .01) during feed deprivation and increased (P < .01) during refeeding. Plasma glucose and IGF-I either decreased or were not altered during feed deprivation. In contrast, plasma concentrations of NEFA and urea nitrogen increased (P < .01) during feed deprivation and decreased (P < .01) during the refeeding period. Plasma somatotropin (ST) increased (P < .01) approximately 80% at 24 to 36 h of feed deprivation, declined (P < .01) to control values at 48 h of feed deprivation, increased (P < .01) nearly three fold at 3 h after refeeding, and returned to control values by 6 h after refeeding. We identified five IGFBP, and their plasma concentrations were not significantly altered during feed deprivation or following refeeding. We conclude that metabolite availability during feed deprivation and following refeeding alters the secretion of thyroid hormones, ST, and possibly IGF-I, thereby maintaining homeostasis in horses.

Feed intake, body weight, body condition score, musculation, and immunocompetence in aged mares given equine somatotropin.

Sixteen 20- to 26-yr-old mares were given 0, 6.25, or 12.5 mg/d equine somatotropin (eST) to determine whether aged mares respond to ST with changes in feed intake, body weight, body condition score (based mostly on fat cover), or immunocompetence. Neither dry matter intake, body weight, nor body condition scores were altered during the 6 wk of eST injection. However, based on photographs taken to evaluate musculation before and after treatment (scores 0 to 4), mares given eST developed greater (P < .07) muscle definition (1.8 +/- .6 and 2.5 +/- .6 for 6.25 and 12.5 mg eST/d, respectively) than control mares (.7 +/- .4). Total circulating leukocytes increased (P < .05) in both of the eST-treated groups during the 6-wk injection period, caused by an increase (P < .05) in granulocytes. Lymphocyte numbers were not altered. Granulocyte oxidative burst activity was not altered by eST treatment. Although lymphocyte proliferative responses to phytohemagglutinin, pokeweed mitogen, or lipopolysaccharide were not altered during the treatment period, lymphocyte proliferation in response to phytohemagglutinin and pokeweed mitogen increased twofold in eST-treated horses at 2 wk after eST treatment. In overview, the increased musculation and the increase in granulocyte numbers in mares given eST suggest that eST supplementation may improve the health and well-being of aged mares.

Effects of dietary fat with or without nicotinic acid on nutrient flow to the duodenum of dairy cows.

Four Holstein cows, fitted with ruminal and duodenal cannulas, were utilized in a 4 x 4 Latin square design to investigate the effects of supplementing nicotinic acid to diets that contained 35% alfalfa haylage, 15% corn silage, and either 50% of a low fat concentrate or 10% whole raw soybeans and 40% of a high fat concentrate containing tallow. Treatments in a 2 x 2 arrangement were 1) low fat, no supplemental nicotinic acid; 2) low fat, 12 g/d of nicotinic acid; 3) high fat, no supplemental nicotinic acid; and 4) high fat, 12 g/d of nicotinic acid. The DMI and OM apparently and truly digested in the rumen and apparently digested postruminally were not different among treatments. Addition of fat to the diet decreased the concentration of total VFA in ruminal fluid but did not alter the molar proportions of any of the VFA; supplementation of nicotinic acid tended to decrease the molar proportion of acetate. Amounts of NAN, microbial N, nonammonia nonmicrobial N, and AA that flowed to the duodenum were similar among diets. The concentration of urea N in plasma decreased, and concentrations of cholesterol and triglycerides increased, when cows were fed supplemental fat. Milk composition and production of milk, 4% FCM, and milk components were not altered by addition of fat or nicotinic acid to the diet. Supplementation of fat or nicotinic acid to diets of dairy cows was not beneficial in this experiment.

Age and breed differences in thyroid hormones, insulin-like growth factor (IGF)-I and IGF binding proteins in female horses.

A survey with horses was conducted to determine whether plasma concentrations of triiodothyronine (T3), thyroxine (T4), insulin-like growth factor (IGF)-I and IGF binding proteins (IGFBP) change as horses grow, mature sexually, and age. Jugular blood was sampled from Standardbred fillies and mares at ages 0, 1, 7, and 14 d, at 1, 2, 4, 5, 6, and 9 mo, and at 5 to 8 and 16 to 22 yr (n = 5 to 18). In a second survey, we measured the same variables in eight breeds of horses with markedly different adult body sizes, from Miniatures to Friesians. Plasma T3, T4, and IGF-I were determined by radioimmunoassays validated for horses, and IGFBP were estimated from radioligand assay following separation of the IGFBP by SDS-PAGE electrophoresis. Plasma T3 decreased (P < .01) nearly continuously from 7.9 ng/mL on the day of birth to .9 ng/mL at 6 mo, and then changed little from .7 ng/mL at 9 mo to .5 ng/mL in mares 16 to 22 yr old. Similarly, T4 declined (P < .01) from 233 ng/mL on the day of birth to 49 ng/mL at 14 d and varied from 35 to 9 ng/mL among all of the older age groups. Plasma concentrations of IGF-I increased (P < .01) from 285 ng/mL on the day of birth to 572 ng/mL at 14 d, remained relatively constant until 9 mo of age (530 ng/mL), and then declined (P < .01) to low levels (295 ng/mL) in the oldest mares. We detected six IGFBP. The two smallest IGFBP (26 and 39 kDa) were highest during the first 14 d after birth and lowest (P < .01) in aged mares. The four larger IGFBP were lowest at birth and increased to the highest values during the most rapid growth period, but these changes were not significant (P > .20). In agreement with data for other species, our data suggest that IGF-I and IGFBP modulate growth in horses. Although there were impressive interbreed differences in circulating concentrations of T3, T4, IGF-I, and IGFBP, these were not related to differences in adult body size.

Effects of amount of protein and ruminally protected amino acids in the diet of dairy cows fed supplemental fat.

The objectives of this experiment were to investigate the effects of amount of dietary CP and ruminally protected AA supplementation on production of milk and milk components, ruminal fermentation, and nutrient digestibilities by cows fed diets containing high oil corn and tallow. Holstein cows in midlactation producing 22 to 25 kg/d of milk were used in a 5 x 5 Latin square design. Treatments were 1) control (16.8% CP, no added fat); 2) 14.2% CP, no AA; 3) 14.2% CP, with AA; 4) 17.5% CP, no AA; and 5) 17.5% CP, with AA. Diets 2 to 5 contained supplemental fat from high oil corn and tallow. Diets consisted of 33% alfalfa haylage, 17% corn silage, and 50% concentrate DM. Intake of DM was not different among treatments. Dietary fat increased yields of milk, fat, SNF, and total solids and percentages of fat and total solids. Increasing CP from 14.2 to 17.5% did not alter production or composition of milk. Supplemental AA increased yields of 4% FCM, milk fat, milk CP, true protein, and casein protein and percentages of CP, true protein, and casein protein in milk when either 14.2 or 17.5% CP was in the diet. Supplemental fat did not alter ruminal fermentation, but increases in dietary CP increased total VFA concentration in the rumen without affecting proportions of individual VFA. Apparent digestibilities of DM, OM, CP, starch, and energy in the total tract were greater for cows fed the 17.5% CP diets. Addition of AA to the 14.2% CP diet increased apparent digestibilities of DM, OM, ADF, NDF, and energy in the total tract but decreased digestibilities for cows fed the 17.5% CP diets. Feeding AA to midlactation cows in diets containing supplemental fat may alleviate the decrease in milk protein percentage associated with fat supplementation; this response was similar for cows fed diets that contained either 14.2 or 17.5% CP.

Infusion of four long-chain fatty acid mixtures into the abomasum of lactating dairy cows.

Five Holstein cows were utilized in a Latin square design to determine the effects of postruminal profile of fatty acids on DMI, milk yield and composition, nutrient digestibilities, and metabolites in blood. Treatments were abomasal infusions of 1) control, 169 to 180 g/d of meat solubles; 2) control plus 450 g/d of mostly saturated fatty acids; 3) canola fatty acids; 4) soybean fatty acids; or 5) sunflower fatty acids. Infusion of fatty acids decreased intakes of DM, CP, and gross energy; yields of milk, FCM, SNF, total solids, CP, NPN, true protein, whey protein, and casein; and percentages of SNF, CP, NPN, true protein, and casein in milk. Cows infused with mostly saturated fatty acids consumed more CP and digestible energy; yielded more milk, FCM, fat, SNF, total solids, CP, true protein, and casein; and had greater percentages of SNF and total solids in milk than cows infused with unsaturated fatty acids. Milk fatty acids reflected the profile of the infused fatty acid mixture. Ruminal characteristics and apparent digestibilities of DM, NDF, energy, and fatty acids generally were not different among treatments. The profile of fatty acids reaching the small intestine may influence responses when supplemental fats are fed to lactating dairy cows.

Kinetics of niacin supplements in lactating dairy cows.

The kinetics of niacin supplements in lactating dairy cows and the stability of supplements during in vitro fermentation were examined. Four multiparous Holstein cows (200 DIM) with ruminal and duodenal cannulas were fed a TMR either unsupplemented or supplemented with 12 g/d of nicotinic acid, 12 g/d of nicotinamide, or 6 g/d combination of each niacin source in a 4 x 4 Latin square design. Ruminal and duodenal concentrations of nicotinic acid increased with niacin supplementation, but DMI, yields of milk and FCM, most measures of milk composition, ruminal VFA, and plasma NEFA and BHBA concentrations were unaffected by niacin supplementation at this stage of lactation. Apparent digestibilities of most nutrients were greater when both sources of niacin were supplemented than when either source was supplemented separately. Duodenal nicotinic acid concentrations were higher for cows supplemented with nicotinamide than for cows receiving nicotinic acid, but the opposite was true for nicotinic acid concentrations in plasma. The results of both experiments indicated that nicotinamide was converted rapidly to nicotinic acid by microorganisms in the reticulorumen. Supplementation with either nicotinic acid or nicotinamide effectively can increase the amount of nicotinic acid available to the cow; however, some source effects remain to be explained.

Emergency department CK-MB: a predictor of ischemic complications. National cooperative CK-MB project group.

OBJECTIVE: To demonstrate that a positive CK-MB in the emergency department (ED) predicts an increased risk for complications of myocardial ischemia in patients admitted to the hospital for evaluation of chest pain. METHODS: 53 academic and community hospital EDs participated in this prospective observational cohort analysis of 5,120 patients with chest pain without ST-segment elevation on the initial ED 12-lead electrocardiogram. All patients were admitted for evaluation of chest pain in one of the participating hospitals as part of the National Cooperative CK-MB Project. Patients were stratified by whether or not they had an elevated CK-MB level in the ED. CK-MB measurements were made on ED presentation and two hours later. Patient medical records were reviewed for inpatient diagnoses--myocardial infarction (MI) or other diagnosis--and for ischemic complication--cardiac-related death, recurrent or delayed in-hospital MI, significant ventricular arrhythmias, new conduction defects, congestive heart failure, and cardiogenic shock. RESULTS: 369 (7.2%) of the 5,120 patients had MI. The proportion of patients with any complication in the MI group was 24%, while the complication rate in the non-MI group was 0.4%. In all patients, regardless of final diagnosis, the relative risk of any complication was 16.1 (95% CI 11.0-23.6) in those with a positive ED CK-MB versus negative ED CK-MB patients. Similarly, the relative risk of death was 25.4 (95% CI 10.8-60.2) in positive ED CK-MB versus negative ED CK-MB patients. CONCLUSIONS: Multicenter data support the hypothesis that CK-MB measurements can help risk-stratify ED chest pain patients whose initial ECGs are without diagnostic ST-segment elevation.

Influence of amount and degradability of protein on production of milk and milk components by lactating Holstein cows.

Forty-one multiparous cows were utilized in a completely randomized design with a 2 x 2 factorial arrangement of treatments to evaluate the amount and degradability of dietary CP on production of milk and milk components. The TMR contained 25% alfalfa haylage, 25% corn silage, and 50% concentrate to provide either 16.4 or 19.4% CP with a calculated ruminal degradability of 55 or 70%. Intakes of DM, ADF, and NDF and BW were not different among treatments. Production of milk, 4% FCM, fat, CP, and SNF was not affected by amount or degradability of dietary CP. Milk CP percentage was not affected significantly by amount or degradability of CP. Milk fat percentage was increased by the diet that was high in ruminally undegradable protein (2.90 and 3.12; low and high ruminally undegradable protein, respectively). These data suggest that synthesis of milk and milk components was not limited by a shortage of AA or that the different dietary sources of supplemental CP did not alter AA availability.

Influence of amount and degradability of dietary protein on nitrogen utilization by dairy cows.

Four Holstein cows fitted with ruminal and T-type duodenal cannulas were utilized in a 4 x 4 Latin square design with a 2 x 2 factorial arrangement of treatments. The TMR contained 25% alfalfa haylage, 25% corn silage, and 50% concentrate and provided either 16.4 or 19.6% CP, with ruminal degradability calculated to be 30 or 45%. Intakes of DM, OM, ADF, NDF, and N were not altered by either amount or degradability of CP. Intake and ruminal and postruminal digestibility of starch were greater when cows were fed diets high in undegradable CP but was not altered by amount of CP. Apparent total tract digestibilities for DM, OM, starch, ADF, and NDF were similar among treatments. Apparent total tract digestibility of N was 4.7 percentage units greater for diets low in ruminally degradable CP. Apparent digestibility of OM, ADF, and NDF and true digestibility of OM in the rumen were not altered by amount of CP or undegradable CP. Increasing the CP content of the diet and the proportion of undegradable CP in the diet increased NAN flow to the duodenum. Except for Met, flows of all AA to the duodenum were increased when CP was increased. Flow of Met to the duodenum was not altered by undegradable CP content of the diet. Production of milk, 4% FCM, and milk CP was not altered by amount of CP or undegradable CP. Milk fat content and yield were increased when diets high in undegradable CP were fed. Results suggest that all diets supplied adequate amounts of AA for these cows or that Met was deficient for all cows.

Complications of laparoscopic cholecystectomy: coordinated radiologic and surgical management in 21 patients.

The authors describe their experience in management of bile duct injuries (n = 11), bile leaks or abscesses (n = 11), and bleeding (n = 1) as complications of laparoscopic cholecystectomy in 21 patients. Clinical presentations included jaundice, sepsis, pain, abdominal distention, and persistent gallstones. Twelve patients underwent operative cholangiography, three underwent conversion to open cholecystectomy, and 12 reoperations were performed in nine patients before interventional radiologic procedures, which included diagnostic percutaneous transhepatic cholangiography (n = 13), percutaneous biliary drainage (PBD) (n = 13), percutaneous stricture dilation (n = 3), stent insertion (n = 1), percutaneous abscess or biloma drainage (n = 19), and gallstone removal (n = 1). Each procedure was technically successful. Clinical improvement occurred in 18 of 19 patients. PBD was used as an operative guide before reconstructive surgery in two patients. Reoperation was unnecessary in 10 of 21 patients (48%). One patient died of fungal sepsis and pulmonary complications. This radiologic-surgical approach provided rapid and safe management of these complications.