Search Results (962)

Background and Objectives: Effective myocardial protection is essential for successful cardiac surgery outcomes, especially in complex and prolonged procedures. To this end, Del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK) cardioplegia solutions are widely used; however, their comparative efficacy in adult surgeries with prolonged aortic cross-clamp (ACC) times remains unclear. This study aimed to compare the efficacy and safety of DN and HTK for myocardial protection during prolonged ACC times in adult cardiac surgery and to define clinically relevant thresholds. Materials and Methods: This retrospective study included a total of 320 adult patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) with an aortic cross-clamp time ≥ 90 min. Data were collected from the medical records of elective adult cardiac surgery cases performed at a single center between 2019 and 2025. Patients were categorized into two groups based on the type of cardioplegia received: Del Nido (n = 160) and HTK (n = 160). The groups were compared using 1:1 propensity score matching. Clinical and biochemical outcomes—including troponin I (TnI), CK-MB, lactate levels, incidence of low cardiac output syndrome (LCOS), and need for mechanical circulatory support—were analyzed between the two cardioplegia groups. Subgroup analyses were performed according to ACC duration (90–120, 120–150, 150–180 and >180 min). The predictive threshold of ACC duration for each complication was determined by ROC analysis, followed by the analysis of independent predictors of each endpoint by multivariate logistic regression. Results: Intraoperative cardioplegia volume and transfusion requirements were lower in the DN group (p < 0.05). HTK was associated with lower TnI levels and less intra-aortic balloon pump (IABP) requirement at ACC times exceeding 180 min. Markers of myocardial injury were lower in patients with an ACC duration of 120–150 min in favor of HTK. The propensity for ventricular fibrillation after ACC was significantly lower in the DN group. Significantly lower postoperative sodium levels were observed in the HTK group. Prolonged ACC duration was an independent risk factor for LCOS (odds ratio [OR]: 1.023, p < 0.001), VIS > 15 (OR, 1.015; p < 0.001), IABP requirement (OR: 1.020, p = 0.002), and early mortality (OR: 1.016, p = 0.048). Postoperative ejection fraction (EF), troponin I, and CK-MB levels were associated with the development of LCOS and a VIS > 15. Furthermore, according to ROC analysis, HTK cardioplegia was able to tolerate ACC for up to a longer duration in terms of certain complications, suggesting a higher physiological tolerance to ischemia. Conclusions: ACC duration is a strong predictor of major adverse outcomes in adult cardiac surgeries. Although DN cardioplegia is effective and economically advantageous for shorter procedures, HTK may provide superior myocardial protection in operations with long ACC duration. This study supports the need to individualize cardioplegia choice according to ACC duration. Further prospective studies are needed to establish standard dosing protocols and to optimize cardioplegia selection according to surgical duration and complexity. Full article

This study aimed to evaluate daily patterns of hourly milking frequency (MF) in dairy cows milked with an automatic milking system (AMSs), considering the effects of season, parity order (PO), days in milk (DIM), and milk yield (MY). A retrospective longitudinal study was conducted on a commercial dairy farm in southern Brazil over one year using data from 130 Holstein cows and 94,611 milking events. MF data were analyzed using general linear models. Overall, hourly MF followed a consistent daily pattern, with peaks between 4:00 and 11:00 a.m. and between 2:00 and 6:00 p.m., regardless of season, PO, DIM, or MY category. MF was higher in primiparous (2.84/day, p = 0.0013), early-lactation (<106 DIM; 3.00/day, p < 0.0001), and high-yielding cows (≥45 L/day; 3.09/day, p < 0.0001). High-yielding cows also showed sustained milking activity into the late nighttime. Although seasonal and individual factors significantly affected MF, they had limited influence on the overall daily distribution of milkings. These results suggest stable behavioral patterns within the specific AMS management conditions observed in this study and suggest that adjusting milking permissions and feeding strategies based on cow characteristics may improve system efficiency. Full article

Due to the feeding system (high-concentrate diet) during the early lactation stage, ruminal pH in dairy cows follows a diurnal pattern and can remain below the critical level of 5.5 for extended periods of the day. This study aimed to evaluate the effect of low ruminal pH on blood concentrations of certain macrominerals, trace minerals, and fat-soluble vitamins and on the oxidative status of dairy cows during the first half of lactation. Fifty-three randomly selected lactating Holstein cows were used; blood and ruminal fluid samples were collected from all cows on days 30, 90 and 150 of lactation. Blood samples were obtained via coccygeal venipuncture, while the ruminal fluid was obtained by rumenocentesis and the pH was measured immediately after collection. Using a threshold pH of 5.5, samples were classified as normal (pH > 5.5) or low pH (pH ≤ 5.5). Serum concentrations of Ca, Mg, K, Cr, Mn, Zn, Se, and vitamins A, D3, E, and K were not significantly affected by ruminal pH, either by days in milk or by their interaction (p > 0.05). Plasma malondialdehyde and reduced glutathione followed the same trend (p > 0.05). Copper concentration was significantly higher (p < 0.05), and Fe concentration tended to be higher in cows with low pH compared to those with normal pH (p = 0.052). On day 150 of lactation, Cu, Fe, and Co concentrations were significantly higher in low-pH cows compared to normal-pH cows (p < 0.05). Low ruminal pH is associated with significant changes in serum concentrations of copper, iron, and cobalt but has no significant effect on the oxidative status of the animals or on the serum concentrations of the macro elements and fat-soluble vitamins studied. Full article

Cardiogenic shock (CS) in the setting of severe aortic stenosis (AS) presents a critical and high-risk scenario with limited therapeutic options and poor prognosis. Transcatheter aortic valve implantation (TAVI), initially reserved for inoperable or high-risk surgical candidates, is increasingly being considered in patients with CS due to improvements in device technology, operator experience, and supportive care. This review synthesizes current evidence from large registries, observational studies, and meta-analyses that support the feasibility, safety, and potential survival benefit of urgent or emergent TAVI in selected CS patients. Procedural success is high, and early intervention appears to confer improved short-term and mid-term outcomes compared to balloon aortic valvuloplasty or medical therapy alone. Critical factors influencing prognosis include lactate levels, left ventricular ejection fraction, renal function, and timing of intervention. The absence of formal guidelines, logistical constraints, and ethical concerns complicate decision-making in this unstable population. A multidisciplinary Heart Team/Shock Team approach is essential to identify appropriate candidates, manage procedural risk, and guide post-intervention care. Further studies and the development of TAVI-specific risk models in CS are anticipated to refine patient selection and therapeutic strategies. TAVI may represent a transformative option for stabilizing hemodynamics and improving outcomes in this otherwise high-mortality group. Full article

Objectives: Febrile neutropenia is a common oncologic emergency with significant morbidity and mortality. Although the MASCC (Multinational Association for Supportive Care in Cancer) score is widely used for risk stratification, its limited sensitivity and lack of laboratory parameters reduce its prognostic utility. This study aimed to evaluate whether incorporating serum lactate and CRP measurements into the MASCC score enhances its predictive performance for hospital admission and the 30-day mortality. Methods: This retrospective diagnostic accuracy study included adult patients diagnosed with febrile neutropenia in the emergency department of a tertiary care hospital between January 2021 and December 2024. The original MASCC score was calculated, and three modified models were derived: the MASCC-L (lactate/MASCC), MASCC-C (CRP/MASCC) and MASCC-LC models (CRP × lactate/MASCC). The predictive accuracy for hospital admission and the 30-day all-cause mortality was assessed using ROC analysis. Results: A total of 269 patients (mean age: 67.6 ± 12.4 years) were included; the 30-day mortality was 3.0%. The MASCC-LC model demonstrated the highest discriminative ability for mortality prediction (area under the curve (AUC): 0.995; sensitivity: 100%; specificity: 98%). For hospital admission prediction, the MASCC-C model had the highest specificity (81%), while the MASCC-LC model showed the best balance of sensitivity and specificity (both 73%). All the modified models outperformed the original MASCC score regarding both endpoints. Conclusions: Integrating lactate and CRP measurements into the MASCC score significantly improves its prognostic accuracy for both mortality and hospital admission in febrile neutropenic patients. The MASCC-LC model, relying on only three objective parameters, may serve as a practical and efficient tool for early risk stratification in emergency settings. Full article

This review aimed to be comprehensive and to critically analyze the factors that may affect the macronutrient and energy content of breast milk. Systematic reviews were prioritized, even though other types of literature reviews on the subject, as well as studies not included in these reviews, were included. Reported factors that potentially affect the macronutrient and energy content of breast milk comprise: maternal factors, such as age, nutritional status, dietary intake, smoking habits, lactation stage, circadian rhythmicity, and the use of galactagogues; obstetrical factors, such as parity, preterm delivery, multiple pregnancies, labor and delivery, and pregnancy morbidities including intrauterine growth restriction, hypertensive disorders, and gestational diabetes mellitus; and newborn factors, including sexual dimorphism, and anthropometry at birth. Some factors underwent a less robust assessment, while others underwent a more in-depth analysis. For example, the milk from overweight and obese mothers has been reported to be richer in energy and fat. A progressive decrease in protein content and an increase in fat content was described over time during lactation. The milk from mothers with hypertensive disorders may have a higher protein content. Higher protein and energy content has been found in early milk from mothers who delivered prematurely. Full article

This study aimed to evaluate cow longevity and identify the main culling reasons in dairy herds in Southern Brazil. Two data sets from 26 predominantly confined Holstein herds were analyzed over a 10-year period (2007–2016). The first included 11,150 cows that were culled, died, or sold, and the second comprised 636,739 cows for demographic analysis. The average annual culling rate was 24.2%, mainly due to reproductive disorders (34.0%), mastitis/high somatic cell count (20.4%), and feet and leg problems (17.9%). Involuntary causes represented 89.5% of all culling. The death rate averaged 3.8%, with the most frequent causes being unknown (27.3%), other reasons (25.6%), tick fever (10.2%), and accidents/injuries (10.0%). Larger herds had higher culling rates than smaller ones (26.2% vs. 22.8%; p = 0.04), as did higher-producing herds compared to lower-producing ones (25.7% vs. 22.0%; p = 0.02). Cows with ≥5 calvings were culled more often (p < 0.01) than those in earlier lactations. Culling was lowest (p < 0.02) in spring and highest (p < 0.01) during early (0–60 d) and late (>420 d) lactation. Herds with a higher proportion of older cows had slightly lower milk yields (p < 0.01), indicating longevity does not always enhance productivity. Full article

The objective of this study was to evaluate the effects of feeding a combination of chicory–plantain silage and supplementing Se yeast on the response of early-lactating ewes to induce subclinical mastitis. Polypay ewes (n = 32) were fed either chicory–plantain silage or grass silage and supplemented with 3.6 mg Se yeast/ewe/day for approximately 2 months prior to the infusion of S. uberis into both mammary glands (i.e., intramammary infection or IMI). The ewes had a typical subclinical mastitis response with an 8-fold increase in milk somatic cell count within 24 h post-IMI, a decrease in milk yield, and changes in all milk components measured. The ewes experienced a mild systemic inflammation post-IMI as determined by an increase in rectal temperature and decrease in feed and water intake and, in blood, by an increase in the concentration of ceruloplasmin, haptoglobin, and myeloperoxidase and a decrease in paraoxonase, Zn, advanced oxidation protein products, and hematocrit with no effect on pro-inflammatory cytokines. No effect of silage type, likely due to a low concentration of secondary compounds, or Se supplementation was detected in response to IMI. In summary, the subclinical mastitis model used was effective in mounting an inflammatory response, although this was mild; however, feeding chicory–plantain silage with a low concentration of secondary compounds and supplementing Se yeast had no significant effect on the response of ewes to mammary infection. Full article

Milk lactose concentration has been proposed as a noninvasive indicator of metabolic health in dairy cows, particularly during early lactation when metabolic demands are elevated. This study aimed to investigate the relationship between milk lactose levels and physiological, biochemical, and behavioral parameters in early-lactation Holstein cows. Twenty-eight clinically healthy cows were divided into two groups: Group 1 (milk lactose < 4.70%, n = 14) and Group 2 (milk lactose ≥ 4.70%, n = 14). Both groups were monitored over a 21-day period using the Brolis HerdLine in-line milk analyzer (Brolis Sensor Technology, Vilnius, Lithuania) and SmaXtec intraruminal boluses (SmaXtec Animal Care Technology^®, Graz, Austria). Parameters including milk yield, milk composition (lactose, fat, protein, and fat-to-protein ratio), blood biomarkers, and behavior were recorded. Cows with higher milk lactose concentrations (≥4.70%) produced significantly more milk (+12.76%) and showed increased water intake (+15.44%), as well as elevated levels of urea (+21.63%), alanine aminotransferase (ALT) (+22.96%), glucose (+4.75%), magnesium (+8.25%), and iron (+13.41%) compared to cows with lower lactose concentrations (<4.70%). A moderate positive correlation was found between milk lactose and urea levels (r = 0.429, p < 0.01), and low but significant correlations were observed with other indicators. These findings support the use of milk lactose concentration as a practical biomarker for assessing metabolic and physiological status in dairy cows, and highlight the value of integrating real-time monitoring technologies in precision livestock management. Full article

Background and Clinical Significance: Antisynthetase syndrome (ASyS) is a rare autoimmune entity defined by the presence of anti-aminoacyl-t ribonucleic acid (RNA) synthetase autoantibodies and classically associated with a triad of interstitial lung disease (ILD), inflammatory myopathy, and arthritis. Additional clinical features may include Raynaud’s phenomenon and “mechanic’s hands”. Among antisynthetase antibodies, anti-PL-12 is notably associated with predominant or isolated ILD and may occur in the absence of clinically evident myositis, thereby complicating timely diagnosis. Case Presentation: We are presenting a 45-year-old non-smoking female patient with a prior diagnosis of seronegative rheumatoid arthritis (RA) who developed progressive dyspnea, dry cough, and sicca symptoms. High-resolution computed tomography revealed a nonspecific interstitial pneumonia (NSIP) pattern. Despite normal creatine kinase and lactate dehydrogenase levels, serological work-up revealed positive anti-PL-12 and anti-Ro52 antibodies, supporting a diagnosis of antisynthetase syndrome without myositis, fulfilling the diagnostic criteria for ASyS per Connors and Solomon. Treatment with corticosteroids and cyclophosphamide induced clinical and functional respiratory improvement, while azathioprine was initiated for maintenance. Conclusions: This case underscores the clinical heterogeneity of antisynthetase syndrome and highlights the diagnostic challenge posed by anti-PL-12–associated ILD in the absence of myositis. Importantly, it demonstrates that in patients with pre-existing rheumatologic diagnoses, the emergence of atypical pulmonary manifestations warrants repeat serologic evaluation to assess ASyS and other autoimmune conditions. Early diagnosis and immunosuppressive treatment are essential to optimize outcomes. Full article

Background and Objectives: This study aimed to compare the effects of HIPEC procedures using oxaliplatin and mitomycin C on serum electrolyte, glucose, and lactate levels, with a specific focus on the carrier solutions employed. Materials and Methods: A retrospective analysis was performed on 82 patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastases. Patients were assigned to one of two groups based on the chemotherapeutic agent used: oxaliplatin (n = 63) or mitomycin C (MMC, n = 19). The oxaliplatin group was further subdivided based on the carrier solution used: 5% dextrose (D5W, n = 29) or peritoneal dialysate (n = 34). The assignment of regimens was based on institutional protocols and surgeon preference. Pre- and post-HIPEC serum levels of sodium, potassium, bicarbonate, glucose, and lactate were compared. Results: Significant biochemical changes were observed across groups, depending on both the chemotherapeutic agent and carrier solution. In the MMC group (peritoneal dialysate), only lactate increased significantly post-HIPEC (p = 0.001). In the oxaliplatin–peritoneal dialysate group, significant changes were observed in bicarbonate (p = 0.009), glucose (p = 0.001), and lactate (p < 0.001), whereas sodium and potassium remained stable. The oxaliplatin–D5W group showed significant changes in all parameters: sodium (p = 0.001), potassium (p = 0.001), bicarbonate (p = 0.001), glucose (p < 0.001), and lactate (2.4 → 7.6 mmol/L, p < 0.001). Between-group comparisons revealed significant differences in sodium, potassium, glucose, and lactate changes (p < 0.05), but not in bicarbonate (p = 0.099). Demographic and clinical characteristics—including age, sex, primary disease, ICU stay, and 90-day mortality were similar across groups. Conclusions: The use of dextrose-containing solutions with oxaliplatin was associated with marked metabolic disturbances, including clinically meaningful hyponatremia, hypokalemia, and hyperglycemia in the early postoperative period. These findings suggest that the choice of carrier solution is as important as the chemotherapeutic agent in terms of perioperative safety. Closer postoperative electrolyte monitoring is recommended when using dextrose-based regimens. The retrospective design and sample size imbalance between groups are acknowledged limitations. Nonetheless, this study offers clinically relevant insights and lays the groundwork for future prospective research. Full article

This on-farm study evaluated the effects of a regenerative (plant polyculture) as compared to conventional (monoculture) pasture-based New Zealand dairy production system on milk and yoghurt nutraceutical properties and environmental impact. Milk and yoghurt produced by two adjacent regenerative and conventional farms were sampled throughout the year and analyzed for chemical composition, metabolomics, and microbiome. Milk samples were also collected over four consecutive days (one day after herbage sampling) on four occasions throughout lactation: early lactation (October), peak lactation (December/January), mid-lactation (March), and late lactation (May). Overall, the regenerative system had a lower environmental impact while maintaining a similar yield and the same milk composition compared to conventional systems. Furthermore, milk and yoghurt from the regenerative system had a more favourable profile of phytochemical antioxidants with potential positive benefits to human health (anti-inflammatory and antioxidant). Full article

Breast milk is the optimal nutrition for infants, yet lactation insufficiency remains a common cause of early breastfeeding cessation. Moringa oleifera has been traditionally used as a galactagogue due to its rich micronutrient and phytosterol content. This systematic review assessed the effects of Moringa leaf supplementation on prolactin levels and breast milk volume in postpartum mothers with lactation insufficiency. A systematic search following PRISMA guidelines, was conducted for randomized controlled trials involving healthy postpartum women supplemented with Moringa oleifera. Risk of bias was evaluated using the Cochrane Risk of Bias Tool. Eight studies met the inclusion criteria, with intervention durations ranged from 3 to 10 days. Moringa supplementation increased significantly breast milk volume by up to 400 mL/day compared to controls. Serum prolactin levels also rose significantly with a mean increase of 231.72 ng/mL Most studies exhibited low to moderate risk of bias, though one study exhibited high risk due to lack of binding and subjective outcome measurement. Moringa oleifera leaf supplementation appears to enhance lactation by increasing milk volume and prolactin levels in postpartum mothers. However, further longer-term studies are needed to establish optimal dosing, sustained effectiveness, and safety. Full article

This study investigated the effect of different farming systems and lactation stages on the physicochemical characteristics, somatic cell count (SCC), and total bacterial count (TBC) of milk from Skopelos goats. This study was conducted over two consecutive lactation periods on two commercial farms in Greece, an extensive system on Skopelos Island and an intensive system in the Attica region, involving 237 goats of shared genetic background, thereby minimizing genetic variability and strengthening the validity of the comparisons between the production systems. Higher milk yields were observed in the extensive system (0.98 vs. 0.85 kg/day), while milk from this system also had a higher protein (3.57% vs. 3.47%; p < 0.001) and casein content (2.72% vs. 2.57%; p < 0.001), which are traits favorable for cheese production. Fat content peaked during mid-lactation (4.83%; p < 0.05) and remained unaffected by the farming system. Lactose declined from early (4.74%) to late lactation (4.42%; p < 0.001). Both SCC and TBC were significantly elevated in the extensive system (p < 0.001), possibly due to hand milking, environmental exposure, and less-controlled hygiene conditions. These findings highlight a trade-off between the nutritional advantages of extensive systems and challenges related to milk hygiene. A balanced approach, optimizing both quality and sustainability, is recommended. Full article

Background: High-voltage electrical injuries (HVEIs) represent a complex and life-threatening entity, frequently involving multi-organ damage. While traditionally linked to occupational hazards, train surfing—riding on moving trains—and train climbing—scaling stationary carriages—have emerged as increasingly common causes among adolescents. Popularized via social media, these behaviors expose individuals to the invisible danger of electric arcs from 15,000-volt railway lines, often resulting in extensive burns, cardiac complications, and severe trauma. This study presents a 30-year retrospective analysis comparing cardiac biomarkers and clinical outcomes in train-surfing injuries versus work-related HVEIs. Methods: All patients with confirmed high-voltage injury (≥1000 volts) admitted to a Level 1 burn center between 1994 and 2024 were retrospectively analyzed. Exclusion criteria comprised low-voltage trauma, suicide, incomplete records, and external treatment. Clinical and laboratory parameters—including total body surface area (TBSA), Abbreviated Burn Severity Index (ABSI), electrocardiogram (ECG) findings, intensive care unit (ICU) and hospital stay, mortality, and cardiac biomarkers (creatine kinase [CK], CK-MB, lactate dehydrogenase [LDH], aspartate transaminase [AST], troponin, and myoglobin)—were compared between the two cohorts. Results: Of 81 patients, 24 sustained train-surfing injuries and 57 were injured in occupational settings. Train surfers were significantly younger (mean 16.7 vs. 35.2 years, p = 0.008), presented with greater TBSA (49.9% vs. 17.9%, p = 0.008), higher ABSI scores (7.3 vs. 5.1, p = 0.008), longer ICU stays (53 vs. 17 days, p = 0.008), and higher mortality (20.8% vs. 3.5%). ECG abnormalities were observed in 51% of all cases, without significant group differences. However, all cardiac biomarkers were significantly elevated in train-surfing injuries at both 72 h and 10 days post-injury (p < 0.05), suggesting more pronounced cardiac and muscular damage. Conclusions: Train-surfing-related high-voltage injuries are associated with markedly more severe systemic and cardiac complications than occupational HVEIs. The significant biomarker elevation and critical care demands highlight the urgent need for targeted prevention, public awareness, and early cardiac monitoring in this high-risk adolescent population. Full article