How can farming intensification affect the environmental impact of milk production? 

The intensification process of the livestock sector has been characterized in recent decades by increasing output of product per hectare, increasing stocking rate, including more concentrated feed in the diet, and improving the genetic merit of the breeds. In dairy farming, the effects of intensification on the environmental impact of milk production are not completely clarified. The aim of the current study was to assess the environmental impacts of dairy production by a life cycle approach and to identify relations between farming intensity and environmental performances expressed on milk and land units. A group of 28 dairy farms located in northern Italy was involved in the study; data collected during personal interviews of farmers were analyzed to estimate emissions (global warming potential, acidification, and eutrophication potentials) and nonrenewable source consumption (energy and land use). The environmental impacts of milk production obtained from the life cycle assessment were similar to those of other recent studies and showed high variability among the farms. From a cluster analysis, 3 groups of farms were identified, characterized by different levels of production intensity. Clusters of farms showed similar environmental performances on product basis, despite important differences in terms of intensification level, management, and structural characteristics. Our study pointed out that, from a product perspective, the most environmentally friendly way to produce milk is not clearly identifiable. However, the principal component analysis showed that some characteristics related to farming intensification, such as milk production per cow, dairy efficiency, and stocking density, were negatively related to the impacts per kilogram of product, suggesting a role of these factors in the mitigation strategy of environmental burden of milk production on a global scale. Considering the environmental burden on a local perspective, the impacts per hectare were positively associated with the intensification level

Intermittent coronary sinus occlusion in dogs: Reduction of infarct size 10 days after reperfusion

Intermittent balloon occlusion of the coronary sinus was applied to 11 open chest dogs subjected to 3 hours of ligation of the left anterior descending coronary artery followed by 8 to 12 days of reperfusion. Anticoagulants were not given during the reperfusion period. Risk region was assessed by planimetry of autoradiographs made from ventricular slices. Infarct size was equivalent when assessed by planimetry of ventricular slices before and after staining with triphenyltetrazolium chloride. In the seven survivors, 30 ± 8% of the risk region was in-farcted. Seven of 11 control dogs survived (p = NS); 75 ± 4% of the risk region was infarcted in the control animals (p < 0.01 versus treated survivors). Light microscopic inspection of specimens stained with hematox-ylin-eosin confirmed the border between necrotic and preserved myocardium. Thrombus was observed in the coronary sinus in all survivors in the treatment group.These findings confirm earlier short-term studies that demonstrated a potent anti-ischemic effect of intermittent coronary sinus occlusion. At the same time, coronary sinus thrombosis warrants caution in the application of this technique to myocardial ischemia in humans

Environmental impact of milk production in intensive farming systems: life cycle assessment approach

Life cycle assessment (LCA) has been shown to be a valuable method for the environmental evaluation of farming systems and has been applied to several agricultural products, particularly in Europe. In LCA the potential environmental impacts of a product are assessed by quantifying the resources consumed and the emissions, at all stages of its life cycle, from the extraction of resources, through the production and transport of materials, to the production process at the farm. The aim of the study was to evaluate the environmental impacts of milk production in intensive farming systems using LCA approach on a sample of 44 dairy farms in northern Italy. Impact categories were: Land use, Non-renewable energy use, Climate change, Acidification and Eutrophication. Functional units were: 1 kg of Fat and Protein Corrected Milk (FPCM); 1 ha of farm land. Data were collected by personal interview with the farmers. Farms involved in the study reared on average 145 (\ub191) cows, with a daily milk production of 28.0 (\ub13.32) kg FPCM/cow. Average farm land was 49.9 (\ub137) ha and stocking density 5.3 (\ub12.5) LU/ha. On average, 59% of the total dry matter of cow rations consisted of feed ingredients produced on the farm. The average results for the 5 LCA categories per kg of FPCM were: 2.84 (\ub11.02) m2 for Land use, 4.98 (\ub11.34) MJ for Energy use, 0.93 (\ub10.29) kg CO2-eq for Climate change, 18.2 (\ub14.2) g SO2-eq for Acidification and 12.0 (\ub13.1) g PO4-eq for Eutrophication. Impact indicators from this study are similar to those reported in recent European LC analyses on intensive dairy farms, although the comparison among LCA studies from different countries can be misleading because of local peculiarities and different methodologies. Within the study, LCA indicators allowed to compare environmental impacts of milk production among farms characterized by different levels of intensification (stocking density, milk production, feed self-supply)

COVID-19 and surgical training in Italy: Residents and young consultants perspectives from the battlefield

COVID-19 is seriously affecting Italy, putting the health system under extreme pressure. Training of medical students and residents is also suffering from this with the suspension of lectures and clinical rotations. What solutions have been taken to deal with the issue

Hemodynamic and anti-inflammatory effects of early esmolol use in hyperkinetic septic shock. a pilot study

Background: Several studies have shown that heart rate control with selective beta-1 blockers in septic shock is safe. In these trials, esmolol was administered 24&nbsp;h after onset of septic shock in patients who remained tachycardic. While an earlier use of beta-blockers might be beneficial, such use remains challenging due to the difficulty in distinguishing between compensatory and non-compensatory tachycardia. Therefore, the Esmosepsis study was designed to study the effects of esmolol aimed at reducing the heart rate by 20% after the initial resuscitation process in hyperkinetic septic shock patients on (1) cardiac index and (2) systemic and regional hemodynamics as well as inflammatory patterns. Methods: Nine consecutive stabilized tachycardic hyperkinetic septic shock patients treated with norepinephrine for a minimum of 6&nbsp;h were included. Esmolol was infused during 6&nbsp;h in order to decrease the heart rate by 20%. The following data were recorded at hours H0 (before esmolol administration), H1–H6 (esmolol administration) and 1&nbsp;h after esmolol cessation (H7): systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, central venous pressure, heart rate, PICCO transpulmonary thermodilution, sublingual and musculo-cutaneous microcirculation, indocyanine green clearance and echocardiographic parameters, diuresis, lactate, and arterial and venous blood gases. Results: Esmolol was infused 9 (6.4–11.6) hours after norepinephrine introduction. Esmolol was ceased early in 3 out of 9 patients due to a marked increase in norepinephrine requirement associated with a picture of persistent cardiac failure at the lowest esmolol dose. For the global group, during esmolol infusion, norepinephrine infusion increased from 0.49 (0.34–0.83) to 0.78 (0.3–1.11) µg/min/kg. The use of esmolol was associated with a significant decrease in heart rate from 115 (110–125) to 100 (92–103) beats/min and a decrease in cardiac index from 4.2 (3.1–4.4) to 2.9 (2.5–3.7) l/min/m−2. Indexed stroke volume remained unchanged. Cardiac function index and global ejection fraction also markedly decreased. Using echocardiography, systolic, diastolic as well as left and right ventricular function parameters worsened. After esmolol cessation, all parameters returned to baseline values. Lactate and microcirculatory parameters did not change while the majority of pro-inflammatory proteins decreased in all patients. Conclusion: In the very early phase of septic shock, heart rate reduction using fast esmolol titration is associated with an increased risk of hypotension and decreased cardiac index despite maintained adequate tissue perfusion (NCT02068287)

Real world hypoglycaemia related to glucose variability and Flash glucose scan frequency assessed from global FreeStyle Libre data.

Flash glucose monitoring provides a range of glucose metrics. In the current study, we aim to identify those that indicate that glycaemic targets can be consistently met and contrast the total (t-CV) and within-day coefficient of variation (wd-CV) to guide the assessment of glucose variability and hypoglycaemia exposure. De-identified data from Flash readers were collected. The readers were sorted into 10 equally sized groups of scan frequency followed by quartiles of estimated A1c (eA1c). A similar grouping was performed for the total coefficient of variation (t-CV) and within-day coefficient of variation (wd-CV). In addition, analysis of the association of time below 54 mg/dl and glucose variability measured by t-CV and wd-CV was performed. The dataset included 1 002 946 readers. Readers sorted by 10 equal groups of scan rate and quartiles by eA1c, t-CV and wd-CV represented 25 074 readers per group. The association of lower eA1c with higher time in range and reduced time above range was clear. The correlation of eA1c quartiles and time below range was not consistent. An association between glucose variability and hypoglycaemia was found. Both wd-CV and t-CV were associated with time below range. For achieving the consensus target of &lt;1% time below 54 mg/dl, the associated wd-CV and t-CV values were 33.5% and 39.5%, respectively. The type of CV reported by the different continuous glucose monitoring systems should be acknowledged. CV &lt;36% might not be adequate to ensure low hypoglycaemia exposure. To our knowledge, the majority of continuous glucose monitoring reports the t-CV. Appropriate thresholds should be used to identify patients that would probably meet time below range targets (t-CV &lt;40% or wd-CV &lt;34%)

Comparison of electron beam computed tomography scanning and conventional risk factor assessment for the prediction of angiographic coronary artery disease

AbstractObjective. To determine whether electron beam computed tomography (CT) adds to conventional risk factor assessment in the prediction of angiographic coronary artery disease.Background. Electron beam CT scanning can be used to predict the severity of coronary atherosclerosis, but whether it does so independently of conventional risk factors is unclear.Methods. Electron beam CT scans were performed and conventional risk factors were measured in 290 men and women undergoing coronary arteriography for clinical indications. The association of the electron beam CT-derived coronary artery calcium score and conventional risk factors with the presence and severity of angiographically defined coronary atherosclerosis was analyzed by logistic regression and receiver-operator characteristics analysis.Results. Age, the ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol and the coronary calcium score were significantly and independently associated with the presence of any coronary disease and obstructive coronary disease. In association with any coronary disease, odds ratios for age, the ratio of total cholesterol to HDL cholesterol and calcium score, highest quartile vs. lowest quartile, were 6.01 (95% confidence interval 2.87 to 12.56), 3.14 (1.56 to 6.31) and 94.08 (21.06 to 420.12), respectively. For obstructive coronary disease, highest quartile vs. lowest quartile, the respective odds ratios for age, the ratio of total cholesterol to HDL and calcium score were 3.86 (1.86 to 8.00), 4.11 (1.98 to 8.52) and 34.12 (12.67 to 91.86). Male gender was also significantly associated with any coronary disease (odds ratio 2.19, p = 0.04) and obstructive coronary disease (odds ratio 2.07, p = 0.04). Cigarette smoking was significantly associated with any coronary disease (odds ratio = 2.74, p = 0.004), and diabetes was significantly associated with obstructive disease (odds ratio 3.16, p = 0.01). After adjustment for the coronary calcium score and other risk factors, it was determined that triglycerides, family history and hypertension were not significantly associated with any disease state. A coronary calcium score ≥80 (Agatston method) was associated with an increased likelihood of any coronary disease regardless of the number of risk factors, and a coronary calcium score ≥170 was associated with an increased likelihood of obstructive coronary disease regardless of the number of risk factors (p < 0.001).Conclusion. Electron beam CT scanning offers improved discrimination over conventional risk factors in the identification of persons with any angiographic coronary disease or angiographic obstructive coronary disease

A simple method to assess the oxidative susceptibility of low density lipoproteins

BACKGROUND: Oxidative modification of low density lipoproteins (LDL) is recognized as one of the major processes involved in atherogenesis. The in vitro standardized measurement of LDL oxidative susceptibility could thus be of clinical significance. The aim of the present study was to establish a method which would allow the evaluation of oxidative susceptibility of LDL in the general clinical laboratory. RESULTS: LDL was isolated from human plasma by selective precipitation with amphipathic polymers. The ability of LDL to form peroxides was assessed by measuring thiobarbituric acid reactive substances (TBARS) after incubation with Cu(2+) and H(2)O(2). Reaction kinetics showed a three-phase pattern (latency, propagation and decomposition phases) which allowed us to select 150 min as the time point to stop the incubation by cooling and EDTA addition. The mixture Cu(2+)/H(2)O(2) yielded more lipoperoxides than each one on its own at the same time end-point. Induced peroxidation was measured in normal subjects and in type 2 diabetic patients. In the control group, results were 21.7 ± 1.5 nmol MDA/mg LDL protein, while in the diabetic group results were significantly increased (39.0 ± 3.0 nmol MDA/mg LDL protein; p < 0.001). CONCLUSION: a simple and useful method is presented for the routine determination of LDL susceptibility to peroxidation in a clinical laboratory