Effects of increased levels of supplemental vitamins during the summer in a commercial artificial insemination boar stud

Heat stress due to increasing extremes in ambient temperature and humidity results in reduced semen quality in boars. This has caused reduced efficiency of the swine industry, requiring more boars to breed the same number of sows. Vitamins such as vitamin C (VC) and E (VE) have been shown to improve semen quality in boars. Recently, vitamin D has been shown to improve semen quality in boars. The purpose of this experiment was to evaluate the effects of increased supplemental vitamins on boar reproduction during the summer season in a commercial boar stud. One hundred and sixty Pig Improvement Company (PIC) terminal line boars (n = 32 per treatment) and 39 maternal, heat-sensitive boars (n = 7 or 8 per treatment) were randomly allocated to treatment and fed a corn and soybean meal-based diet adjusted based on individual boar body condition score. A control (CNT) diet was used that met PIC recommendations for boars. Increased supplementation of specific vitamins was given in the form of a top-dress and consisted of CNT wheat middlings, CNT plus VC (560 mg/day), CNT plus 25-hydroxy vitamin D3 (VD) (125 µg/day), CNT plus VE (275 mg/day) and CNT plus VC, VD and VE (CDE). The experiment was split into three periods based on maximum daily high temperatures in the barn, where period 1 was weeks 1 to 4, period 2 was weeks 5 to 11 and period 3 was weeks 12 to 14. Semen was collected from boars as needed using the stud's normal production schedule and was analyzed for sperm quantity and quality characteristics. There were no dietary effects on semen volume, sperm concentration or total sperm production (P ≥ 0.553). Total motility of sperm was not impacted by diet (P = 0.115); although, VC tended (P = 0.064) to have a greater progressive motility than CDE. Percentages of morphologically normal sperm and normal acrosomes were not affected by dietary supplementation (P ≥ 0.157). Period effects were observed for most semen quality parameters, with quality generally becoming reduced over time. The present study demonstrates that increased supplementation of vitamins beyond PIC recommendations was not beneficial for boar reproduction during the summer.

Left renal vein ligation: a technique to mitigate low portal flow from splenic vein siphon during liver transplantation

Low portal vein flows in liver transplant have been associated with poor allograft survival. Identifying and ameliorating causes of inadequate portal flow is paramount. We describe successful reversal of significant splenic vein siphon from a spontaneous splenorenal shunt during liver transplant. The patient is a 43-year-old male with cirrhosis from hepatitis C and Budd-Chiari syndrome, who had a variceal hemorrhage necessitating an emergent splenorenal shunt with 8 mm PTFE graft. Imaging in 2006 revealed thrombosis of the splenorenal shunt and evidence of a new spontaneous splenorenal shunt. The patient developed hepatocellular carcinoma and underwent transplant in 2009. After reperfusion, portal flows were low (150-200 mL/min). A mesenteric varix was ligated without improvement. Due to adhesions, direct collateral ligation was not attempted. In order to redirect the splenic siphon, the left renal vein was stapled at its confluence with the inferior vena cava. Portal flows subsequently increased to 1.28 L/min. Postoperatively, the patient had stable renal and liver function. We conclude that spontaneous splenorenal shunts can cause low portal flows. A diligent search for shunts with understanding of flow patterns is critical; ligation or rerouting of splanchnic flow may be necessary to improve portal flows and allograft outcomes.

Biliary complications after orthotopic liver transplantation from donors after cardiac death: broad spectrum of disease

BACKGROUND

Donation-after-death liver transplantation (DCD-LT) carries higher complication rates compared with donation-after-brain death liver transplantation (DBD-LT). In this report we describe our experience with biliary complications in DCD-LT with emphasis on anatomical patterns and outcomes.

MATERIALS AND METHODS

We performed retrospective review of patients' medical records from August 2004 to December 2008, during which time total of 26 DCD-LTs were performed. Mean follow-up was 29 months (range 3 to 51 months).

RESULTS

Biliary complications occurred in 12 patients (46%), of whom 9 were related to DCD (35%). Four patients had more than 1 biliary complication, and 4 had concomitant arterial problems (stricture/thrombosis). Treatment of complications included: ERCP (n = 5, 3 resolved), conversion to roux (n = 5, 2 resolved), revision of roux (n = 1), percutaneous transhepatic cholangiography (n = 1), artery revision (n = 3). Three patients with casts had operative extraction of casts depicting a mummified biliary tree; histology showed casts and fibrosis and anastomotic suture material. Six patients underwent retransplantation (23%). Among retransplanted patients, 2 deaths occurred (7.7%).

CONCLUSION

Our experience with DCD-LT reveals a high prevalence of biliary complications with a new and wide spectrum of clinicopathologic findings. Better strategies for prevention of these unique biliary complications are needed to better justify the added risks and costs for performance of DCD-LT.

DRG reimbursement: geriatric hip fractures in the community hospital trauma center

BACKGROUND

The purpose of this paper was to determine whether Medicare reimbursement for hip fracture reaches cost in geriatric patients.

METHODS

We conducted a retrospective review using the hospital trauma registry. Demographics, operations, length of stay, clinical outcome, discharge disposition, hospital charges, and hospital costs were reviewed and compared with diagnosis-related group (DRG) reimbursement.

RESULTS

The study included 153 Medicare patients. Mortality was 3.9%, 71% were discharged to a nursing home or rehabilitation unit, and 25% went directly home. DRG reimbursement constituted 58% of charges. Compared with costs, the DRG amount represented a mean loss of nearly $1,000 per patient.

CONCLUSIONS

DRG reimbursement undercompensates the community hospital trauma center for treating a common malady among the geriatric population. A population shift toward the elderly, decreasing Medicare remuneration, and the advance of managed care will make correct identification and control of costs extremely important for the hospital caring for hip fractures in the geriatric population.

Pet Project: The Use of Pet Facilitated Therapy Among the Chronically Mentally III

1. The effects of animal companions on people can be of therapeutic benefit. Using pet facilitated therapy with the chronically mentally ill as a treatment modality offers great potential for positive patient care outcomes. 2. Initiating a pet facilitated therapy program involves establishing policy and procedures regarding animals at the facility. The personality and animal experiences of the patient must be taken into consideration for pet selection. 3. Evaluate the effectiveness of the pet facilitated therapy program. Assess your patient care outcomes to design further interventions.

Measurement of cholesterol in serum by gas chromatography/mass spectrometry at moderate mass resolution, with a nonendogenous cholesterol isomer as internal standard

We describe a gas chromatography/mass spectrometry method for the quantitative analysis of cholesterol in serum. A structural isomer of cholesterol, 7,(5 alpha)-cholesten-3 beta-ol, is used as an internal standard, its primary advantage being its lesser cost relative to that of a stable-isotope-labeled analog. Analysis of the National Bureau of Standards Certified Reference Serum (SRM 909) was used to validate the method. The results show this method to be highly accurate (bias = -0.6%) and precise (CV = 1.6% between-run, 1.2% within-run). The performance of this method is, therefore, sufficiently good to allow its use as a reference method for determinations of cholesterol in serum.

Measurement of cholesterol in serum by gas chromatography/mass spectrometry at moderate mass resolution, with a nonendogenous cholesterol isomer as internal standard

We describe a gas chromatography/mass spectrometry method for the quantitative analysis of cholesterol in serum. A structural isomer of cholesterol, 7,(5 alpha)-cholesten-3 beta-ol, is used as an internal standard, its primary advantage being its lesser cost relative to that of a stable-isotope-labeled analog. Analysis of the National Bureau of Standards Certified Reference Serum (SRM 909) was used to validate the method. The results show this method to be highly accurate (bias = -0.6%) and precise (CV = 1.6% between-run, 1.2% within-run). The performance of this method is, therefore, sufficiently good to allow its use as a reference method for determinations of cholesterol in serum.