Search Results (30)

The use of lower crude protein (CP) diets immediately after weaning has long been associated with reduced post-weaning diarrhoea (PWD). However, failing to maintain an appropriate standardized ileal digestible lysine ratio (SID: Lys) may outweigh the benefits in improving PWD outcomes. In this experiment, 560 weaners were fed either a control diet (CON; 20.6% crude protein 1.34% standardized ileal digestible lysine, SID Lys: CP = 0.06), LH: a low crude protein, higher SID Lys: CP ratio diet (19.0% CP, 1.34% SID Lys, SID Lys: CP = 0.07), or LL: a low crude protein control SID Lys: CP ratio diet (18.7% CP, 1.1% SID Lys, SID Lys: CP = 0.05) for 1 week after weaning. Pigs were scored for the presence or absence of diarrhoea for 12 days after weaning. Blood samples were taken on days 5, 12 and 28 for inflammatory marker analyses and plasma creatinine analyses. Relative to the CON diet, there was a 42% reduction in the diarrhoea index in pigs fed the LH diet and a 63% reduction in those fed the LL diet (p < 0.05), but LH was significantly higher than LL. There tended to be a greater average daily gain in the LH diet in the first week post-wean (p = 0.054). In summary, lower crude protein diets, irrespective of Lys: CP ratio, were found to be effective at reducing PWD. Moreover, increasing the SID Lys: CP ratio by reducing the CP content of diets from 20.6 to 19% appeared to improve post-weaning growth. Full article

Background and Clinical Significance: Fulminant pulmonary embolism (PE) leading to an out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate and cardiopulmonary resuscitation (CPR) frequently failing to achieve return of spontaneous circulation (ROSC). Extracorporeal CPR (eCPR) has emerged as a potential life-saving intervention. Case Presentation: A 66-year-old woman suffered an OHCA due to massive PE, presenting with pulseless electrical activity (PEA). After 90 min of pre- and in-hospital CPR without sustained ROSC, venoarterial extracorporeal membrane oxygenation (va-ECMO) was initiated as eCPR upon arrival at the hospital. Even after implantation of the va-ECMO, there was initially a pronounced acidosis (pH 6.9) with a high elevated lactate level (>30 mmol/L); these factors, together with the prolonged low-flow period, indicated a poor prognosis. Further diagnostic tests revealed intracranial hemorrhage (subdural hematoma), and systemic lysis was not possible. With persistent right heart failure, surgical thrombectomy was performed during hospitalization. Intensive multidisciplinary management finally led to successful therapy and weaning from mechanical ventilation, as well as to complete neurological recovery (CPC-Score 1-2). Conclusions: This case illustrates that eCPR can facilitate survival with good favorable neurological outcomes despite initially poor prognostic predictors. It underscores the importance of refining patient selection criteria and optimizing management strategies for eCPR in refractory cardiac arrest secondary to PE. Full article

Background/Objectives: Weaning failure remains a major challenge in patients requiring prolonged mechanical ventilation. This study aimed to describe outcomes in patients ventilated for >14 days and identify specific predictors of weaning success. Methods: A retrospective analysis of 88 patients from the Soroka University Medical Center database was conducted. Outcomes in the successful weaning (SW) group were compared to those in the failed weaning (FW) group. Predictors of weaning success were analyzed using multivariate logistic regression. Results: Forty patients (45%) were successfully weaned and discharged to rehabilitation or home. In-hospital mortality was 28%, with deaths occurring exclusively in the FW group (p < 0.001). One-month and one-year post-discharge all-cause mortality rates were 11% and 28%, respectively, with no group differences. Hypoalbuminemia and the Sequential Organ Failure Assessment (SOFA) score at admission significantly predicted weaning failure (odds ratio: 5.71 and 0.54, respectively). Demographics, comorbidities, ventilation indications, admission data, and diuretic use were not predictive. Conclusions: Hypoalbuminemia and the SOFA score at admission were key predictors of weaning success in patients ventilated for more than 2 weeks. Age and comorbidities were not significant. Prospective studies on albumin supplementation and high-protein diets are warranted to assess their impact on weaning outcomes. Full article

Background: Right ventricular primary graft dysfunction (RV-PGD) is a rare but serious complication following heart transplantation, associated with a high morbidity and mortality. Temporary mechanical circulatory support is indicated when patients fail to respond to pharmacological therapy. This study aimed to evaluate the outcomes of patients with RV-PGD who received RV mechanical support with the Impella RP Flex device at our institution. Methods: Medical records of patients with RV-PGD supported by the Impella RP Flex device between December 2022 and March 2024 were reviewed retrospectively to assess survival, procedural complications, duration of support, and end organ dysfunction. Results: Of the 20 patients reviewed, 5 met the inclusion criteria. All five patients demonstrated recovery of RV function after a mean support duration of 8.6 ± 3.05 days. One pump showed transient evidence of biologic material ingestion during a weaning trial. No cases of tricuspid valve injury were observed. The most common complications were hemolysis, bleeding, and acute kidney dysfunction, with all patients requiring hemodialysis. Conclusions: Impella RP Flex support is safe and effective for managing primary and isolated RV-PGD without the need for additional blood oxygenation. However, bleeding complications requiring intervention remain a significant concern, and further evaluation of renal recovery is warranted. Full article

Background/Objectives: Dietary glucose is transported across the intestinal absorptive cell into the systemic circulation by the apically located Na⁺-dependent glucose transporter 1 (SGLT1, SLC5A1) and basally residing Na⁺-independent glucose transporter 2 (GLUT2, SLC2A2). Whilst recent experimental evidence has shown that sensing of sweet compounds by the gut-expressed sweet taste receptor T1R2–T1R3 and glucagon-like peptide-2 receptor signalling are components of the pathway controlling SGLT1 expression, little is known about the mechanisms involved in the regulation of GLUT2. In this study, we tested the hypothesis that T1R2–T1R3 and its downstream signalling pathway participate in the regulation of intestinal GLUT2. Methods: We used in vivo and in vitro approaches employing a weaning pig model, a heterologous expression assay, and knockout mice for elucidating the regulation of GLUT2 by luminal sugars. Results: A plant-based sweetener formulation included in piglets’ diet led to a marked increase in GLUT2 expression in piglets’ intestine, compared to controls. The sweeteners that do not activate pig T1R2–T1R3 failed to upregulate GLUT2. There was a significant increase in GLUT2 expression when the sweetener sucralose, which activates T1R2–T1R3, was included in the drinking water of wild-type mice. However, in knockout mice, in which the genes for the sweet receptor subunit T1R3 and the associated G-protein gustducin were deleted, there was no upregulation of GLUT2 expression in response to sucralose supplementation. There was a notable increase in GLUT2 expression in wild-type mice fed a high-carbohydrate diet compared to when maintained on a low-carbohydrate diet. However, in GLP-2 receptor knockout mice kept on the high-carbohydrate diet, there was no enhancement in GLUT2 expression. Conclusions: The experimental evidence suggests that luminal sweet sensing via T1R2–T1R3 and the enteroendocrine-derived GLP-2 are constituents of the regulatory pathway controlling GLUT2 expression. Full article

Delayed or failed postpartum estrus can impede the reproductive performance of rebreeding dams. Our study aimed to test whether dietary fish oil can promote estrus return and improve fecal microbiota in multiparous sows. Forty-five sows were randomly allocated into three treatments: a basal diet, or a basal diet plus 30 or 60 g/day of fish oil from gestation day 90 to lactation day 21. Results showed that dietary fish oil significantly elevated circulating DHA in sows, without significant changes in litter size, litter weight, or backfat loss. Supplementation of fish oil (30 or 60 g/day) shortened the interval from weaning to estrus by 1.8 days and 1.67 days, respectively, associated with a significant boost of estradiol. Increases in prolactin and IgA were only significant in the high-dosage group. In addition, plasma MDA and antioxidant activities were up-regulated by fish oil, combined with elevated serum IL-1β and IL-6. Moreover, dietary fish oil significantly reduced serum zonulin, improved the Simpson index of fecal microbiota, and increased the abundance of Lactobacillus and Ruminococcaceae_UCG-014 genera. In conclusion, dietary omega-3 PUFA-enriched fish oil provides a promising approach to aiding estrus return and reshaping fecal microbiota in post-weaning sows. Full article

Yangtze sturgeon is an endangered fish species. After weaning, some Yangtze sturgeon fry refuse to consume any food, which causes a low survival rate during the artificial breeding period. This study showed that the body length and body weight of failed weaning Yangtze sturgeons were significantly lower than those of successful weaning sturgeons. Since the brain is the center of appetite regulation, RNA-seq of the brain was employed to analyze the differentially expressed genes and their biological functions in successfully and unsuccessfully weaned fry. After that, 82,151 unigenes and 3222 DEGs were obtained. Based on the results of RNA-seq, appetite factors, including POMC, CART, NPY and AgRP, were cloned, and then a weaning experiment was designed to explore the changes in appetite after feeding a microcapsule diet (weaning group). The results showed that, during the weaning period, the expression of CART was increased on the 1st and 3rd days but decreased on the 5th, 6th, 8th and 10th days. The expression of AgRP was downregulated on the 1st and 3rd days but upregulated on the 5th, 6th, 8th and 10th days. These findings indicate that appetite was suppressed in the early and middle periods but enhanced in the latter period of weaning and that CART may play an important role in the appetite-suppressing effect. Full article

Acute cardiovascular disorders are incriminated in up to 33% of maternal deaths, and the presence of sickle cell anemia (SCA) aggravates the risk of peripartum complications. Herein, we present a 24-year-old Caribbean woman with known SCA who developed a vaso-occlusive crisis at 36 weeks of gestation that required emergency Cesarean section. In the early postpartum period, she experienced fever with rapid onset of acute respiratory distress in the context of COVID-19 infection that required tracheal intubation and mechanical ventilatory support with broad-spectrum antibiotics and blood exchange transfusion. Shortly thereafter, transthoracic echocardiography documented severe biventricular dysfunction associated with raising levels of cardiac troponin and ECG signs of myocardial ischemia. Medical treatment with incremental dobutamine and noradrenaline infusion failed to improve cardiac output and blood gas exchange. After consultation with the regional cardiac center, a prompt decision was made to provide cardiac and respiratory support via implantation of femoral cannula and initiation of veno-arterial extracorporeal membrane oxygenation (ECMO, Cardiohelp^®). Under stable ECMO, the patient was transferred by helicopter to a specialized cardiac center. There were no signs of ongoing hemolysis, and progressive recovery of the right and left ventricular function facilitated forward blood flow through the aortic valve. Three days after implantation, ECMO was weaned, and the cannula were removed. One day later, the patient’s chest X-rays showed partial resolution of lung edema. The patient was successfully extubated, and non-invasive ventilation with pulmonary rehabilitation was initiated to speed up her functional recovery. Full article

Background: This study analyzed weaning characteristics and assessed the association of clinical and ultrasonographic indices—maximum inspiratory pressure (MIP), rapid shallow breathing index (RSBI), peak flow expiratory (PFE), diaphragm-thickening fraction (DTF), diaphragm thickness (DT), diaphragm excursion (DE), diaphragm-RSBI (D-RSBI), and lung ultrasound (LUS) patterns—with weaning failure. Methods: This retrospective cohort study included critically ill COVID-19 patients aged 18 and older who had been on invasive mechanical ventilation for at least 48 h and undergoing weaning. Exclusion criteria included absence of ultrasound assessments, neuromuscular diseases, and chronic cardio-respiratory dysfunction. Results: Among 61 patients, 44.3% experienced weaning failure, 27.9% failed the spontaneous breathing trial (SBT), 16.4% were re-intubated within 48 h, and 28% required tracheostomy. Weaning failure was associated with prolonged ventilation (29 vs. 7 days, p < 0.001), extended oxygen therapy, longer ICU stays, and higher ICU mortality. These patients had higher pressure support, lower oxygenation levels, a higher RSBI, and a lower MIP. While PEF, DTF, DE, and D-RSBI showed no significant differences, both right and left diaphragm thicknesses and the inspiratory thickness of the left diaphragm were reduced in failure cases. LUS scores were significantly higher before and after SBT in the failure group. Bivariate analysis identified RSBI [OR = 1.04 (95% CI = 1.01–1.07), p = 0.010], MIP [OR = 0.92 (95% CI = 0.86–0.99), p = 0.018], and LUS [OR = 1.15 (95% CI = 0.98–1.35), p = 0.025] as predictors of weaning failure; however, these associations were not confirmed in multivariate analysis. Conclusions: Ultrasound provides supplementary information during weaning, but no definitive association between ultrasound indices and weaning failure was confirmed in this study. Full article

Background: Refractory end-stage pulmonary failure may benefit from extracorporeal life support (ECLS) as a bridge to lung transplantation. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) has been recommended for patients who have failed conventional medical therapy and mechanical ventilation. Veno-arterial (VA) ECMO may be used in patients with acute right ventricular (RV) failure, haemodynamic instability, or refractory respiratory failure. Peripheral percutaneous approaches, either dual-site single-lumen cannulation for veno-pulmonary (VP) ECMO or single-site dual-lumen (dl)VP ECMO, using the ProtekDuo right ventricular assist device (RVAD) cannula, has made this configuration a desirable option as a bridge to transplantation. These configurations support the right ventricle, prevent recirculation by placing the tricuspid and pulmonary valve between the drainage and return cannulas, provide the direct introduction of oxygenated blood into the pulmonary artery, and have been shown to decrease the incidence of acute kidney injury (AKI), requiring continuous renal replacement therapy (CRRT) in certain disease states. This promotes haemodynamic stability, potential sedation-weaning trials, extubation, mobilisation, and pre-transplant rehabilitation. Methods: A web-based literature search in PubMed and EMBASE was undertaken based on a combination of keywords. The PICOS and PRISMA approaches were used. Results: Four case series were identified out of 323 articles, with a total of 34 patients placed on VP ECMO as a bridge to lung transplantation. All relevant data are reviewed and integrated into the Discussion. Conclusions: Despite the limited available evidence, the use of ProtekDuo has become very promising for the management of end-stage lung disease as a bridge to lung transplantation. Full article

Obesity is a global health problem and is increasing in prevalence in most countries. Although obesity affects all age groups, children are the most vulnerable sector. Functional foods are novel formulated foods containing substances (i.e., nutrients, phytochemicals, probiotics, etc.) that have potential health-enhancing or disease-preventing value. The research objective was to study the possible beneficial effects of providing a functional food made with amaranth flour, chia seed, and curcumin extract on the metabolism and behavior of a rat model of childhood obesity. Male Wistar rat pups from two litters of different sizes, a normal litter (NL) (10 pups) and a small litter (SL) (4 pups), were used. After weaning, the rats were fed a hypercaloric diet (HD) or an HD supplemented with the functional food mixture. Body weight and energy intake were measured for seven weeks, and locomotor activity, learning, and memory tests were also performed. At the end of the experiment, glucose and lipid metabolism parameters were determined. The results showed that in this model of obesity produced by early overfeeding and the consumption of a hypercaloric diet, anxiety-like behaviors and metabolic alterations occurred in the rat offspring; however, the provision of the functional food failed to reduce or prevent these alterations, and an exacerbation was even observed in some metabolic indicators. Interestingly, in the NL rats, the provision of the functional food produced some of the expected improvements in health, such as significant decreases in body weight gain and liver cholesterol and non-significant decreases in adipose tissue and leptin and insulin serum levels. Full article

Background and Objectives: Cardiogenic shock (CS) is a potentially severe complication following acute myocardial infarction (AMI). The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in these patients has risen significantly over the past two decades, especially when conventional treatments fail. Our aim is to provide an overview of the role of VA-ECMO in CS complicating AMI, with the most recent literature highlights. Materials and Methods: We have reviewed the current VA-ECMO practices with a particular focus on CS complicating AMI. The largest studies reporting the most significant results, i.e., overall clinical outcomes and management of the weaning process, were identified in the PubMed database from 2019 to 2024. Results: The literature about the use of VA-ECMO in CS complicating AMI primarily has consisted of observational studies until 2019, generating the need for randomized controlled trials. The EURO-SHOCK trial showed a lower 30-day all-cause mortality rate in patients receiving VA-ECMO compared to those receiving standard therapy. The ECMO-CS trial compared immediate VA-ECMO implementation with early conservative therapy, with a similar mortality rate between the two groups. The ECLS-SHOCK trial, the largest randomized controlled trial in this field, found no significant difference in mortality at 30 days between the ECMO group and the control group. Recent studies suggest the potential benefits of combining left ventricular unloading devices with VA-ECMO, but they also highlight the increased complication rate, such as bleeding and vascular issues. The routine use of VA-ECMO in AMI complicated by CS cannot be universally supported due to limited evidence and associated risks. Ongoing trials like the Danger Shock, Anchor, and Recover IV trials aim to provide further insights into the management of AMI complicated by CS. Conclusions: Standardizing the timing and indications for initiating mechanical circulatory support (MCS) is crucial and should guide future trials. Multidisciplinary approaches tailored to individual patient needs are essential to minimize complications from unnecessary MCS device initiation. Full article

Background: Veno-arterial extracorporeal membrane oxygenation (vaECMO) removal reflects a critical moment and factors of adverse outcomes are incompletely understood. Thus, we studied various patient-related factors during vaECMO removal to determine their association with outcomes. Methods: A total of 58 patients from a university hospital were included retrospectively. Demographic, clinical, and echocardiographic parameters were recorded while under vaECMO support, as well as the need for inotropic and vasoactive-inotropic scores (VIS). Successful weaning was defined as 28-day survival without reinitiation of vaECMO. Results: Patient age differed significantly between patients with a successful and a failed vaECMO weaning (54 ± 14 vs. 62 ± 12 years, p = 0.029). In univariable logistic regression, age (OR 0.952 (0.909–0.997), p = 0.038), the necessities for inotropic agents at the time of echocardiography (OR 0.333 (0.113–0.981), p = 0.046), and vaECMO removal (OR 0.266 (0.081–0.877), p = 0.030) as well as the dobutamine dose during removal (OR 0.649 (0.473–0.890), p = 0.007), were significantly associated with a successful weaning from vaECMO. Age (HR 1.048 (1.006–1.091), p = 0.024) and the VIS (HR 1.030 (1.004–1.056), p = 0.025) at the time of vaECMO removal were independently associated with survival in bivariable Cox regression. In Kaplan–Meier analysis, a VIS of >5.1 at vaECMO removal was associated with impaired survival (log-rank p = 0.025). Conclusions: In this cohort, age and the extent of vasoactive-inotropic agents were associated with adverse outcomes following vaECMO, whereas echocardiographic biventricular function during vaECMO support was not. Full article

Data concerning PRRSV-1 vaccine virus strains dissemination within vaccinated sow herds are scarce. However, it is a big concern for swine practitioners when designing the PRRSV diagnostics strategy in vaccinated farms. At the same time, the possibility of vaccine virus transmission from sows to their offspring is important to have in mind in order to limit the risk of recombination between different PPRSV-1 modified live virus vaccine (MLV1) when both sows and piglets have to be vaccinated. This study was conducted in five PRRSV-stable breeding herds. The selected farms presented different characteristics regarding production parameters and biosecurity management practices in order to be, as much as possible, representative of French swine production herds. In four different batches following a sow mass vaccination with a PRRSV-1 modified live virus vaccine (ReproCyc^® PRRS EU, Boehringer Ingelheim, Ingelheim, Germany), we failed to detect the vaccine virus in due-to-wean piglets in all of the herds. This should mean that the dissemination of the vaccinal strain is a rare event, even just after a sow vaccination, at least for the vaccine tested in our study. Full article

The optimal extubating moment is still a challenge in clinical practice. Respiratory pattern variability analysis in patients assisted through mechanical ventilation to identify this optimal moment could contribute to this process. This work proposes the analysis of this variability using several time series obtained from the respiratory flow and electrocardiogram signals, applying techniques based on artificial intelligence. 154 patients undergoing the extubating process were classified in three groups: successful group, patients who failed during weaning process, and patients who after extubating failed before 48 hours and need to reintubated. Power Spectral Density and time-frequency domain analysis were applied, computing Discrete Wavelet Transform. A new Q index was proposed to determine the most relevant parameters and the best decomposition level to discriminate between groups. Forward selection and bidirectional techniques were implemented to reduce dimensionality. Linear Discriminant Analysis and Neural Networks methods were implemented to classify these patients. The best results in terms of accuracy were, 84.61 ± 3.1% for successful versus failure groups, 86.90 ± 1.0% for successful versus reintubated groups, and 91.62 ± 4.9% comparing the failure and reintubated groups. Parameters related to Q index and Neural Networks classification presented the best performance in the classification of these patients. Full article