Composición química y cinética de degradación ruminal del ensilado de pasto elefante con inclusión de cáscara de maracuyá

Se evaluó los parámetros de composición química, degradación y cinética ruminal del ensilado de pasto elefante (Pennisetum purpureum) con inclusión  residuos de  cascara de maracuyá (Passiflora edulis). Se aplico un diseño de bloques completos al azar con cuatro tratamientos (T1:0%; T2:10%;  T3:20% ,k  30% T4:40%) de inclusión de residuos de maracuyá, tres bloques (bovinos con rumen fistulados)  y siete tiempos de incubación  ruminal (0, 3, 6, 12, 24, 48 y 72 horas).  Las diferencias entre medias de tratamientos se establecieron mediante la prueba de Tukey (p<0.05). Tras 30 días de almacenamientos se  aperturaron  los minisilos y fueron similares en materia seca (MS)  y diferentes  (p<0.05)  en materia orgánica (MO),  el T1 (81.73%) presentó  menor porcentaje que los T2, T3, T4 y T5( 85.32, 85.54, 84.57 y 82,02% correspondientemente ), la cenizas (Cen) T1(18.27%) fue mayor (p<0.05) a los  T1; T2; T3; T4 y T5  ( 14.86, 14.46, 15.43 y 17.987% en su orden), la proteína cruda (PC) el T1 (4.42%) fue  menor   (p<0.05), a mayor inclusión de  residuos de maracuyá  se incrementa  la PC en los T1; T2; T3; T4 y  T5  (5.693; 5.25; 5.58 y 5.59%)  y el extracto etereo (EE) el T5: (0.90%)  fue diferente (p<0.05)  con los   T1; T2; T3 y  T4 (1.10; 1.43, 1.18 y 0.92% en su orden). Los contenidos de FDN y FDA fue mayor el T1 con (79.19 y 50.83% respectivamente), sin embargo, con la mezcla de 10% de RM (76.65 y 48.87%), 20% de RM (76.81 y 47.49%%) y 30% de RM (74.98 y 45.74%) se redujeron los porcentajes de fibra detergente neutra y ácida  (FDN y FDA). El porcentaje de digestibilidad in situ  de la materia seca    fue similar  (p>0.05) a las 0, 3, 6 12, 48 y 72 horas de incubación ruminal con la  inclusión de residuos de maracuyá  en el  pasto elefante y aumenta la degradabilidad del ensilaje y la cinética de degradación es similar

Clinical validation of cutoff target ranges in newborn screening of metabolic disorders by tandem mass spectrometry: A worldwide collaborative project

PURPOSE:: To achieve clinical validation of cutoff values for newborn screening by tandem mass spectrometry through a worldwide collaborative effort. METHODS:: Cumulative percentiles of amino acids and acylcarnitines in dried blood spots of approximately 25-30 million normal newborns and 10,742 deidentified true positive cases are compared to assign clinical significance, which is achieved when the median of a disorder range is, and usually markedly outside, either the 99th or the 1st percentile of the normal population. The cutoff target ranges of analytes and ratios are then defined as the interval between selected percentiles of the two populations. When overlaps occur, adjustments are made to maximize sensitivity and specificity taking all available factors into consideration. RESULTS:: As of December 1, 2010, 130 sites in 45 countries have uploaded a total of 25,114 percentile data points, 565,232 analyte results of true positive cases with 64 conditions, and 5,341 cutoff values. The average rate of submission of true positive cases between December 1, 2008, and December 1, 2010, was 5.1 cases/day. This cumulative evidence generated 91 high and 23 low cutoff target ranges. The overall proportion of cutoff values within the respective target range was 42% (2,269/5,341). CONCLUSION:: An unprecedented level of cooperation and collaboration has allowed the objective definition of cutoff target ranges for 114 markers to be applied to newborn screening of rare metabolic disorders. © 2011 Lippincott Williams & Wilkins

Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients from 29 Countries

Importance: Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events. Objective: To evaluate the incidence and nature of adverse peri-intubation events and to assess current practice of intubation in critically ill patients. Design, Setting, and Participants: The International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) study was an international, multicenter, prospective cohort study involving consecutive critically ill patients undergoing tracheal intubation in the intensive care units (ICUs), emergency departments, and wards, from October 1, 2018, to July 31, 2019 (August 28, 2019, was the final follow-up) in a convenience sample of 197 sites from 29 countries across 5 continents. Exposures: Tracheal intubation. Main Outcomes and Measures: The primary outcome was the incidence of major adverse peri-intubation events defined as at least 1 of the following events occurring within 30 minutes from the start of the intubation procedure: cardiovascular instability (either: systolic pressure <65 mm Hg at least once, <90 mm Hg for >30 minutes, new or increase need of vasopressors or fluid bolus >15 mL/kg), severe hypoxemia (peripheral oxygen saturation <80%) or cardiac arrest. The secondary outcomes included intensive care unit mortality. Results: Of 3659 patients screened, 2964 (median age, 63 years; interquartile range [IQR], 49-74 years; 62.6% men) from 197 sites across 5 continents were included. The main reason for intubation was respiratory failure in 52.3% of patients, followed by neurological impairment in 30.5%, and cardiovascular instability in 9.4%. Primary outcome data were available for all patients. Among the study patients, 45.2% experienced at least 1 major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 42.6% of all patients undergoing emergency intubation, followed by severe hypoxemia (9.3%) and cardiac arrest (3.1%). Overall ICU mortality was 32.8%. Conclusions and Relevance: In this observational study of intubation practices in critically ill patients from a convenience sample of 197 sites across 29 countries, major adverse peri-intubation events - in particular cardiovascular instability - were observed frequently