Influence of mastitis metritis agalactia (MMA) on bone and fat metabolism

Mastitis metritis agalactia (MMA) is a common disease in post-partum sows and has a negative effect on sows' longevity as well as on sows' and piglets' health. MMA leads to an inflammatory state. The aim was to investigate the impact of MMA on bone and fat metabolism. The hypothesis was that it is possible to predict MMA by measuring ketone bodies and bone markers. Blood samples from 175 sows were taken within 72 hr after farrowing. Serum was analysed for 25-hydroxyvitamin D (25-(OH)-D), serum crosslaps (CTX-I), osteocalcin (OC), alkaline phosphatase (ALP), calcium (Ca), magnesium (Mg), phosphorus (P), parathyroid hormone (PTH), triglycerides (TG), beta-hydroxybutyric acid (BHB), tumour necrosis factor-alpha (TNF-α) and haptoglobin. Spontaneous urine was collected, and pH value was measured in addition to Ca and P. A proximate analysis of the sows' diets was performed. Age, litter size, body condition score (BCS) and clinical signs of MMA were recorded for each sow. A multivariable logistic regression was undertaken with disease status (MMA or healthy) as the dependent variable. Significance was accepted at p < .05. MMA sows had a poorer BCS (p < .001) in relation to healthy sows. Age and number of piglets did not differ. MMA sows showed increased serum CTX-I (p = .004) and decreased serum OC (p < .001). Concentrations of P (p = .007), activity of ALP (p = .002) and BHB (p = .019) as well as TNF-α (p < .001) and haptoglobin (p = .048) concentrations were increased in MMA sows. No difference in urinary pH value between MMA and healthy sows was found. Our results are in accordance with the known fact that sows are in an extreme catabolic state peripartum. Bone metabolism in MMA sows is much more negatively affected than in healthy sows post-partum, due to inflammatory processes shown by higher concentrations of pro-inflammatory cytokines

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p&lt;0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology