Cytomegalovirus pleuropericarditis after orthotopic liver transplantation.

Cytomegalovirus (CMV) reactivation is a common complication after liver transplantation. In patients with CMV infection, indicated by a positive CMV DNA titer, the presence of any clinical symptom is termed CMV disease. The most common organ affected in CMV disease is the gastrointestinal tract, causing esophagitis, gastritis, enteritis or colitis. CMV infection of the pleura and pericard has been reported in immunocompromised patients, but is rarely seen following liver transplantation.We report a case of a 59-year-old male who developed CMV pleuropericarditis after liver transplantation. Initial ganciclovir treatment did not improve the patient's symptoms and therapy was switched to Foscarnet which ultimately resulted in resolution of infection. However, a few weeks after Foscarnet cessation, the patient again developed bilateral pleural effusion. Ultimate biochemical and clinical response was achieved with IV ganciclovir treatment. The patient was discharged from the hospital with oral Valganciclovir for 3 weeks and has since remained relapse free for >1 year.

A time-series approach for clustering farms based on slaughterhouse health aberration data.

A large amount of data is collected routinely in meat inspection in pig slaughterhouses. A time series clustering approach is presented and applied that groups farms based on similar statistical characteristics of meat inspection data over time. A three step characteristic-based clustering approach was used from the idea that the data contain more info than the incidence figures. A stratified subset containing 511,645 pigs was derived as a study set from 3.5 years of meat inspection data. The monthly averages of incidence of pleuritis and of pneumonia of 44 Dutch farms (delivering 5149 batches to 2 pig slaughterhouses) were subjected to 1) derivation of farm level data characteristics 2) factor analysis and 3) clustering into groups of farms. The characteristic-based clustering was able to cluster farms for both lung aberrations. Three groups of data characteristics were informative, describing incidence, time pattern and degree of autocorrelation. The consistency of clustering similar farms was confirmed by repetition of the analysis in a larger dataset. The robustness of the clustering was tested on a substantially extended dataset. This confirmed the earlier results, three data distribution aspects make up the majority of distinction between groups of farms and in these groups (clusters) the majority of the farms was allocated comparable to the earlier allocation (75% and 62% for pleuritis and pneumonia, respectively). The difference between pleuritis and pneumonia in their seasonal dependency was confirmed, supporting the biological relevance of the clustering. Comparison of the identified clusters of statistically comparable farms can be used to detect farm level risk factors causing the health aberrations beyond comparison on disease incidence and trend alone.

Single-Center Case Series of Donor-Related Malignancies: Rare Cases With Tremendous Impact.

BACKGROUND: Donor-related malignancy is a rare complication of organ transplantation. METHODS: In this case series, we discuss three cases of donor-related cancers in kidney transplant recipients who were registered in our center between 1979 and 2015. They account for an incidence of 0.29% of donor-related malignancies of a total of 1015 transplanted kidney grafts (deceased and living donors). The three cases that we describe presented in different ways and with different severity, although the response to the initiated treatment was comparable. RESULTS: All three patients not only survived their cancer episode but also had a complete oncological remission and underwent successful second kidney transplantation, accounting for a 100% survival rate in our small cohort. CONCLUSIONS: Despite the very low incidence of this complication, transplant clinicians must be aware of the occurrence of donor-related malignancies when selecting a donor and should be able to diagnose and treat a case of donor-related cancer.

Evaluation of the sustainability of contrasted pig farming systems: economy.

The aim of this paper is to present an efficient tool for evaluating the economy part of the sustainability of pig farming systems. The selected tool IDEA was tested on a sample of farms from 15 contrasted systems in Europe. A statistical analysis was carried out to check the capacity of the indicators to illustrate the variability of the population and to analyze which of these indicators contributed the most towards it. The scores obtained for the farms were consistent with the reality of pig production; the variable distribution showed an important variability of the sample. The principal component analysis and cluster analysis separated the sample into five subgroups, in which the six main indicators significantly differed, which underlines the robustness of the tool. The IDEA method was proven to be easily comprehensible, requiring few initial variables and with an efficient benchmarking system; all six indicators contributed to fully describe a varied and contrasted population.

Evaluation of the sustainability of contrasted pig farming systems: development of a market conformity tool for pork products based on technological quality traits.

A market conformity tool, based on technological meat quality parameters, was developed within the Q-PorkChains project, to be included in a global sustainability evaluation of pig farming systems. The specific objective of the market conformity tool was to define a scoring system based on the suitability of meat to elaborate the main pork products, according to their market shares based on industry requirements, in different pig farming systems. The tool was based on carcass and meat quality parameters that are commonly used for the assessment of technological quality, which provide representative and repeatable data and are easily measurable. They were the following: cold carcass weight; lean meat percentage; minimum subcutaneous back fat depth at m. gluteus medius level, 45 postmortem and ultimate pH (measured at 24-h postmortem) in m. longissimus lumborum and semimembranosus; meat colour; drip losses and intramuscular fat content in a m. longissimus sample. Five categories of pork products produced at large scale in Europe were considered in the study: fresh meat, cooked products, dry products, specialties and other meat products. For each of the studied farming systems, the technological meat quality requirements, as well as the market shares for each product category within farming system, were obtained from the literature and personal communications from experts. The tool resulted in an overall conformity score that enabled to discriminate among systems according to the degree of matching of the achieved carcass and meat quality with the requirements of the targeted market. In order to improve feasibility, the tool was simplified by selecting ultimate pH at m. longissimus or semimembranosus, minimum fat thickness measured at the left half carcass over m. gluteus medius and intramuscular fat content in a m. longissimus sample as iceberg indicators. The overall suitability scores calculated by using both the complete and the reduced tools presented good correlation and the results obtained were similar. The tool could be considered as robust enough to discriminate among different systems, since it was tested in a wide range of them. It also can be used to detect improvement opportunities to enhance sustainability of pig farming systems. The final objective of the study was achieved, since the market suitability tool could be used in an integrated sustainability analysis of pig farming systems.

Evaluation of the sustainability of contrasted pig farming systems: the procedure, the evaluated systems and the evaluation tools.

Although a few studies consider the sustainability of animal farming systems along the three classical main pillars (economy, environment and society), most studies on pig farming systems address only one of these pillars. The present paper is the introduction to a series of companion papers presenting the results of a study undertaken within the EU-supported project Q-PorkChains, aiming at building a comprehensive tool for the evaluation of pig farming systems, which is robust to accommodate the large variability of systems existing in Europe. The tool is mostly based on questions to farmers and comprises a total of 37 dimensions distributed along eight themes: Animal Welfare, Animal Health, Breeding Programmes, Environmental Sustainability, Meat Safety, Market Conformity, Economy and Working Conditions. The paper describes the procedure that was used for building the tool, using it on 15 contrasted pig farming systems and analysing the results. The evaluated systems are briefly described and a short overview of the dimensions is provided. Detailed descriptions of the theme-wise tools and results, as well as the results of an integrated evaluation, are available in the companion papers.

Evaluation of the sustainability of contrasted pig farming systems: integrated evaluation.

The aim of this paper is to present an approach for an integrated evaluation of the sustainability of pig farming systems, taking into account the three classical pillars: economy, environment and society. Eight sustainability themes were considered: Animal Welfare (AW), Animal Health (AH), Breeding Programmes (BP), Environment (EN), Meat Safety (MS), Market Conformity (MC), Economy (EC) and Working Conditions (WC). A total of 37 primary indicators were identified and used for the evaluation of 15 much contrasted pig farming systems in five EU countries. The results show that the eight themes were not redundant and all contributed to the observed variation between systems. The tool was very robust for highlighting the strengths and weaknesses of the systems along the eight themes that were considered. The number of primary indicators could be reduced from 37 to 18 with limited impact on the strengths/weaknesses profile of the individual systems. Integrating the eight theme evaluations into a single sustainability score is based on hypotheses or presumptions on the relative weights that should be given to the eight themes, which are very dependent on the context and on the purpose of the users of the tool. Therefore, the present paper does not have the ambition to provide a ready-for-use tool, rather to suggest an approach for the integrated evaluation of the sustainability of pig farming systems.

Evaluation of the sustainability of contrasted pig farming systems: breeding programmes.

The sustainability of breeding activities in 15 pig farming systems in five European countries was evaluated. One conventional and two differentiated systems per country were studied. The Conventional systems were the standard systems in their countries. The differentiated systems were of three categories: Adapted Conventional with focus on animal welfare, meat quality or environment (five systems); Traditional with local breeds in small-scale production (three systems) and Organic (two systems). Data were collected with a questionnaire from nine breeding organisations providing animals and semen to the studied farming systems and from, on average, five farmers per farming system. The sustainability assessment of breeding activities was performed in four dimensions. The first dimension described whether the market for the product was well defined, and whether the breeding goal reflected the farming system and the farmers' demands. The second dimension described recording and selection procedures, together with genetic change in traits that were important in the system. The third dimension described genetic variation, both within and between pig breeds. The fourth dimension described the management of the breeding organisation, including communication, transparency, and technical and human resources. The results show substantial differences in the sustainability of breeding activities, both between farming systems within the same category and between different categories of farming systems. The breeding activities are assessed to be more sustainable for conventional systems than for differentiated systems in three of the four dimensions. In most differentiated farming systems, breeding goals are not related to the system, as these systems use the same genetic material as conventional systems. The breeds used in Traditional farming systems are important for genetic biodiversity, but the small scale of these systems renders them vulnerable. It is hoped that, by reflecting on different aspects of sustainability, this study will encourage sustainable developments in pig production.

Meta-analysis on the effects of the physical environment, animal traits, feeder and feed characteristics on the feeding behaviour and performance of growing-finishing pigs.

A meta-analysis, using information from 45 experiments on growing-finishing pigs published in 39 manuscripts, was carried out to determine the simultaneous effects of the physical environment (space allowance, group size, flooring conditions, temperature, presence of enrichment), pig traits (initial body weight (BW) for each studied time interval, sex, genetics), feeder characteristics (water provision within the feeder, feeder design (individual/collective), feeder places/pig, presence of feeder protection) and feed characteristics (feed allowance (ad libitum/restricted), net energy content, crude protein (CP) content), as well as their potential interactions, on the feeding behaviour and performance of growing-finishing pigs. The detrimental effect of low temperature on performance was particularly evident for restricted-fed pigs (P < 0.05). At reduced feeder space allowance, a reduction in the percentage of time spent eating was predicted when increasing initial BW, whereas the opposite was predicted for larger feeder space allowances (P < 0.001). The reduction in visit duration to the feeder in higher BW groups became gradually more important with increasing feeder space allowance (P < 0.01), whereas the increase in the ingestion rate and average daily feed intake (ADFI) with increasing initial BW became smaller with increasing feeder space (P < 0.05). The model predicted a reduction in feed conversion ratio (FCR) with increasing group size (P < 0.05) and floor space allowance (P < 0.01) and on solid floors with or without bedding (P < 0.05). In comparison with other feeders, wet/dry feeders were associated with more frequent but shorter feeder visits (P < 0.05), higher ingestion rates (P < 0.001) and higher ADFI (P < 0.10). The use of protection within individual feeders increased the time spent feeding (P < 0.001), reduced the number of visits per day (P < 0.01), the ingestion rate (P < 0.001) and FCR (P < 0.01) in comparison with other feeder types. Sex modulated the effect of the number of feeder places/pig on FCR (P < 0.05), with a gradual reduction of FCR in entire males and females when increasing feeder space allowance. Genetics tended to modulate the effect of diets' CP content on FCR (P < 0.10). Overall, these results may contribute to the improvement of the welfare and performance of growing-finishing pigs by a better knowledge of the influence of the rearing environment and may help optimize the feeding strategies in current production systems.

A cognitive-behavioural pedometer-based group intervention on physical activity and sedentary behaviour in individuals with type 2 diabetes.

The purpose of this study was to investigate the benefits of a pedometer and a cognitive-behavioural group intervention for promoting physical activity (PA) in type 2 diabetes patients. We recruited 41 participants and randomized them into an intervention group (IG) (n=20) and a control group (CG) (n = 21). The intervention consisted of five sessions within 12 weeks, a booster session after 22 weeks and a pedometer. Primary outcome was PA assessed by accelerometer (minutes per day) and pedometer (steps per day). Secondary outcomes were weight, body mass index, blood pressure, haemoglobin A1c and total cholesterol. After 12 weeks, the IG increased with more than 2000 steps day(-1) compared with the CG, whereas sedentary behaviour decreased more than 1 hour day(-1) in the IG and showed no change in the CG. There was no intervention effect on the accelerometer-based PA nor on health measurements. After 1 year, the increase in steps per day remained significant in the IG, but sedentary activity increased again to baseline levels. This pilot study showed that the combination of a 12-week cognitive-behavioural intervention and a pedometer has a significant short-term impact on daily steps and sedentary behaviour but that the effects on total PA and long-term effects were limited.

Quantitative assessment of the effects of space allowance, group size and floor characteristics on the lying behaviour of growing-finishing pigs.

To obtain quantitative information that can be later used in animal welfare modelling, the relationship between the lying behaviour of growing-finishing pigs (initial body weight (BW) between 19 and 87 kg) and different factors related to the housing conditions, with a potential negative effect on their welfare, was studied by means of a meta-analytical approach. Data from 22 experiments reported in 21 scientific publications were collected. The space allowance, expressed on an allometric basis by means of a k-value (m2/BW0.667), the group size (n) and the floor characteristics (fully and partly slatted v. non-slatted floor), as well as their significant two-way interactions were used as fixed effects, and the experiment was used as a random factor to take into account the interexperiment effect. Further regression analyses were performed on the predicted values of observations in order to improve the adjustment of data. A significant quadratic relationship was established between space allowance (k-value, P < 0.05; squared k-value, P < 0.01) and the percentage of time spent lying. A significant interaction between the k-value and the floor type was also found (P < 0.05), showing that the relationship between space allowance and lying behaviour is affected by the presence or absence of slats. Threshold k-values were obtained using broken-line analyses, being about 0.039 for slatted floors and almost double for non-slatted floors. Compared to other studies, these values suggest that the ability to rest as space availability decreases may be compromised before a reduced performance becomes apparent. Group size did not show a significant effect. Additional information should be added to the model, as further data become available, to adjust the proposed parameters as well as to try to include the effect of other important aspects such as that of ambient temperature.

Organ procurement after euthanasia: Belgian experience.

Euthanasia was legalized in Belgium in 2002 for adults under strict conditions. The patient must be in a medically futile condition and of constant and unbearable physical or mental suffering that cannot be alleviated, resulting from a serious and incurable disorder caused by illness or accident. Between 2005 and 2007, 4 patients (3 in Antwerp and 1 in Liège) expressed their will for organ donation after their request for euthanasia was granted. Patients were aged 43 to 50 years and had a debilitating neurologic disease, either after severe cerebrovascular accident or primary progressive multiple sclerosis. Ethical boards requested complete written scenario with informed consent of donor and relatives, clear separation between euthanasia and organ procurement procedure, and all procedures to be performed by senior staff members and nursing staff on a voluntary basis. The euthanasia procedure was performed by three independent physicians in the operating room. After clinical diagnosis of cardiac death, organ procurement was performed by femoral vessel cannulation or quick laparotomy. In 2 patients, the liver, both kidneys, and pancreatic islets (one case) were procured and transplanted; in the other 2 patients, there was additional lung procurement and transplantation. Transplant centers were informed of the nature of the case and the elements of organ procurement. There was primary function of all organs. The involved physicians and transplant teams had the well-discussed opinion that this strong request for organ donation after euthanasia could not be waived. A clear separation between the euthanasia request, the euthanasia procedure, and the organ procurement procedure is necessary.

Simultaneous kidney-parathyroid allotransplantation from a single donor after 20 years of tetany: a case report.

Persistent hypocalcemia after total parathyroidectomy and autotransplantation is rare and occasionally has been treated using allotransplantation of parathyroid tissue. We present the case of a 32-year-old woman with terminal renal failure who at age 5 years underwent a first renal transplantation from a brain-dead donor. The graft was lost as a result of acute rejection. Tertiary hypoparathyroidism developed, which was treated with total parathyroidectomy and implantation in the forearm of a standardized amount of parathyroid tissue. The graft failed, and hypoparathyroidism developed. Despite a second implantation of cryopreserved autologous tissue, severe hypocalcemia persisted with a tendency for tetany. Although the patient was highly dependent on high-dose vitamin D(3) (tacalcitol) and calcium supplements, regular paresthesias and tetany developed. At age 9 years, the patient underwent a second renal transplant from a living related donor (her mother). After 18 years, the graft was lost as a result of chronic cyclosporine toxicity and angiosclerosis. Four years later, the patient underwent combined kidney and parathyroid transplantation from a local brain-dead donor. Preservation of the parathyroid glands was in University of Wisconsin solution, with cold ischemia time of 14 hours. Directly after the renal transplantation, parathyroid transplantation was performed, with implantation in the forearm of the total amount of donor parathyroid tissue. Postoperatively, there was recovery of parathyroid function, and the patient was able to discontinue vitamin D and calcium supplements after more than 20 years.

Toxicity and efficacy of isolated lung perfusion with gemcitabine in a rat model of pulmonary metastases.

BACKGROUND: Long-term toxicity and efficacy of isolated left lung perfusion (ILuP) with gemcitabine (GCB) were studied in a rat model of metastatic pulmonary adenocarcinoma. TOXICITY: Forty rats were randomized into six groups and administered 160 or 320 mg/kg GCB or buffered starch, received either via intravenous injection (i.v.) or via ILuP. Efficacy experiment: Rats with unilateral metastases had ILuP with 320 mg/kg GCB (maximally tolerated dose administered by ILuP), while rats with bilateral metastases had an i.v. injection of 160 mg/kg GCB (maximally tolerated dose given by i.v.). RESULTS: TOXICITY experiment: After i.v. treatments, all rats receiving 320 mg/kg GCB died within one week, while rats who had received 160 mg/kg GCB had a survival rate of 60%. After ILuP with 160 mg/kg GCB and 320 mg/kg GCB, survival rates were 83% in both groups. A significant increase in collagen deposits was observed for ILuP with 320 mg/kg GCB compared to rats treated i.v. with 160 mg/kg GCB. Efficacy experiment: Median survival of ILuP rats treated with 320 mg/kg (38 +/- 4 days) was significantly longer compared to i.v. rats treated with 160 mg/kg (27 +/- 2 days; p = 0.02). CONCLUSIONS: ILuP with GCB prolongs survival in experimental metastatic adenocarcinoma while no major acute or long term toxicity is observed.

Breeding for societally important traits in pigs.

Pig breeding programs traditionally focus on the genetic improvement of production and reproduction traits that have a clear economic value. Because citizens and consumers increasingly attach value to traits that have little or no direct relationship to production costs or to the price of a product, pig breeding organizations want to pay more attention to societally important traits, such as the welfare and health of pigs, the ecological effects of pork production, and the healthiness and sensory quality of pork. Most societally important traits have an economic and a noneconomic value and are sufficiently heritable for effective genetic selection, although many genetic and phenotypic (co)-variances still have to be estimated. However, it often is not clear to a pig breeding organization how it may deal with the noneconomic value of breeding-goal traits. In this study, a retrospective selection-index method is proposed to obtain the proper weights for societally important traits in the breeding goal. First, the genetic-progress space for each breeding-goal trait is explored by increasing the weights, in a stepwise manner, to each societally important trait in the breeding goal, starting from zero. Subsequently, a pig breeding organization can adopt the resulting genetic-progress scenario that it considers most sustainable or most acceptable. The weights underlying the adopted scenario are considered to be the proper breeding-goal weights. The noneconomic value of each societally important breeding-goal trait is found by deducting its economic value from its obtained weight and is thereby expressed in monetary units. In addition to obtaining weights for societally important breeding-goal traits, the proposed method offers the possibility to estimate the societal costs of selecting for economic traits only, as well as the societal benefits and the economic costs of selecting for traits with a noneconomic value. The method is therefore a useful tool for the development of sustainable breeding goals. An example has been worked out for a sow-line breeding program.

Aortic graft infection from appendicitis. A case report.

Fifteen years after aortobifemoral bypass and five years after left femoropopliteal bypass, a 73-year old man presented with a vague abdominal pain syndrome. After an extensive work-up, aortobifemoral graft infection was suspected; an appendiceal abscess infiltrating the prosthesis was discovered during exploratory laparotomy. Appendectomy was performed followed by removal of the vascular graft, the latter being replaced by a bilateral axillofemoral prosthesis. Aortic graft infection from appendicitis is an extremely rare condition; a review of similar cases is presented.

The importance of a high feed intake during lactation of primiparous sows nursing large litters.

The objective of this study was to investigate whether nursing a large number of piglets has negative effects on lactation and postweaning performance of primiparous sows and whether a greater lactation feed intake can prevent possible negative effects. Data were recorded on 268 ad libitum-fed sows of three genotypes (G1, G2, and G3) in an experiment where litter size was standardized to 8, 11, or 14 piglets during a 4-wk lactation. Compared to G1 and G2, G3 sows were heavier (P < 0.05) and leaner (P < 0.05) at weaning of their litters, lost similar amounts of BW and backfat, and their piglets grew faster (P < 0.05). Compared to G1, feed intake during lactation was higher for G3 sows (P < 0.05), and their risk of a prolonged weaning-to-estrus interval was lower (P < 0.01). Daily feed intake by sows was not affected by litter size in G1 and G3, but it was quadratically affected in G2 (P < 0.05), with a maximum at 10.8 piglets. Backfat loss of the sows increased linearly with litter size (P < 0.05) in G1 and G3. In G2, backfat loss increased only at litter sizes > 9.8 piglets (P < 0.01). Body weight loss of the sow and litter weight gain increased linearly with litter size (P < 0.001). Per extra piglet nursed, sows had a 23% (P < 0.01) higher probability of a prolonged weaning-to-estrus interval. A higher daily feed intake during lactation reduced tissue loss of the sow, increased litter weight gain (P < 0.01), and reduced the probability of a prolonged weaning-to-estrus interval (by 42% per extra kilogram; P < 0.01). Sows with a lower daily body weight loss during first lactation had a larger second litter (1.28 piglets/kg; P < 0.01), and their probability of a prolonged weaning-to-estrus interval was reduced by 61% per kilogram (P < 0.001). With increasing litter size, it is therefore recommended to reduce body weight loss during lactation by stimulating daily feed intake and by genetic selection.

Protein and lipid deposition rates in male broiler chickens: separate responses to amino acids and protein-free energy.

Two experiments of similar design were conducted with male broiler chickens over two body weight ranges, 200 to 800 g in Experiment 1 and 800 to 1,600 g in Experiment 2. The data were used to test the hypothesis that protein deposition rate increases (linearly) with increasing amino acid intake, until energy intake becomes limiting for protein deposition rate. Additional amino acid intake above this point would be deposited less efficiently. An increase in energy intake would increase lipid deposition rate, but should, at low amino acid intakes, not affect protein deposition rate. Each experiment consisted of 18 treatments: two levels of protein-free energy (energy(pf)) intake, combined with nine amino acid to energypf ratios. Protein was balanced for amino acid content and lysine was the first limiting amino acid in the diet. Protein deposition rate increased with additional amino acid intake. No evidence was found that energy(pf) intake limited protein deposition rate at high amino acid intake. Extra intake of energy(pf) increased lipid deposition rate, which was independent of amino acid intake. Where amino acid intake was limiting, additional intake of energy(pf) had generally no effect on protein deposition rate. The marginal efficiency of amino acid utilization for protein deposition did not depend on body weight. The facts are relevant to the modeling of the growth of broiler chickens.