Supply of palmitic, stearic, and oleic acid changes rumen fiber digestibility and microbial composition

The concept that fat supplementation impairs total-tract fiber digestibility in ruminants has been widely accepted over the past decades. Nevertheless, the recent interest in the dietary fatty acid profile to dairy cows enlightened the possible beneficial effect of specific fatty acids (e.g., palmitic, stearic, and oleic acids) on total-tract fiber digestibility. Because palmitic, stearic, and oleic acids are the main fatty acids present in ruminal bacterial cells, we hypothesize that the dietary supply of these fatty acids will favor their incorporation into the bacterial cell membranes, which will support the growth and enrichment of fiber-digesting bacteria in the rumen. Our objective in this experiment was to investigate how dietary supply of palmitic, stearic, and oleic acid affect fiber digestion, bacterial membrane fatty acid profile, microbial growth, and composition of the rumen bacterial community. Diets were randomly assigned to 8 single-flow continuous culture fermenters arranged in a replicated 4 × 4 Latin square with four 11-d experimental periods. Treatments were (1) a control basal diet without supplemental fatty acids (CON); (2) the control diet plus palmitic acid (PA); (3) the control diet plus stearic acid (SA); and (4) the control diet plus oleic acid (OA). All fatty acid treatments were included in the diet at 1.5% of the diet (dry matter [DM] basis). The basal diet contained 50% orchardgrass hay and 50% concentrate (DM basis) and was supplied at a rate of 60 g of DM/d in 2 equal daily offers (0800 and 1600 h). Data were analyzed using a mixed model considering treatments as fixed effect and period and fermenter as random effects. Our results indicate that PA increased in vitro fiber digestibility by 6 percentage units compared with the CON, while SA had no effect and OA decreased fiber digestibility by 8 percentage units. Oleic acid decreased protein expression of the enzymes acetyl-CoA carboxylase compared with CON and PA, while fatty acid synthase was reduced by PA, SA, and OA. We observed that PA, but not SA or OA, altered the bacterial community composition by enhancing bacterial groups responsible for fiber digestion. Although the dietary fatty acids did not affect the total lipid content and the phospholipid fraction in the bacterial cell, PA increased the flow of anteiso C13:0 and anteiso C15:0 in the phospholipidic membrane compared to the other treatments. In addition, OA increased the flow of C18:1 cis-9 and decreased C18:2 cis-9,cis-12 in the bacterial phospholipidic membranes compared to the other treatments. Palmitic acid tended to increase bacterial growth compared to other treatments, whereas SA and OA did not affect bacterial growth compared with CON. To our knowledge, this is the first research providing evidence that palmitic acid supports ruminal fiber digestion through shifts in bacterial fatty acid metabolism that result in changes in growth and abundance of fiber-degrading bacteria in the microbial community.

Feeding Grazing Dairy Cows With Different Energy Sources on Recovery of Human-Edible Nutrients in Milk and Environmental Impact

The use of grazing systems for milk production is widely used globally because it is a lower-cost feeding system. However, under tropical conditions, the energy content of pastures became is a limitation to improve animal performance and efficiency while reducing the environmental impact. The objective of our study was to evaluate the impact of supplying different dietary sources of energy to lactating dairy cows grazing tropical pastures on the recovery of human-edible (HE) nutrients in milk and the environmental impact. Two experiments were conducted simultaneously. In experiment 1, forty early lactating dairy cows were used in a randomized block design. In experiment 2, four late-lactating rumen-cannulated dairy cows were used in a 4 × 4 Latin Square design. All cows had free access to pasture and treatments were applied individually as a concentrate supplement. Treatments were flint corn grain-processing method either as fine ground (FGC) or steam-flaked (SFC) associated with Ca salts of palm fatty acids supplementation either not supplemented (CON) or supplemented (CSPO). We observed that feeding cows with SFC markedly reduced urinary nitrogen excretion by 43%, and improved milk nitrogen efficiency by 17% when compared with FGC. Additionally, we also observed that feeding supplemental fat improved milk nitrogen efficiency by 17% compared with cows receiving CON diets. A tendency for decreased methane (CH4) per unit of milk (−31%), CH4 per unit of milk energy output (−29%), and CH4 per unit of milk protein output (−31%) was observed when CSPO was fed compared with CON. Additionally, SFC diets increased HE recovery of indispensable amino acids by 7–9% when compared with FGC diets, whereas feeding supplemental fat improved HE recovery of indispensable amino acids by 17–19% compared with CON. Altogether, this study increased our understanding of how manipulating energy sources in the dairy cow diet under tropical grazing conditions can benefit HE nutrient recovery and reduce nutrient excretion.

Milk production responses to altering the dietary ratio of palmitic and oleic acids varies with production level in dairy cows

We evaluated the effects of altering the dietary ratio of palmitic (C16:0; PA) and oleic (cis-9 C18:1; OA) acids on production responses of cows with a wide range of milk production (32 to 65 kg/d) in a crossover design experiment with a preliminary period. Thirty-two multiparous Holstein cows (144 ± 54 d in milk) were assigned randomly to a treatment sequence. Treatments were diets supplemented with fatty acid (FA) blends (1.5% of diet dry matter) that provided 80% C16:0 + 10% cis-9 C18:1 (PA) and 60% C16:0 + 30% cis-9 C18:1 (PA+OA). The corn silage and alfalfa-based diets contained 20.0% forage neutral detergent fiber (NDF), 28.5% starch, and 17.1% crude protein. Treatment periods were 21 d with the final 5 d used for data and sample collection. Treatment did not affect dry matter intake (DMI), milk yield, energy-corrected milk (ECM), body weight, or body weight change. The PA+OA diet increased total, 16-carbon, and 18-carbon FA digestibility compared with the PA diet. Compared with PA+OA, PA increased fat yield (1.97 vs. 1.91 kg/d) and protein yield (1.61 vs. 1.55 kg/d). The PA diet also increased the yield of de novo (448 vs. 428 g/d) and mixed (749 vs. 669 g/d) milk FA and decreased the yield of preformed FA (605 vs. 627 g/d) compared with PA+OA. Interactions were detected between treatment and preliminary milk yield for DMI, total FA intake, 16-carbon FA intake, ECM, 3.5% fat-corrected milk (linear interaction), and a tendency for milk yield (linear interaction); lower-producing cows (<45 kg/d) had increased DMI and ECM on the PA diet, whereas higher-producing cows (>55 kg/d) had increased DMI and ECM on the PA+OA diet. A linear interaction was detected between treatment and preliminary milk yield for mixed milk FA yield (linear interaction) and a tendency for de novo milk FA yield (linear interaction). Our results demonstrate that feeding a fat supplement containing more cis-9 C18:1 replacing C16:0 increased production responses (DMI, milk yield, and ECM) in higher-producing cows, but decreased production responses in lower-producing cows.

Effect of feeding a palmitic acid-enriched supplement on production responses and nitrogen metabolism of mid-lactating Holstein and Jersey cows

This study evaluated the effect of feeding a palmitic acid-enriched supplement on production responses and nitrogen metabolism of mid-lactating Holstein and Jersey cows. Eighty mid-lactating dairy cows, 40 Holstein and 40 Jersey, were used in a randomized complete block design with a split-plot arrangement; the main plot was breed and the subplot was fatty acid treatment. Cows within each breed were assigned to 1 of 2 treatments: (1) control diet with no fat supplement or (2) control diet plus a palmitic acid-enriched supplement dosed at 1.5% of diet dry matter (PA treatment). The treatment period was 6 wk with the final 3 wk used for data and sample collection. There were no treatment × breed interactions for the variables analyzed. Compared with control, PA treatment increased milk fat yield (1.36 vs. 1.26 kg/d) and tended to increase 3.5% fat-corrected milk (35.6 vs. 34.0 kg/d) and energy-corrected milk (35.7 vs. 34.1 kg/d). There was no effect of PA treatment on dry matter intake, milk yield, milk protein yield, milk lactose yield, body condition score, body weight (BW) change, nitrogen intake, and variables related to nitrogen metabolism and excretion. Compared with Holstein cows, Jersey cows had greater dry matter intake as a percent of BW (4.90 vs. 3.37% of BW) and lower milk production (29.6 vs. 32.7 kg/d) and milk lactose yield (1.58 vs. 1.42 kg/d), but tended to have greater milk fat yield (1.36 vs. 1.26 kg/d). There was a breed effect on BW change; Holstein cows gained 0.385 kg/d during the experiment, and Jersey cows gained 0.145 kg/d. Jersey cows had lower nitrogen intake (636 vs. 694 g/d), blood urea nitrogen (12.6 vs. 13.8 mg/dL), urine total nitrogen (125 vs. 145 g/d), and urine total nitrogen as a percent of nitrogen intake (19.5 vs. 21.1%). Overall, feeding a palmitic acid-enriched supplement increased milk fat yield as well as dry matter and fiber digestibility in both Holstein and Jersey cows. The PA treatment did not have any major effects on nitrogen metabolism in both Holstein and Jersey cows. In addition, our results indicated that Jersey cows had lower urinary nitrogen excretion (g/d) than Holstein cows.

Effects of commercially available palmitic and stearic acid supplements on nutrient digestibility and production responses of lactating dairy cows

We evaluated the effects of commercially available fatty acid (FA) supplements containing palmitic (C16:0) and stearic acid (C18:0) on nutrient digestibility and production responses of dairy cows. Thirty-six mid-lactation (146 ± 55 d in milk) multiparous Holstein cows were randomly assigned to twelve 3 × 3 balanced truncated Latin squares, with 3 treatments and 2 consecutive 35-d periods, with the final 5 d used for sample and data collection. Treatments were (1) a control diet containing no supplemental FA (CON), (2) a control diet supplemented with a commercially available C16:0 supplement (PA), and (3) a control diet supplemented with a commercially available C16:0 and C18:0 supplement (MIX). Supplements were fed at 1.5% dry matter and replaced soyhulls in CON. The statistical model included the random effect of cow nested within square and the fixed effects of treatment, period, square, and their interactions. Preplanned contrasts were (1) overall effect of FA treatments [CON vs. the average of the FA treatments (FAT); 1/2 (PA + MIX)], and (2) effect of FA supplement (PA vs. MIX). Treatment had no effects on dry matter intake, body weight, or body weight change. Compared with CON, FAT decreased digestibilities of total FA and 18-carbon FA but did not affect dry matter and neutral detergent fiber digestibility. Compared with MIX, PA increased dry matter and neutral detergent fiber digestibilities by 3.6 and 4.8 percentage units, respectively. The PA also increased total FA and 18-carbon FA digestibilities but did not alter 16-carbon FA digestibility compared with MIX. Using a Lucas test, we estimated apparent digestibility coefficients of 0.768 and 0.553 for the PA and MIX supplements, respectively. Compared with CON, FAT increased milk yield and tended to increase energy-corrected milk, but did not affect yield of milk fat or milk protein. The PA increased energy-corrected milk and milk fat yield but had no effect on milk protein yield compared with MIX. Our results indicate that dairy cows producing around 45 kg of milk respond better to a FA supplement enriched in C16:0 compared with a supplement containing both C16:0 and C18:0, which is likely due in part to PA increasing FA and neutral detergent fiber digestibility compared with MIX.

Lipolysis modulates the biosynthesis of inflammatory lipid mediators derived from linoleic acid in adipose tissue of periparturient dairy cows

Oxidized linoleic acid metabolites (OXLAM) are products of adipocyte lipolysis with the potential to modulate adipose tissue (AT) lipid metabolism and inflammation. In periparturient cows, linoleic acid is preferentially mobilized from AT during lipolysis by hormone-sensitive lipase (HSL) compared with other polyunsaturated fatty acids. Enzymatic and nonenzymatic reactions generate OXLAM from linoleic acid. Among OXLAM, 9-, 10-, and 12-hydroxy-octadecadienoic acids (HODE) are associated with pro-inflammatory responses, whereas 9- and 13-oxo-octadecadienoic acids (oxoODE) and 13-HODE can facilitate inflammation resolution and promote lipogenesis. This study evaluated the effect of HSL activity on OXLAM biosynthesis using subcutaneous AT explants collected from multiparous dairy cows at 10 d before and again at 10 and 24 d after calving. Explants were treated for 3 h without or with the β-adrenergic agonist isoproterenol (ISO; 1 µM; MilliporeSigma, Burlington, MA) to induce HSL activity. The contribution of HSL to OXLAM biosynthesis was determined by inhibiting its activity with CAY10499 (2 µM; Cayman Chemical, Ann Arbor, MI). After treatments, media and explants were collected for lipidomic analysis using HPLC-tandem mass spectroscopy. Results indicated that ISO increased the biosynthesis of 9-, 12-, and 13-HODE and 9-oxoODE, and this effect was reduced at 24 d after calving. Inhibiting HSL activity partially reversed ISO effects on HODE and 9-oxoODE. Our ex vivo model demonstrated for the first time a direct effect of HSL activity on the biosynthesis of OXLAM in AT, especially at 10 d before and 10 d after calving. The biosynthesis of anti-inflammatory OXLAM is limited during the first weeks after parturition and may promote AT inflammation and lipolytic responses to negative energy balance. These results indicate that HSL activity releases linoleic acid for OXLAM biosynthesis in concentrations of a magnitude that may bypass the need for the activation of phospholipases linked with the inflammatory cascade and thus supports, in part, lipolysis-driven inflammation within AT of periparturient cows.

Effects of dietary roughage neutral detergent fiber levels and flint corn processing method on growth performance, carcass characteristics, feeding behavior, and rumen morphometrics of Bos indicus cattle1

Flint corn processing method [coarse ground corn (CGC; 3.2 mm average particle size) or steam-flaked corn (SFC; 0.360 kg/L flake density)] was evaluated in conjunction with 4 levels of NDF from sugarcane bagasse (SCB) as roughage source (RNDF; 4%, 7%, 10%, and 13%; DM basis) to determine impact on growth performance, carcass characteristics, starch utilization, feeding behavior, and rumen morphometrics of Bos indicus beef cattle. Two hundred and forty Nellore bulls were blocked by initial BW (350 ± 37 kg), assigned to 32 feedlot pens and pens within weight block were randomly assigned, in a 2 × 4 factorial arrangement (2 corn processing and 4 levels of RNDF) to treatments. Effects of corn grain processing × RNDF level were not detected (P ≥ 0.14) for growth performance, dietary net energy concentration, carcass traits, rumen morphometrics, and feeding behavior, except for time spent ruminating and time spent resting (P ≤ 0.04), and a tendency for papillae width (P ≤ 0.09). Bulls fed SFC-based diets consumed 7% less (P = 0.001), had 10.6% greater carcass-adjusted ADG (P < 0.001) and 19% greater carcass-adjusted feed efficiency (P < 0.001) compared with bulls fed CGC-based diets. Observed net energy for maintenance and gain values were 14.9% and 19.4% greater (P < 0.001), respectively, for SFC than for CGC-based diets. Fecal starch concentration was less (P < 0.001) for bulls fed SFC compared with those fed CGC. No grain processing effects were detected (P = 0.51) for rumenitis score; however, cattle fed SFC presented smaller ruminal absorptive surface area (P = 0.03). Dry matter intake increased linearly (P = 0.02) and carcass-adjusted feed efficiency tended (P = 0.06) to decrease linearly as RNDF increased. Dietary RNDF concentration did not affect carcass characteristics (P ≥ 0.19), except for dressing percentage, which tended to decrease linearly (P = 0.06) as RNDF in finishing diets increased. Increasing RNDF in finishing diets had no effect (P = 0.26) on time spent eating, but time spent ruminating and resting increased linearly (min/d; P < 0.001) with increased dietary RNDF. Steam flaking markedly increased flint corn energy value, net energy of diets, and animal growth performance, and led to improvements on feed efficiency when compared with grinding, regardless of RNDF content of diets. Increasing dietary RNDF compromised feedlot cattle feed efficiency and carcass dressing.

Fetuin-A: A negative acute-phase protein linked to adipose tissue function in periparturient dairy cows

Fetuin-A (FetA) is a free fatty acid transporter and an acute-phase protein that enhances cellular lipid uptake and lipogenesis. In nonruminants, FetA is involved in lipid-induced inflammation. Despite FetA importance in lipid metabolism and inflammation, its expression and dynamics in adipose tissue (AT) of dairy cows are unknown. The objectives of this study were to (1) determine serum and AT FetA dynamics over the periparturient period and in mid-lactation cows in negative energy balance (NEB) after a feed restriction protocol and (2) characterize how an inflammatory challenge affects adipocyte FetA expression. Blood and subcutaneous AT were collected from 16 cows with high (≥3.75, n = 8) or moderate (≤3.5, n = 8) body condition score (BCS) at -26 ± 7 d (far off) and -8 ± 5 d (close up) before calving and at 10 ± 2 d after parturition (early lactation) and from 14 nonpregnant mid-lactation cows (>220 d in milk) after a feed restriction protocol. Serum FetA concentrations were 0.89 ± 0.13 mg/mL at far off, 0.96 ± 0.13 mg/mL at close up, and 0.77 ± 0.13 mg/mL at early lactation and were 1.09 ± 0.09 and 1.17 ± 0.09 mg/mL in feed-restricted and control cows, respectively. Serum and AT FetA contents decreased at the onset of lactation when lipolysis was higher. No changes in AT and serum FetA were observed after feed restriction induced NEB in mid-lactation cows. Prepartum BCS had no effect on serum FetA, but AT expression of AHSG, the gene encoding FetA, was reduced in periparturient cows with high BCS at dry-off throughout all time points. Circulating FetA was positively associated with serum albumin and calcium and with BCS variation over the periparturient period. The dynamics of AHSG expression were analogous to the patterns of lipogenic markers ABDH5, ELOVL6, FABP4, FASN, PPARγ, and SCD1. Expression of AHSG and FetA protein in AT was inversely correlated with AT proinflammatory markers CD68, CD44, SPP1, and CCL2. In vitro, bovine adipocytes challenged with lipopolysaccharide downregulated FetA protein expression. Adipocytes treated with FetA had lower CCL2 expression compared with those exposed to lipopolysaccharide. Overall, FetA is a systemic and local AT negative acute-phase protein linked to AT function in periparturient cows. Furthermore, FetA may support physiological adaptations to NEB in periparturient cows.

Periparturient lipolysis and oxylipid biosynthesis in bovine adipose tissues

The periparturient period of dairy cows is characterized by intense lipolysis in adipose tissues (AT), which induces the release of free fatty acids (FFA) into circulation. Among FFA, polyunsaturated fatty acids are susceptible to oxidation and can modulate inflammatory responses during lipolysis within AT. Linoleic and arachidonic acid oxidized products (oxylipids) such as hydroxy-octadecadienoic acids (HODE) and hydroxy-eicosatetraenoic acids (HETE), were recently identified as products of lipolysis that could modulate AT inflammation during lipolysis. However, the effect of lipolysis intensity during the transition from gestation to lactation on fatty acid substrate availability and subsequent AT oxylipid biosynthesis is currently unknown. We hypothesized that in periparturient dairy cows, alterations in AT and plasma fatty acids and oxylipid profiles coincide with changes in lipolysis intensity and stage of lactation. Blood and subcutaneous AT samples were collected from periparturient cows at -27±7 (G1) and -10±5 (G2) d prepartum and at 8±3 d postpartum (PP). Targeted lipidomic analysis was performed on plasma and AT using HPLC-MS/MS. We report that FFA concentrations increased as parturition approached and were highest at PP. Cows exhibiting high lipolysis rate at PP (FFA>1.0 mEq/L) had higher body condition scores at G1 compared to cows with low lipolysis rate (FFA<1.0 mEq/L). Concentrations of plasma linoleic and arachidonic acids were increased at PP. In AT, 13-HODE, and 5-, 11- and 15-HETE were increased at PP compared to G1 and G2. Concentrations of beta hydroxybutyrate were positively correlated with those of 13-HODE and 15-HETE in AT. Plasma concentrations of 5- and 20-HETE were increased at PP. These data demonstrate that prepartum adiposity predisposes cows to intense lipolysis post-partum and may exacerbate AT inflammation because of increased production of pro-inflammatory oxylipids including 5- and 15-HETE and 13-HODE. These results support a role for certain linoleic and arachidonic acid-derived oxylipids as positive and negative modulators of AT inflammation during periparturient lipolysis.

Effect of sources of calcium salts of fatty acids on production, nutrient digestibility, energy balance, and carryover effects of early lactation grazing dairy cows

The objective of our study was to investigate the effects of sources of calcium salts of fatty acids (FA) on production, nutrient digestibility, energy balance, and carryover effects of early lactation grazing dairy cows. Treatment diets were offered from 3 to 16 wk postpartum (the treatment period), in which all cows grazed elephantgrass (Pennisetum purpureum 'Cameroon') and treatments were added to a concentrate supplement. The treatments were (1) control (concentrate without supplemental fat); (2) concentrate with calcium salts of soybean FA (CSSO); and (3) concentrate with calcium salts of palm FA (CSPO). From 17 to 42 wk postpartum (the carryover period), all cows received a common diet fed as a total mixed ration. During the treatment period, CSPO increased milk yield, milk fat yield, 3.5% fat-corrected milk, energy-corrected milk, and cumulative milk yield compared with control and CSSO. Treatment CSSO increased the yield of milk but did not affect 3.5% fat-corrected milk or energy-corrected compared with control. Also, CSSO decreased milk fat yield, dry matter intake, neutral detergent fiber digestibility, and body weight and body condition loss. Compared with control, both CSSO and CSPO increased feed efficiency (3.5% fat-corrected milk:dry matter intake), and CSPO increased feed efficiency compared with CSSO. When considering energy partitioning (as % energy intake), CSPO increased energy partitioning toward milk and increased energy mobilized from body reserves compared with control and CSSO. Furthermore, CSSO tended to reduce the mobilization of energy from body reserves compared with control. In the carryover period, no differences in milk composition were observed among treatments. A treatment by time interaction was observed during the carryover period for milk yield because cows on CSPO maintained higher production compared with control and CSSO cows until 30 wk postpartum; CSSO had a lower carryover effect sustaining higher milk yield compared with control until 25 wk postpartum. In conclusion, supplementation with CSPO was an effective strategy to increase energy intake and yields of milk and milk solids and it had a greater carryover effect. Supplementation with CSSO resulted in lower mobilization of reserves and less variation in body weight and body condition throughout lactation.

Supplementation with Ca salts of soybean oil interacts with concentrate level in grazing dairy cows: intake, ingestive behavior, and ruminal parameters

In this study, we investigated the associative effects of concentrate levels and Ca salts of soybean oil (CSSO) supplementation on performance and ruminal parameters of mid-lactation dairy cows grazing on tropical pasture. Twenty-four Jersey × Holstein cows were used in a randomized block design and assigned to four treatments arranged in a 2 × 2 factorial design. Factors evaluated were concentrate levels (low, 3 kg/day vs. high, 7 kg/day of concentrate) and CSSO supplementation (without CSSO vs. with 250 g CSSO cow/day). All cows grazed on elephant grass (Pennisetum purpureum cv. Cameroon) and received the supplemental treatments for a 90-day period. The high concentrate level decreased forage intake and grazing time. In addition, the high concentrate level increased rumen propionate concentration and microbial synthesis and tended to decrease ammonia-N compared with low concentrate level. The addition of CSSO tended to decrease valerate, isobutyrate, isovalerate, and microbial synthesis. In conclusion, feeding CSSO for mid lactating cows grazing on tropical pasture had negative effects on rumen function. In contrast, CSSO supplementation tended to interact with concentrate level and increased energy intake when fed at low concentrate level. Feeding the high level of concentrate was an effective strategy to increase energy intake and microbial synthesis and improve N utilization.

The Parity Paradigm: Can Legislation Help Reduce the Cost Burden of Oral Anticancer Medications?

Over the last decade, there has been increased development and use of oral anticancer medications, which sometimes leads to high cost sharing for patients. Drug parity laws require insurance plans to cover oral anticancer medications with the same cost sharing as intravenous/injected chemotherapy or have a capped limit on out-of-pocket costs. There are currently 36 enacted state laws (plus the District of Columbia) addressing drug parity, but no federal laws. In this policy perspective piece, we discuss the history, opportunities, and limitations of drug parity laws in oncology. We also discuss the implications of provisions of the Affordable Care Act and other proposed policy reforms on financing oral chemotherapy.

Replacing soybean meal for wet brewer's grains or urea on the performance of lactating dairy cows

The purpose of this research was to evaluate the partial replacement of soybean meal (SBM) for wet brewer's grains (WBG) or urea on the performance of lactating dairy cows. The second investigated whether WBG ensiled with corn kept animal performance in low- and high-producing dairy cows compared with WBG. In experiment I, 40 Holstein cows were used in 4 × 4 Latin square design. The treatments comprised WBG or urea as partial replacement for SBM, as follows: control (diet based on SBM and 1 % of urea), 10 % of WBG, 20 % of WBG, and 2 % of urea. Dry matter intake (DMI) was not affected by treatments. WBG increased milk yield linearly, but it decreased with urea. Milk fat content responded quadratically to WBG levels. Milk protein content decreased, while plasma urea nitrogen increased with high urea addition. In experiment II, 42 Holstein cows were divided into two groups according to production levels. Eighteen cows composed the group of low producing, while the high-producing group comprised 24 cows. The experimental design was a crossover with two periods of 14 days. The experimental treatments consisted of feeding WBG or WBG ensiled with ground corn. Regardless of the production level, no difference in milk yield and milk composition between treatments was observed.

Ex vivo antibody-dependent cellular cytotoxicity inducibility predicts efficacy of cetuximab

We conducted in vitro studies and a clinical trial for patients with squamous cell carcinoma of the head and neck (SCCHN) to study the relationship between FcγRIIIa polymorphisms and antibody-dependent cellular cytotoxicity (ADCC). In vitro, FcγRIIIa genotype was correlated with ADCC and innate cytotoxicity using natural killer (NK) cells harvested from healthy donors. In the phase II study, patients with recurrent or metastatic SCCHN were treated with cetuximab (500 mg/m(2) i.v. every 2 weeks) and lenalidomide (25 mg daily). FcγRIIIa genotype and ex vivo ADCC were correlated with clinical response, progression-free survival (PFS), and overall survival (OS). In vitro, healthy donors with a FcγRIIIa 158-V allele demonstrated more effective ADCC against two colon cancer cell lines HT29 and SW480, mean cytotoxicity: FF 16.1%, VF/VV 24.3% (P = 0.015) and FF 11.7%, VF/VV 21.0% (P = 0.008), respectively. We observed a linear relationship between ADCC response and innate cytotoxicity. In the phase II trial, 40 patients received cetuximab and lenalidomide with median PFS of 7.2 weeks and OS of 16.4 weeks. Thirty-six patients had FcγRIIIa genotype: VV (2), VF (20), and FF (14), and 25 patients had sufficient NK-cell yield to perform ex vivo ADCC. FcγRIIIa genotype was not associated with any clinical outcomes. Patients mounting ex vivo ADCC response had a higher likelihood of stable disease (P = 0.01) and showed a trend toward increased PFS: 14 weeks versus 6.8 weeks, respectively (P = 0.13). Enhanced ex vivo ADCC and innate immunity responses were more predictive of clinical response than FcγRIIIa and may offer a functional assay to select patients suitable for cetuximab therapy.

Using clinically nuanced cost sharing to enhance consumer access to specialty medications

With specialty pharmaceutical prices on the rise, patients are often expected to pay anywhere from 30% to 50% of the specialty-tier drug price through co-insurance-based cost sharing. As these prices continue to climb, patients may choose lower-value medications for their medical needs or become nonadherent for cost-related reasons. Value-based insurance design implementations for specialty medications connect cost sharing and clinical value by moving high-value medications into lower-priced tiers, adjusting cost-sharing based on patient-specific variables, applying the "reward the good soldier" strategy, and encouraging patients to seek high-performing providers.

A checklist for ascertaining study cohorts in oncology health services research using secondary data: report of the ISPOR oncology good outcomes research practices working group

OBJECTIVES

The ISPOR Oncology Special Interest Group formed a working group at the end of 2010 to develop standards for conducting oncology health services research using secondary data. The first mission of the group was to develop a checklist focused on issues specific to selection of a sample of oncology patients using a secondary data source.

METHODS

A systematic review of the published literature from 2006 to 2010 was conducted to characterize the use of secondary data sources in oncology and inform the leadership of the working group prior to the construction of the checklist. A draft checklist was subsequently presented to the ISPOR membership in 2011 with subsequent feedback from the larger Oncology Special Interest Group also incorporated into the final checklist.

RESULTS

The checklist includes six elements: identification of the cancer to be studied, selection of an appropriate data source, evaluation of the applicability of published algorithms, development of custom algorithms (if needed), validation of the custom algorithm, and reporting and discussions of the ascertainment criteria. The checklist was intended to be applicable to various types of secondary data sources, including cancer registries, claims databases, electronic medical records, and others.

CONCLUSIONS

This checklist makes two important contributions to oncology health services research. First, it can assist decision makers and reviewers in evaluating the quality of studies using secondary data. Second, it highlights methodological issues to be considered when researchers are constructing a study cohort from a secondary data source.

Multidetector CT Evaluation in Arterial Stenting

BACKGROUND

Multidetector CT (MDCT) represents breakthrough in CT technology, significantly improving CT Angiography applications.

METHODS

Twenty one patients with aortoiliac & branch aneurysms or stenosis were evaluated by Digital Subtraction Angiography (DSA) and Multidetector CT (MDCT) before and after endovascular repair.

RESULTS

There were eight cases of aortic & branch aneurysms and 13 with stenosis. Four cases had aortic aneurysms, while one case had left subclavian artery aneurysm, thoracic aneurysm, femoral and popliteal artery pseudoaneurysms. Of the 13 cases with stenotic lesions, iliac stenosis was seen in eight patients. The others included carotid, vertebral, aortic, renal and aortic bifurcation stenotic. MDCT offered accurate information on shape and size of aneurysm, shape and patency of graft, the presence or absence of perigraft thrombosis or endoleaks, while in stenotic lesions it provided useful information on shape of graft, its location, its patency and the presence and quantity of distal flow.

CONCLUSION

MDCT was found to be a potentially useful modality during initial evaluation and follow up of patient undergoing endovascular repair.

Stress-induced changes in the function of the parasympathetic nervous system are mimicked by blocking GABA in the CNS of the cat

The purpose of this study was to determine the effect of blockade of receptors for gamma-aminobutyric acid (GABA) in the forebrain, on vagal activity to the stomach and heart. This was done by injecting bicuculline (50 micrograms) into the lateral ventricle of the brain and restricting the drug to the forebrain ventricles by cannulating the cerebral aqueduct. Studies were performed in chloralose-anesthetized cats and gastric motility was monitored using extraluminal force transducers, sutured to the antrum and pylorus. Cardiac vagal activity was determined by noting the sinus bradycardia that developed from activation of the baroreceptor reflex induced by phenylephrine. Administration of bicuculline into the lateral ventricle of 7 animals produced increases in the minute motility index of 5.3 +/- 0.8 (antrum) and 13.9 +/- 2.1 (pylorus). This was associated with inhibition of baroreceptor-induced vagal bradycardia (i.e. -38 +/- 6.4 beats/min before bicuculline and -7.7 +/- 5.7 beats/min after bicuculline). These data indicate that a GABAergic mechanism in the forebrain may be important for controlling vagal outflow to both the stomach and the heart.

Comparative cardiorespiratory effects produced by taurine and glycine applied to the ventral surface of the medulla

The purpose of our study was to determine whether taurine, like other naturally occurring central nervous system amino acid neurotransmitters (e.g., gamma-aminobutyric acid and glycine), act at the ventral surface of the medulla to influence cardiorespiratory activity. This was accomplished by monitoring cardiorespiratory activity. This was accomplished by monitoring cardiorespiratory activity in chloralose-anesthetized cats and then applying several doses of taurine locally to the ventral medullary surface chemosensitive areas. We found that 2 and 4 mumol of taurine applied to the intermediate area of the ventral surface produced cardiorespiratory depression, whereas taurine, in a similar dose range, produced only respiratory depression when applied to the rostral area. In contrast, taurine applied to the caudal area had no cardiorespiratory effects. Similar experiments with glycine revealed that this inhibitory amino acid elicited a similar pattern of cardiorespiratory depression as taurine. Furthermore, strychnine, an antagonist of glycine, counteracted the cardiorespiratory depressant effects of both taurine and glycine effectively. Pretreatment with strychnine prevented most of the cardiorespiratory depressant effects of taurine and glycine. 6-Aminomethyl-3-methyl-4H-1, 2,4-benzothiadiazine-1,1-dixoide, a putative antagonist of taurine, had antagonistic effects similar to those of strychnine in both treatment and pretreatment studies. 6-Aminomethyl-3-methyl-4H-1,2,4-benzothiadiazine-1,1-dioxide, per se, increased tidal volume when applied to the intermediate area; strychnine had no effect. These results indicate that taurine acts at the chemosensitive areas on the ventral surface of the medulla to produce cardiorespiratory depression, and these effects are due to an interaction of taurine with receptors similar to, but probably not identical with, glycine receptors.

Blockade of bicuculline-induced pressor and tachycardic responses by forebrain administration of muscimol

To determine whether i.v. administered bicuculline acts in the forebrain to increase arterial blood pressure and heart rate, this agent was administered i.v. to chloralose anesthetized cats that had muscimol injected into and restricted to the forebrain ventricles. Bicuculline (0.5 mg/kg i.v.) given alone increased arterial pressure by 56 +/- 8 mm Hg and heart rate by 45 +/- 11 beats/min. Bicuculline given to animals exposed to muscimol exhibited no increase in either of these parameters. Muscimol localized to the forebrain did not alter the pressor response to a non-GABA antagonist agent, strychnine, indicating a specific interaction of the drugs with GABA receptors in the forebrain.

Central nervous system site of action for the respiratory depressant effect of diacetylmorphine (heroin) in the cat

The purpose of our study was to identify central nervous system sites involved in the respiratory depressant effect of drugs that stimulate opioid receptors. Diacetylmorphine (heroin) was administered into several cerebroventricular regions of chloralose-anesthetized cats, while monitoring pulmonary ventilation with a Fleisch pneumotachograph. Administration of heroin (17, 50, 150, and 450 micrograms) into the forebrain ventricles, which was restricted to these ventricles, resulted in no significant respiratory effects. In contrast, administration of heroin into either the fourth ventricle or the cisterna magna resulted in a significant (P less than 0.05) decrease in respiratory minute volume (VE). In the fourth ventricle this was because of a decrease in frequency (f) and in the cisterna magna, to a decrease in tidal volume (VT). Intravenous administration of heroin in the same dose-range produced a decrease in VE, which was primarily due to a decrease in f. Bilateral application of heroin (70 micrograms/side) to each of three ventral medullary surface sites (Mitchell's, Schlaefke's, and Loeschcke's areas) known to influence respiration elicited a decrease in VE only at Mitchell's area. This decrease was due to decreases in f and VT. The role of this site in the action of intravenously administered heroin was tested by topical application of naloxone to this area in animals with respiratory depression evoked by intravenous heroin. Bilateral application of naloxone (15 micrograms/side) to Mitchell's area restored breathing to normal. These results lead us to suggest that the site of heroin-induced respiratory depression is a specific area (Mitchell's area) on the ventral surface of the medulla.

Comparative vagolytic effects of procainamide and N-acetylprocainamide in the dog

Procainamide exerts vagolytic effects which are deleterious in clinical therapy for supraventricular arrhythmias. The purpose of the present study was to determine if N-acetylprocainamide (NAPA), an active metabolite of procainamide which has been proposed as an effective and less toxic alternative, would exert an equivalent degree of vagal blockade. In anesthetized dogs, the right cervical vagus nerve was electrically stimulated at supramaximal voltage using frequencies from 0.5 to 20 Hz to slow the sinus rate. The ability of NAPA and procainamide to block this response was tested with infusion of equimolar doses (1.0 and 0.87 mg/kg/min i.v., respectively) continuously over a period of 40-78 min. Both drugs exerted statistically significant vagolytic effects at the higher frequencies of stimulation. Although the vagolytic effect appeared to be more pronounced with procainamide, this could not be demonstrated by statistical analysis of the data.

Activation of central nervous system cholecystokinin receptors stimulates respiration in the cat

Cholecystokinin-octapeptide (CCK-OP) was injected into the lateral brain ventricle of chloralose-anesthetized cats while monitoring pulmonary ventilation, mean blood pressure (BP) and heart rate (HR). Initial values for respiratory minute volume, BP and HR were 436 +/- 32 ml/min, 126 +/- 8 mm Hg and 204 +/- 9 beats/min, respectively. CCK-OP in doses of 8.8 x 10(-13) to 8.8 x 10(-10) M (i.e., 1 to 1000 ng) increased respiratory minute volume by +56 +/- 18 ml/min to +370 +/- 73 ml/min, respectively. This response was due to an increase in tidal volume (P less than .05) with no effect on respiratory rate. Most of these doses increased BP and HR (P less than .05). These responses were mimicked when CCK-OP was administered into and restricted to the lateral and 3rd ventricles, whereas no significant responses occurred with administration into the 4th ventricle. The highest dose of CCK-OP, when given i.v., produced no significant effects. Central nervous system injections (lateral ventricle) of CCK-OP in deafferented animals also produced respiratory and cardiovascular stimulation, but higher doses were required. Central nervous system injections of comparable doses of desulfated CCK-OP or pentagastrin had no effect on respiratory minute volume, BP or HR. Proglumide (0.8 and 8.0 mg), a specific CCK receptor antagonist, prevented both respiratory and cardiovascular effects induced by CCK-OP. These doses of proglumide exerted no antagonism of CO2-induced respiratory stimulation. These data suggest that a specific receptor reacting with CCK-OP may be important for the control of respiration.

Blood pressure and heart rate effects of prostaglandin E2 and F2 alpha produced by intracerebroventricular injections in cats

Blood pressure and heart rate effects of prostaglandin E2 and F2 alpha were examined after administering each agent into the left lateral brain ventricle of chloralose-anesthetized cats. Administration of prostaglandin E2 (1 micrograms) resulted in significant, prolonged increases in arterial pressure (25.7 +/- 6.7 mm Hg) and heart rate (19.4 +/- 07.7 beats/min). These responses were mimicked when the same dose of prostaglandin E2 was administered into and restricted to the lateral and third ventricles via cannulation of the cerebral aqueduct, whereas no significant cardiovascular responses occurred with administration into the fourth ventricle. Intravenous injection of prostaglandin E2 resulted in a transient decrease in blood pressure but no change in heart rate. Administration of prostaglandin F2 alpha (1 and 3 micrograms) into the CNS produced no significant cardiovascular responses. The same was true when prostaglandin F2 alpha was administered by the intravenous route. These results indicate that pronounced cardiovascular effects can be produced by administering prostaglandin E2 but not F2 alpha into the CNS, and that the central site of action of prostaglandin E2 is in the forebrain.

Interaction of serotonin and deslanoside on cardiac rhythm in the cat

The present study was performed to determine whether increases in the tissue content of serotonin creatinine SO4 in the periphery would influence the arrhythmogenic effect of deslanoside. This was accomplished by infusing serotonin into anesthetized cats exposed to a subarrhythmic dose of deslanoside, determining doses of deslanoside required to produce ventricular tachycardia and ventricular fibrillation, and determining ventricular pacemaker rate (obtained during vagal-induced sinus node suppression). It was found that animals receiving serotonin creatinine SO4 plus deslanoside exhibited a greater increase in ventricular rate during sinus node suppression than with 5-HT infusion alone. No corresponding increase in ventricular pacemaker rate during sinus node suppression was observed with creatinine SO4 plus deslanoside. In addition, the dose of deslanoside to produce ventricular fibrillation in these animals was significantly correlated with the increase in ventricular pacemaker rate seen during th 5-HT infusion in the presence of deslanoside. Studies were also performed to determine whether the arrhythmogenic interaction of serotonin with deslanoside was associated with alterations in either cardiac tissue, blood or plasma levels of serotonin and 5-hydroxyindoleacetic acid. The data revealed a significant correlation between serotonin content in the left ventricle and the dose of deslanoside required to produce ventricular fibrillation. These results suggest that exogenous serotonin interacts with deslanoside to enhance the arrhythmogenic action of deslanoside.

Deleterious effects of taurine in cats with digitalis-induced arrhythmias

An established model of digitalis toxicity was used to investigate the antiarrhythmic properties of taurine. I.v. doses of taurine ranging from 0.01 to 4.0 mmole/kg were ineffective in converting a deslanoside-induced arrhythmia to sinus rhythm. Indeed, taurine was found to aggravate the arrhythmia and in three experiments precipitated ventricular fibrillation. In addition, pretreatment with 5 mmole/kg taurine i.v. had no significant effect on the doses of deslanoside to produce ventricular arrhythmia and fibrillation.