\u3cem\u3eIn Situ\u3c/em\u3e Digestibility of \u3cem\u3eGliricidia sepium\u3c/em\u3e Combined with \u3cem\u3eBrachiaria decumbens\u3c/em\u3e in a Silvopastoral System

Silvopastoral system (SPS) are characterized by a combination of trees, pasture and herbivores animals, in the same physical area, in order to obtain diversified products. A promising legume tree that has been studied and used in SPS in tropical areas is gliricidia [Gliricidia sepium (Jacq.) Steud]. Advantages of gliricidia use in SPS include N inputs via biological fixation, improvement of soil properties, nutrient cycling and also a source of feed to grazing animals (Cubillos-Hinojosa et al., 2011). Gliricidia has high crude protein concentration in its leaves, which complements the usual N-poor diet of ruminants grazing warm-season grasses. The introduction of gliricidia in SPS faces a problem due to the low initial acceptability by cattle, being necessary an adaptation period in order to cattle reach satisfactory intake levels (Carvalho Filho et al., 1997). In general, the quality of the forages can be predicted by accessing their nutritive value, represented by the chemical composition and digestibility of the forage constituents (Van Soest, 1994). The digestibility of dry matter in forages consumed in a SPS can be influenced by the forage species used, by grass/legume combinations, and by the proportion that each forage species takes in the diet of the ruminants. This study evaluated in situ digestibility of gliricidia in increasing levels of inclusion in the diet composed by sabi grass (Brachiaria decumbens, Stapf) in a silvopastoral system

Animal Performance and Pasture Characteristics of \u3cem\u3eBrachiaria decumbens\u3c/em\u3e Stapf., \u3cem\u3eGliricidia sepium\u3c/em\u3e (Jacq.) Steud, and \u3cem\u3eMimosa caesalpiniifolia\u3c/em\u3e Benth. in Silvipastoral Systems

Grasslands are the major source of feed for ruminants (Zanine 2005). Seasonality of production, however, is a constraint in forage-based systems. Silvopastoril systems combine different components (animals, trees, and forages) into one integrated system and may improve forage distribution across seasons. Resource use is usually more efficient both spatially and temporally, increasing land use efficiency (Nair 1993). Tree legumes present potential for silvopastoril systems because they can fix N from the atmosphere, improve cattle diet, and lead to a faster N cycle. In addition, trees provide shade and may reduce heat stress for grazing animals in warm-climate grasslands. Legume trees are commonly found in warm-season climates and present potential for use in silvopastoril systems. This research studied the animal performance and pasture characteristics of signal grass (Brachiaria decumbens Stapf.) in pure stand or in silvopastoril systems with Gliricidia sepium (Jacq.) Steud or Mimosa caesalpinifolia Benth

Publisher Correction: Whole-genome sequencing of a sporadic primary immunodeficiency cohort (Nature, (2020), 583, 7814, (90-95), 10.1038/s41586-020-2265-1)

An amendment to this paper has been published and can be accessed via a link at the top of the paper

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline