Effect of Monensin and Forage Source on Digestion and Energy Metabolism in Limit-Fed Beef Cows

As beef demand increases and available land resources are diminished, innovative approaches to livestock production are required to meet global demand for food. One such strategy is the intensification of cow-calf systems, which allow for greater dietary control during times of limited forage availability. Monensin, an ionophore feed additive, may have value in intensified cow-calf operations by increasing feed utilization and energy efficiency. Furthermore, forage source may affect digestion and ruminal fermentation of limit-fed diets. Three experiments were designed to determine the effect of monensin on energy and nitrogen balance in nutrient-restricted bred heifers and to evaluate the effect of differing forage sources in a limit-fed total mixed ration (TMR) as well as consequences of limit feeding on voluntary intake and ruminal fill. Monensin had no effect on intake (P > 0.94) or digestion (P > 0.52) in limit-fed bred heifers. There were also no differences (P > 0.16) observed in fecal, urinary, methane, or heat energy losses due to monensin inclusion, and thus, monensin also had no effect (P = 0.36) on RE. Nitrogen balance did not differ (P > 0.13) between control and monensin heifers. In assessing the inclusion of varying forage sources in a limit-fed TMR, DE intake was greater (P < 0.03) for bermudagrass than alfalfa with milo stalks being intermediate. Dry matter digestion (DMD) was greater (P < 0.02) for wheat straw and bermudagrass than milo stalks, and there was a tendency (P = 0.06) for alfalfa DMD to be lower than wheat straw DMD. Organic matter, NDF, and ADF digestion were greater (P < 0.02) for wheat straw than alfalfa or milo stalks. Ruminal DM fill was not different (P = 0.18) between treatments and averaged 4.90 kg; however, liquid fill was greater (P < 0.02) for alfalfa and milo stalk treatments than bermudagrass with a tendency (P = 0.06) for wheat straw to also be greater than bermudagrass. Ruminal solid passage rate was greatest (P < 0.01) for steers consuming wheat straw diets and not different between bermudagrass, alfalfa, and milo stalk diets. Dry matter intake and ruminal DM fill following feed restriction remained lower (P < 0.04) than pre-trial levels, while ruminal liquid fill returned to pre-trial levels by d 10 of refeeding. Results of these experiments suggest that adding monensin to limit-fed, corn stalk-based diets has little effect on the energy and nitrogen balance of confined heifers. Additionally, there does not seem to be a clear advantage of feeding one forage over another when considering limit-fed TMR, and voluntary intake and ruminal fill are not restricted following a prolonged period of limit feeding

Early surgical intervention among patients with acute central cord syndrome is not associated with higher mortality and morbidity

Background: Conflicting reports exist regarding mortality and morbidity of early surgical decompression in the setting of acute central cord syndrome (ACS) in multisystem trauma despite evidence of improved neurological outcomes. Consequently, optimal decompression timing in ACS in multisystem trauma patients remains controversial. This study aims to determine the association between early surgery for acute traumatic central cord and all-cause mortality among multisystem trauma patients in the National Trauma Data Bank (NTDB) using propensity score matching. Methods: We used the NTDB (years 2011-2014) to perform a retrospective cohort study, which included patients \u3e18 years, with ACS (identified using ICD-9 coding). Collected patient data included demographics, surgery timing (≤24 hours, \u3e24 hours), injury mechanism, Charlson comorbidity index (CCI), injury severity score (ISS), serious adverse events (SAE). Logistic regression and propensity matching were used to investigate the relationship between surgery timing and subsequent inpatient mortality. Results: We identified 2,379 traumatic ACS patients. This group was 79.3% male with an average age of 56.3±15.2. They had an average ISS of 19.5±9.0 and mortality rate of 3.0% (n=72). A total of 731 (30.7%) patients underwent surgery for ACS within 24 hours. Univariate analysis did not show a significantly higher mortality rate in the early versus late surgery groups (3.8% Conclusions: Early surgical intervention does not appear to be associated with increased mortality among ACS patients unlike previously suggested. We theorize that survival noted within the NTDB is confounded by factors including existing comorbidities and multisystem trauma, rather than surgical timing. Delaying definitive surgical care may predispose patients to worsened greater neurological morbidity

Single Position Spinal Surgery for the Treatment of Grade II Spondylolisthesis: A Technical Note

Background and importance: Minimally invasive transpsoas approach to treat lumbar spondylolisthesis is associated with increased clinical benefits. Clinical presentation: Robotic and navigation aided deformity correction for grade II spondylolisthesis was performed using transpsoas approach with pedicle screw placement in lateral decubitus position. Conclusion: Keeping the patient in the lateral decubitus position, we supplemented interbody cage placement with screws. Single position lateral transpsoas approach provides grade II spondylolisthesis improvement

Analysis of Cost and 30-Day Outcomes in Single-Level Transforaminal Lumbar Interbody Fusion and Less Invasive Stand-Alone Lateral Transpsoas Interbody Fusion

Background: A comparative evaluation of operative costs between single-level transforaminal interbody fusion (TLIF) and stand-alone lateral transpsoas interbody fusion (LIF) has not yet been done. We analyzed the costs, operative parameters, and early outcomes of single-level stand-alone LIF versus single-level TLIF. Methods: Ten patients who underwent single-level TLIF and 10 patients who underwent single-level stand-alone LIF were included in the analysis. Total, variable, and fixed costs from perioperative data were available from a single institution. In addition, patient demographics, length of hospital stay, and 30-day outcomes and readmission rates were reviewed. Results: Total cost, variable cost, and fixed costs were significantly lower in the LIF group, and there was no difference in outcomes. Conclusions: Single-level stand-alone LIF may prove to be more cost-effective and provide cost savings with analogous 30-day outcomes compared with single-level TLIF procedures

Minimally Invasive Anterior Longitudinal Ligament Release for Anterior Column Realignment.

Study Design: Review of the literature. Objectives: Anterior column realignment (ACR) is a powerful but relatively new minimally invasive technique for deformity correction. The purpose of this study is to provide a literature review of the ACR surgical technique, reported outcomes, and future directions. Methods: A review of the literature was performed regarding the ACR technique. A review of patients at our single center who underwent ACR was performed, with illustrative cases selected to demonstrate basic and nuanced aspects of the technique. Results: Clinical and cadaveric studies report increases in segmental lordosis in the lumbar spine by 73%, approximately 10° to 33°, depending on the degree of posterior osteotomy and lordosis of the hyperlordosis interbody spacer. These corrections have been found to be associated with a similar risk profile compared with traditional surgical options, including a 30% to 43% risk of proximal junctional kyphosis in early studies. Conclusions: ACR represents a powerful technique in the minimally invasive spinal surgeon\u27s toolbox for treatment of complex adult spinal deformity. The technique is capable of significant sagittal plane correction; however, future research is necessary to ascertain the safety profile and long-term durability of ACR