Tryptophan requirements and the effects of supplemental tryptophan on growth performance, plasma metabolites, and meat quality in nursery, growing, and finishing pigs

This research was conducted to estimate the true digestible Trp (dTrp) requirements in nursery, growing, and late finishing pigs and the effects of supplemental Trp on physiology, behavior, and meat quality. Five experiments were conducted to estimate the dTrp requirement in nursery pigs. Using broken-line regression analysis, dTrp requirements were 0.21, 0.20, and 0.18% for Phase I (5.2 to 7.3 kg), II (6.3 to 10.2 kg), and III (10.3 to 15.7) nursery pigs. In addition, four experiments were conducted to estimate the dTrp requirements in growing and finishing pigs. Using broken-line regression analysis, the dTrp requirement of pigs weighing 30.9, 51.3, and 74.6 to 104.5 kg was 0.167, 0.134, and 0.102%, respectively. An experiment also was conducted to determine the ratio of Trp:Lys and Thr:Lys in diets for nursery pigs (7.1 to 15.6 kg BW). The treatments were arranged in a 3 x 3 factorial with three ratios of true digestible Thr:Lys (0.55, 0.60, or 0.65) and three ratios of true digestible Trp:Lys (0.145, 0.170, or 0.195). Overall, optimal performance was in pigs fed the true digestible Trp:Lys ratio of 0.195 at Thr:Lys ratios 0.60 and 0.65. These results indicate that dietary levels of Trp above 0.19% may be needed to maximize growth performance in diets containing wheat and barley. Four experiments were conducted to determine the effects of supplemental Trp on meat quality and plasma and salivary cortisol and plasma lactate in growing pigs. Pigs fed the diet with supplemental Trp had lower (P \u3c 0.01) mean plasma cortisol and lactate (P \u3c 0.07) concentration than pigs fed the basal diet. Meat quality effects varied, but overall, results indicated that Trp had no positive effect on meat quality. Lastly, a study was conducted to evaluate the effects of Trp on growth, behavior, intestinal morphology, and brain and plasma metabolites subsequent to weaning and mixing. Cortisol was decreased (P \u3c 0.07) after mixing in pigs fed Trp. Brain metabolites also were increased (P \u3c 0.09) by Trp. Tryptophan supplementation has varied effects on growth performance, behavior, physiology, and meat quality in pigs

Results of the ICTuS 2 Trial (Intravascular Cooling in the Treatment of Stroke 2)

Background and purposeTherapeutic hypothermia is a potent neuroprotectant approved for cerebral protection after neonatal hypoxia-ischemia and cardiac arrest. Therapeutic hypothermia for acute ischemic stroke is safe and feasible in pilot trials. We designed a study protocol to provide safer, faster therapeutic hypothermia in stroke patients.MethodsSafety procedures and 4°C saline infusions for faster cooling were added to the ICTuS trial (Intravascular Cooling in the Treatment of Stroke) protocol. A femoral venous intravascular cooling catheter after intravenous recombinant tissue-type plasminogen activator in eligible patients provided 24 hours cooling followed by a 12-hour rewarm. Serial safety assessments and imaging were performed. The primary end point was 3-month modified Rankin score 0,1.ResultsOf the intended 1600 subjects, 120 were enrolled before the study was stopped. Randomly, 63 were to receive hypothermia plus antishivering treatment and 57 normothermia. Compared with previous studies, cooling rates were improved with a cold saline bolus, without fluid overload. The intention-to-treat primary outcome of 90-day modified Rankin Score 0,1 occurred in 33% hypothermia and 38% normothermia subjects, odds ratio (95% confidence interval) of 0.81 (0.36-1.85). Serious adverse events occurred equally. Mortality was 15.9% hypothermia and 8.8% normothermia subjects, odds ratio (95% confidence interval) of 1.95 (0.56-7.79). Pneumonia occurred in 19% hypothermia versus 10.5% in normothermia subjects, odds ratio (95% confidence interval) of 1.99 (0.63-6.98).ConclusionsIntravascular therapeutic hypothermia was confirmed to be safe and feasible in recombinant tissue-type plasminogen activator-treated acute ischemic stroke patients. Protocol changes designed to reduce pneumonia risk appeared to fail, although the sample is small.Clinical trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01123161

Predictors of Outcomes in Patients With Mild Ischemic Stroke Symptoms: MaRISS

Background and Purpose: Although most strokes present with mild symptoms, these have been poorly represented in clinical trials. The objective of this study is to describe multidimensional outcomes, identify predictors of worse outcomes, and explore the effect of thrombolysis in this population. Methods: This prospective observational study included patients with ischemic stroke or transient ischemic attack, a baseline National Institutes of Health Stroke Scale (NIHSS) score 0 to 5, presenting within 4.5 hours from symptom onset. The primary outcome was a 90-day modified Rankin Scale score of 0 to 1; secondary outcomes included good outcomes in the Barthel Index, Stroke Impact Scale-16, and European Quality of Life. Multivariable models were created to determine predictors of outcomes and the effect of alteplase. Results: A total of 1765 participants were included from 100 Get With The Guidelines-Stroke participating hospitals (age, 65±14; 42% women; final diagnosis of ischemic stroke, 90%; transient ischemic attack, 10%; 57% received alteplase). At 90 days, 37% were disabled and 25% not independent. Worse outcomes were noted for older individuals, women, non-Hispanic Blacks and Hispanics, Medicaid recipients, smokers, those with diabetes, atrial fibrillation, prior stroke, higher baseline NIHSS, visual field defects, and extremity weakness. Similar outcomes were noted for the alteplase-treated and untreated groups. Alteplase-treated patients were younger (64±13 versus 67±1.4) with higher NIHSS (2.9±1.4 versus 1.7±1.4). After adjusting for age, sex, race/ethnicity, and baseline NIHSS, we did not identify an effect of alteplase on the primary outcome but did find an association with Stroke Impact Scale-16 in the restricted sample of baseline NIHSS score 3–5. Few symptomatic intracerebral hemorrhages were recorded (<1%). Conclusions: A large proportion of stroke patients presenting with low NIHSS have a disabled outcome. Baseline predictors of worse outcomes are described. An effect of alteplase on outcomes was not identified in the overall cohort, but a suggestion of efficacy was noted in the NIHSS 3–5 subgroup. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02072681