Effect of qualitative feed restriction on energy metabolism and nitrogen retention in sheep

Periodic restrictions in feed quality and quantity is an important phenomenon in regions where animal production should bridge the gap between periods of forage production separated by a dry season. Eighteen Swifter male lambs, weaned at the age of ca. three months, were used to quantify effects of feed quality restriction and realimentation on changes in energy and nitrogen metabolism. The diet consisted of grass straw (17 MJ of gross energy [GE] and 46 g crude protein [CP] per kg dry matter [DM]) on an ad libitum basis and 35 g/kg0.75/d mixed concentrates (16.5 MJ of GE and 173 g CP per kg DM). At the age of ca. 3.5 months the animals were randomly divided into six blocks, based on live weight, according to a randomized complete block design. Within each block, the animals were randomly assigned to two restricted treatments (R1 and R2) and an unrestricted control (C) treatment. Treatments R1 and R2 were subjected to feed quality restriction by withholding the concentrate for 3 and 4.5 months, respectively. A modified linear model was developed to study the effects of restriction and realimentation. The comparison between treatments was made by analyzing the data of the R1 and R2 animals as deviations from the control animal in each block. During the restriction period, restricted animals lost weight and showed negative energy (EB) and nitrogen balances (NB), whereas their intake of low quality roughage increased significantly. During the realimentation period (5 and 6 months for the R1 and R2 animal, respectively), the R1 and R2 animals grew significantly faster than the control animals. The realimented animals persisted in ingesting significantly more low quality roughage and their EB and NB were significantly greater that those of the control animals. The R2 animals needed a longer period of realimentation because of a longer period of restriction. The expression of compensatory growth was mainly related to a sustained higher grass straw (low quality roughage) intake during the realimentation periods, and a significantly greater efficiency of metabolizable energy intake. The maintenance requirement of realimented animals was significantly lower only during the initial stages of realimentation compared with the controls. It seemed as if a three months feed restriction period in weaned sheep was better than 4.5 months

Dual-Wavelength Spectral Correction Method for Simultaneous Determination of V(IV) and V(V)

Abstract: Simultaneous determination of V(IV) and V(V) was performed when the calibration matrix was obtained using beta-corrected spectral data. The method is based on the reaction between V(IV) and V(V) and 4-(2-pyridylazo)-resorcinol (PAR) as a ligand at pH 6. Using β-correction technique true absorbance of chelate produced can be calculated because the quantity of absorbance, which has related to the fraction of reagent that reacted with metal ion and has been subtracted when reagent applied as reference by this correction has compensated. The parameters controlling behavior of the system were investigated and optimum conditions selected. Calibration model was constructed based on absorption spectra in the 540-600 nm range for 25 different mixtures of V(IV) and V(V) in the concentration ranges of 0.10-4.00 µgmL −1 of V(IV) and 0.10-5.00 µgmL −1 of V(V). Applying this method to the analysis of mixtures of V(IV) and V(V) in waste water and soil samples with total relative standard error of less than 4.3% validated the proposed method

A Simple and Efficient One-Pot Synthesis of 1,4-Dihydropyridine and Polyhydroquinoline Derivatives Using Phosphosulfonic Acid as a Heterogeneous Catalyst under Solvent-Free Conditions

Phosphosulfonic acid (PSA) was found to be an efficient catalyst for the one-pot three-component Hantzsch condensation reaction of arylaldehydes, ethylacetoacetate and ammonium acetate to afford the corresponding 1,4-dihydropyridine and polyhydroquinoline derivatives in high yields. PSA was also applied for the one-pot preparation of polyhydroquinolines via four-component reaction of arylaldehydes, ethylacetoacetates, dimedone and ammonium acetate. The main advantages of the present approach are short reaction times, clean reaction profiles, catalyst recyclability, and facile experimental and workup procedures

Investigation of Friedel-Crafts Alkylation in the Presence of Supported Sulfonic Acid on Silica Gel

From the Reaction between cellulose and chloro sulfonic acid was prepared sulfuric acid cellulose composition as a new solid acid. The solid acid supported on silica gel and then as an effective catalyst in Friedel-Crafts alkylation of alcohols and aromatic compounds was used. The reaction progress was controlled using thin layer chromatography and the reaction products were analyzed using IR spectroscopy devise. The results show this new catalyst is effective in the friedel crafts alkylation and C-C bond formation was done in short time with very good yields

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone