Productivity and canopy modification of Medicago arborea as affected by defoliation management and genotype in a Mediterranean environment

Medicago arborea is one of the most potentially valuable fodder shrubs in a Mediterranean environment because of its high preference by small ruminants and its nutritive value. Edible biomass production is affected by agronomic and environmental factors. A study, carried out in an inland area of Sicily in the growing seasons of 1994/95, 1995/96 and 1996/97, evaluated the forage production and canopy modification in a M. arborea plantation after (i) commencing defoliation 1 or 2 years after transplanting and (ii) defoliating only in autumn (A), only in early summer (S) or in both seasons (A and S). Six clones derived from five different Mediterranean populations were used. Plant age at the first defoliation did not significantly influence forage production. The genotypes differed in growth rate and forage production. The season and frequency of defoliation markedly influenced forage production and canopy size. The highest annual production was obtained by defoliating once a year in early summer (on average, 1Æ65, 2Æ85 and 4Æ50 tonnes ha)1 respectively in the three growing seasons). With the A and S, and A defoliation treatments, production decreased over 3 years by, on average, 0Æ19 and 0Æ57 respectively, but the differences became more marked over a 3-year period. Defoliating only in early summer, however, resulted in an excessive shrub height (>120 cm, 3 years after transplanting), thereby increasing problems of accessibility to small grazing ruminants, and possibly necessitating cutting. On the contrary, the A and S defoliation made it possible to limit the height to <90 cm

Iatrogenic hypoglycemia secondary to tight glucose control is an independent determinant for mortality and cardiac morbidity

Objective: Evaluation of the effects of tight glycemia control in critically ill patients should include temporal as well as punctual glycemia data. Methods: Insulin drip was used to target intensive care unit (ICU) glucose levels between 80 and 126mgdl(-1) in a consecutive series of adult cardiac surgery patients. ICU hourly glycemia was prospectively recorded. Glycemia standard deviation, hyperglycemia index (area under the curve for glycemia>126mgdl(-1) divided by total hours in ICU), and hypoglycemic episodes were recorded and analyzed, together with outcomes. Results: A total of 596 patients were included. Hypoglycemia occurred in 21% of the patients. In-hospital mortality was 2.6%. There was a univariate correlation between mortality and glycemia standard deviation, and hypoglycemia occurrence. At multivariate analysis, hypoglycemia was a determinant for mortality (p=0.002; odds ratio (OR)=20.0), respiratory failure (p=0.0001; OR=1.4), requirement of a tracheostomy (p=0.0001; OR=21.6), and hemodynamic instability requiring intra-aortic balloon pump (IABP) (p=0.01; OR=1.5). To clarify the determinants of hypoglycemia, a second multivariate model was built. Diabetes (p=0.0001; OR=23) and chronic renal failure (p=0.01; OR=25) were the sole determinants for hypoglycemia occurrence. Conclusion: Iatrogenic hypoglycemia secondary to ICU tight glycemia control correlates with hospital mortality, respiratory, and cardiac morbidity in patients undergoing cardiac surgery. ICU hyperglycemia index and glycemia temporal variability have no independent correlation with outcomes. Higher glycemia targets should be advised in the perioperative management of patients with diabetes and renal failure, as both conditions independently increase the risk of hypoglycemia occurrence

Intraoperative antiaggregant strategy for off-pump coronary artery bypass grafting in a patient with heparin-induced thrombocytopenia

Immune heparin-induced thrombocytopenia is a rare complication of heparin administration. We describe a patient with a previous diagnosis of heparin-induced thrombocytopenia and related contraindications to anticoagulation who underwent urgent off-pump myocardial revascularization with the administration of only antiaggregant therapy