Hot topic: apparent total-tract nutrient digestibilities measured commercially using 120-hour in vitro indigestible neutral detergent fiber as a marker are related to commercial dairy cattle performance

Measuring individual feed nutrient concentration is common practice for field dairy nutritionists. However, accurately measuring nutrient digestibility and using digestion values in total digestible nutrients models is more challenging. Our objective was to determine if in vivo apparent total-tract nutrient digestibility measured with a practical approach was related to commercial milk production parameters. Total mixed ration and fecal samples were collected from high-producing cows in pens on 39 commercial dairies and analyzed at a commercial feed and forage testing laboratory for nutrient concentration and 120-h indigestible NDF (iNDF) content using the Combs-Goeser in vitro digestion technique. The 120-h iNDF was used as an internal marker to calculate in vivo apparent nutrient digestibilities. Two samples were taken from each dairy and were separated in time by at least 3 wk. Samples were targeted to be taken within 7d of Dairy Herd Improvement (DHI) herd testing. Approved DHI testers measured individual cow milk weights as well as fat and protein concentrations. Individual cow records were averaged by pen corresponding to the total mixed ration and fecal samples. Formulated diet and dry matter intake (DMI) records for each respective pen were also collected. Mixed model regression analysis with dairy specified as a random effect was used to relate explanatory variables (diet nutrient concentrations, formulated DMI, in vivo apparent nutrient digestibilities, and fecal nutrient concentrations) to milk production measures. Dry matter intake, organic matter (OM) digestibility, fecal crude protein (CP) concentration, and fecal ether extract concentration were related to milk, energy-corrected milk, and fat yields. Milk protein concentration was related to CP digestibility, and milk protein yield was related to DMI, OM digestibility, CP digestibility, and ether extract digestibility. Although many studies have related DMI and OM digestibility to milk production under controlled experimental settings, very few have related practical in vivo measures to milk production. By documenting the practical OM digestibility relationship with milk production, nutritionists and scientists may have confidence in this approach for measuring diet performance and collecting nutritional data for commercial dairies.

Blood Epstein-Barr virus DNA load and risk of progression to AIDS-related systemic B lymphoma

BACKGROUND

AIDS-related lymphoma (ARL) remains the main cause of AIDS-related deaths in the combined antiretroviral therapy (cART) era. Although most ARLs are associated with the Epstein-Barr virus (EBV), whether patients with high EBV burden are more at risk of developing ARL is unknown. This study investigated the relationship between high blood EBV DNA loads and subsequent progression to ARL.

METHODS

We identified 43 cases of ARL diagnosed between 1988 and 2007 within two cohorts (ANRS SEROCO/HEMOCO and PRIMO) and for which stored serum and peripheral blood mononuclear cell (PBMC) samples were available within 3 years before ARL diagnosis. For each case, two controls matched for the cohort and CD4 cell count in the year of ARL diagnosis were selected. EBV DNA was measured in PBMCs and serum samples with a commercial kit.

RESULTS

High levels of EBV DNA in PBMCs collected a median of 10 months before diagnosis were associated with an increased risk of developing systemic B lymphoma (adjusted odds ratio 2.47; 95% confidence interval 1.15; 5.32 for each 1 log copies/10(6) PBMC increase in EBV load) but not with primary brain lymphoma.

CONCLUSION

In this study, HIV-infected patients with undetectable EBV DNA in PBMCs did not develop ARL in the following 3 years, while high levels of EBV DNA in PBMCs predicted subsequent progression to systemic B lymphoma. Clinicians should be aware of the increased risk of developing systemic B lymphoma in HIV-infected patients with a high blood EBV DNA load.

Impact of early chest radiography and empirical antibiotherapy on delay in the diagnosis of pulmonary tuberculosis

OBJECTIVE

The treatment of community-acquired pneumonia relies on empirical antibacterial treatment, guided by chest X-ray. We evaluated the impact of this practice on delay in the diagnosis of pulmonary tuberculosis.

PATIENTS AND METHODS

We performed a retrospective monocentric study on 64 documented cases of pulmonary tuberculosis.

RESULTS

Empirical antibacterial treatment was prescribed between the first symptoms and pulmonary tuberculosis diagnosis in 42.2% of cases. The median delay between first contact with a healthcare provider and pulmonary tuberculosis treatment initiation (medical delay) was 13.5 days. The factors associated with medical delay above 30 days were alcohol abuse (OR 7.62; P = 0.02), and late chest X-ray (OR 9.33; P = 0.01). Empirical antibacterial treatment was more frequent in case of late chest X-ray (P = 0.02) and increased the risk of medical delay above 7 days (OR 6.3; P = 0.05).

CONCLUSION

When lower respiratory tract infection is suspected, early chest X-ray reduces the empirical use of antibacterial agents and decreases delay in the diagnosis of pulmonary tuberculosis.

Single-nucleotide polymorphism-defined class I and class III major histocompatibility complex genetic subregions contribute to natural long-term nonprogression in HIV infection

We performed a genome-wide association study comparing a cohort of 144 human immunodeficiency virus (HIV type 1-infected, untreated white long-term nonprogressors (LTNPs) with a cohort of 605 HIV-1-infected white seroconverters. Forty-seven single-nucleotide polymorphisms (SNPs), located from class I to class III major histocompatibility complex (MHC) subregions, show statistical association (false discovery rate, <0.05) with the LTNP condition, among which 5 reached genome-wide significance after Bonferonni correction. The MHC LTNP-associated SNPs are ordered in ≥4 linkage disequilibrium blocks; interestingly, an MHC class III linkage disequilibrium block (defined by the rs9368699 SNP) seems specific to the LTNP phenotype.

[Gastric stump carcinoma--a surgical and oncological challenge]

Gastric stump carcinoma after gastric surgery for benign disease is now widely recognized as a distinct clinical entity. An electronic literature search was performed in the MEDLINE database to identify relevant studies concerning epidemiology, prognosis, treatment, aetiology and pathology of gastric stump carcinoma. The references reported in these studies were used to complete the literature search. It can be assumed that approximately 10 % of patients who had undergone a distal gastric resection for benign disease will develop a carcinoma in the gastric remnant about 15 to 20 years after the primary procedure. The incidence is reported to be higher in males and following Billroth II resection. The site of tumour growth is predominantly in the anastomotic area, but may occur anywhere in the stump. Enterogastric reflux, achlorhydria, bacterial overgrowth, and genetic factors appear to be the major factors involved in the aetiopathogenesis of the gastric stump cancer. Unfortunately, a significant proportion of patients presents with synchronous metastases. Clinical symptoms are mainly attributed to locally advanced tumour growth. Surgical therapy comprises total removal of the gastric remnant and the jejunal segment including modified lymphadenectomy (D2 lymphadenectomy and jejunal mesentery). Surveillance of patients with endoscopy and multiple biopsies should be initiated from the tenth postoperative year and may provide the means to diagnose tumours at an early stage.